Books reviews

Derek Paravicini was born in 1979, 14 weeks prematurely, which resulted in total blindness, severe learning difficulties, and autism.  However he demonstrated a remarkable musical talent from an early age.

Two people gave him individual attention to develop his everyday abilities and his phenomenal musical skills to their full potential:  An ‘old-style’ English nanny gave him the one-to-one attention needed (as an adult, Paravicini still cannot look after himself in a practical sense).  His musical development began with a toy organ given to him by this Nanny.  At the age of four, he became a pupil of Adam Ockleford who specialises in teaching music to visually impaired children, many with additional disabilities. 

I believe the most interesting part of the book for ‘Eye and Mind’ readers is Adam Ockleford’s account of teaching Derek Paravicini:  He had to teach musical technique to someone who had no sight, could not distinguish fingers from thumbs, left from right, and found verbal communication extremely difficult.  Years of patient attention were needed before he was able to perform publicly and with an orchestra. 

The book gives a fascinating description of an intense and extraordinary teacher-pupil relationship, with the teacher coping with totally unpredictable behaviour.  Adam Ockleford is at pains to show that Derek Paravicini is not a “human I-Pod” as some have described him.  As well as having near-photographic memory and musical ability, he can improvise brilliantly.  However he cannot make any practical decisions for himself.  Adam Ockleford describes the moral dilemma of deciding on his vulnerable pupil’s behalf whether or not public appearances would be beneficial.

The description of the educational options for visually impaired children at that time will also be of interest.

The book is understandably more reticent on the conflicts that must have arisen between parents, nanny and teacher.  How did his family feel about two other people having such a dominant role in their son’s life?  There is a hint of disagreements over choice of schools, otherwise Professor Ockleford is tactfully silent over what must have been an emotionally complex situation.

Here is a biography for anyone interested in visual impairment, autism or music, as well as being what the media would call a heart-warming story. 

Frank Luck
August 2008

[You can follow Derek Paravicini’s progress on his website ]http://www.derekparavicini.net.]

For me the very title of this book was a challenge. It reminded me I was about to consider a very complex subject from the very limited, personal perspective of therapist. I was intrigued to know if the author might throw some light on patients experiencing psychosomatic eye disorders.

He begins with a historical outline of psychosomatic medicine from pre-Greek and Roman civilisations to the present day. His clear style gives the reader detailed information on the impact of stress upon the body. He highlights a range of physical illnesses, explains their symptoms and neuro-scientific basis for understanding such conditions, as well as giving a clear account of the development of psychoanalytic approaches.  He stresses the importance of well-informed therapeutic assessments of patients referred for therapy, and reminds us that some patients who engage in therapy may have on-going medical treatments and a range of professionals involved in their care.

He weaves all these strands of information into brief case studies, which I personally found interesting and helpful. One of these is about a woman, referred from the eye hospital, whose symptoms “improved quite dramatically” as she addressed her emotional distress.  It was reassuring to discover that Shoenberg sets out to convey the need for a psychosomatic imagination, which allows for an approach to illness in which the body and the mind can be taken into account. He encourages Balint group participation for trainee doctors.

I think this will be a very useful reference book for therapists, not only to deal with patients who present with long- term health issues, but also to encourage a reflective approach to periods of ill-health which some patients experience during the course of therapy.

Reviewer

My background is in education; I taught in Liverpool inner-city and eventually specialised in visual impairment to work at St Vincent’s School for the Blind.  My first contact with visually-impaired children had been as a volunteer, at St Vincent’s, during my teacher training 1960 - 63. In 1990 I moved into the adult side of the Charity to work on the rehabilitation programme with people adjusting to loss of sight. I set up a counselling service for the clients, and eventually secured Lottery Funding to open up the service to visually-impaired people throughout Merseyside. The withdrawal of funding culminated in closure of the service.  Since the early 80s I have also worked as a psychotherapist. I am working now in Primary Care in Birkenhead with the Wirral Partnership NHS Trust and in private practice.

Adam Phillips is a psychoanalyst and author of ten previous books.  In ‘Going Sane’, he analyses what it might be to be sane.  Madness is often spoken and written about yet sanity is rarely mentioned.  Madness can be easily defined but what about sanity?

In this book, Adam Phillips looks at history, philosophy, literature and at his own professional experience to suggest answers to questions we rarely ask, if ever, about ourselves.

This interesting journey explores these three areas: is it wise to be sane, does it really make us happier and what might a sane way of life involve?

This book is articulate, witty and enlightening and well worth a read.

Reviewer

Lizzie May has been a full time Vision Educator for the last 10 years.  She helps people improve their eyesight naturally with relaxation and stimulation techniques by retraining the mind to see in a more balanced and relaxed way.  She joined the board of the Eye and Mind Society in 2007. 

Published by Guide Dogs
ISBN 978-0-9559268-0-8

Anne Sinclair is an ophthalmologist, Barbara Ryan an optometrist.  They have been aware for a long time of their professions’ reputation for being good on the clinical side but backward on emotional and psychological support.

This Report addresses the above problem as well as being a good practical guide for anyone coming into contact with severe loss of vision for the first time, whether medical professional, social worker, relative, carer or, of course, the patient.

Chapter 2 “Low vision in daily ophthalmological practice” is of most interest to us.  A section on “the patient’s experience” has an excellent description of how not to treat a patient before the actual consultation, followed by “meeting …” and “guiding a patient with Visual Impairment”

The Report goes on to say that the ophthalmologist should have sufficient knowledge of social and rehabilitation services to be able to refer the patient on appropriately.  He/she should also ask patients basic questions on how their sight loss will affect their lives, covering such diverse subjects as reading, cooking, mobility and communication.  Patients should be made aware of the Charles Bonnet Syndrome and reassured that because of this visual hallucinations are not a sign of mental illness.

I was very pleased to see a section “Breaking bad news well”; this is something on which ophthalmologists have a poor reputation (my personal view based on talking to many visually impaired people).  The need for psychological support is stressed.

It was also good to see stress on the importance of multi-disciplinary working.  The Royal College Of Ophthalmologists Curriculum recommends that a junior ophthalmologist should visit a social services team and make a home visit with a social worker or rehabilitation officer (How often does this happen, I wonder?)
Chapter 7 “Low Vision in Children” adapts the points made in Chapter 2 to the needs of parents of visually impaired children.  There needs to be a ‘key worker’ among the bewildering array of professionals whom the parents will meet.

I went to the launch of the Report on 25 July 2008 and spoke to the authors.  Their concern was whether ophthalmologists will read it – not many had turned up.  They were wondering whether to send a copy to every ophthalmologist they knew of! 

I have a spare copy if anyone would like one, or you can obtain one from Guide Dogs for £5.

Reviewer

Frank Luck was chief executive of Metropolitan Society for the Blind (MSB) for 14 years.  MSB is a voluntary organisation providing various services to blind and partly sighted residents of inner London.

In the emerging brave new world of the NHS where chronic disease will be managed in community based polyclinics and acute illness will be treated in super specialised hospitals, this book is a welcome addition to the small literature warning against the dangers of fragmentation of care and in favour of listening to the patient.

Darian Leader, a Lacanian psychoanalyst, and David Corfield, a mathematician and a researcher in the department of biological cybernetics at the Marx Plank Institute, have reviewed a great number of psychosomatic research papers, both classic and contemporary and have written a fairly comprehensive psychosomatic theory of developing somatic symptoms and diseases that is essential for active listening. According to their theory, falling ill has something to do with what they call the bacterial model of illness, in which what threatens us is always seen as something external.  Every life event involves some change, either for the better or worse and it has been claimed that it is change of our external environment as such that predicts illness. We tend to use the word stress to describe the effects of these changes on us but the authors believe that a diagnosis of stress can be regarded as the modern way of avoiding listening and finding out more about a patient. It replaces the richness of an individual story with a blanket concept that can be used to explain just about anything from anger to grief to frustration and depression. The authors believe that it is an inability to register this change, to elaborate it mentally and symbolize it that increases vulnerability to falling ill. They believe that listening to the patient in a way that is sensitive to the meaning of life events to the life of the individual, can go a long way towards making him feel understood and recognized. Listening and speech is very important in psychosomatic medicine because the very mechanisms involved in somatising imply in some cases a difficulty or even impossibility in elaborating problems through speech.

But who is going to listen? The authors are rather concerned about the medical profession’s unwillingness to listen to its patients. They have obviously not heard of the work of The Eye and Mind Society and they mention ophthalmology as an example of a branch of medicine that like dentistry has become isolated. They point out that analysts and psychiatrists once received many referrals from ophthalmologists, yet today this would be seen as bizarre. Despite the many hundreds of papers written and the detailed case reports which show the rationale and efficacity of such treatments, their usefulness has been forgotten. In 1960 it was reckoned that between 40 and 100% of recorded eye disorders were influenced by psychological factors. Intraocular pressure for example can be clearly associated with states of anxiety and emotional conflict and so may influence conditions such as glaucoma. This has never been disproved and advances in medical technology have drawn attention away from it. Whereas in the past talking therapies have been successfully used in conjunction with medication to reduce pressure within the eye, today drug treatments are applied almost automatically. Textbooks like Schlaegel and Hoyt’s, once popular psychosomatic ophthalmology, have become historical curiosities. The amazing and detailed knowledge now available about the eye and its structure must seem much more appealing than psychological theories about the unconscious factors underlying eye problems.

Yet the patient is being compromised. The emergence of corneal ulcers, styes, glaucoma, optic neuritis and many other disorders have all been linked to our unconscious mental life. In one case a man consulted an ophthalmologist for an inflammation of the iris of his right eye. A detailed examination of the iris revealed traces of previous attacks, the patient confirming that twelve years previously, on Good Friday, he had woken up at night by a severe pain in his eyes. The explanation offered for this earlier attack had been syphilis, yet although this was soon disproved, it had sown a seed of doubt in the man’s mind. It turned out that the second and third attacks had also occurred on Good Friday, the day on which Christians are obliged to remember their misdeeds. Whatever cause we posit for the first attack, it is surely more than a coincidence that the subsequent episodes of iritis all chose the same highly significant day, as if the symptom of – and perhaps punishment for – his imagined sexual fault was being visited upon him.

A treatment that focused solely on reducing the inflammation could hardly be said, then to be responding to the patient’s problem.  The iritis here seems to be more a way of articulating distress than the cause of distress itself.

In another example of the value of listening to ophthalmological patients the authors mention the ophthalmic surgeon and psychoanalyst William Inman. Exploring the psychological context of acute glaucoma he was struck by how often his patients had become ill on the anniversaries of significant dates. In many cases, the loss or trauma had occurred decades previously, yet still even forty or fifty years later the patient would develop symptoms on the relevant date. Although the obvious explanation was that they had been unusually stressed due to painful memories evoked by the date, Inman was surprised to find that in most cases the patient was completely unaware of the condition. It was only after detailed questioning that the significance of the date was discovered. No conscious stress would be reported. Perhaps it was the very absence of acute emotions that played some role in the emergence of the illness. The symptoms marked the anniversary where conscious thought processes could not. These so called anniversary reactions involve the emergence or exacerbation of physical symptoms on the anniversary of an important date, often that of a bereavement and suggest that the body contains memory systems that bypass conscious thought. 

All these observations converge on the issue of how we are able – or unable to process our mental life. Perhaps the less something can be thought, the more likely it is to return in the body.

Increasing bureaucracy and workload allow less and less time to listen to the individual. The management of chronic disease, that incidentally is gradually becoming a central feature of general practice, often has the unfortunate consequence of putting patients on a conveyor belt and making them the object of a series of pieces of localized expertise. This movement away from biography and particularity towards fragmentation has created a gap in medical provision that is filled by a wide range of alternative and complementary therapies.

The authors recognise that just because we have a theory explaining the importance of psychological factors in the development of illness, it does not give psychological methods of treatment the exclusive recipe for a cure. A somatic problem more often than not requires a medical treatment.  However, there is great advantage in combining medical treatment with an exploration of the patient’s emotional life. It sheds light not only on the course of the illness but also on the timing of its emergence.

The authors emphasise that patients tend to fall ill at certain symbolic moments. They identify four such periods that are likely to be registered at some level as a symbolic event.  The postoperative period after transplant operations. The time when patients have finished a course of treatment, however successful it might have been, and are told: you are well now! At last you are back on your feet!  Periods of waiting for an operation or medical treatment, and the symbolic moment of retirement. The authors believe that if therapy can matter here, it does not necessarily mean psychotherapy but simply the possibility of speaking with someone, if the patient so wishes. It is less insight into unconscious processes that can be hoped for, than the possibilities of identification and recognition, reinvestment in the body and an opening of the pathways of speech and dialogue. The authors believe that it would be ideal if every patient should receive an opportunity to speak about himself on his first medical visit or when hospitalized. Such work requires skill and sensitivity, yet there are just not enough trained practitioners available to do this. Dialogue is what so many alternative therapies offer. It is the principal way of recognizing someone else’s experience. The authors are not advocating the usurping of medical procedures and medication by speech. Far from it. But these practices may be most fruitfully conducted within the broader context of a dialogue. It is important to be reminded that The Eye and Mind Society was founded in order to bring the above human dimension of dialogue to ophthalmological patients.

This is a long read (290 pp + refs), sometimes brain-taxing, but well worth it.  Simon Ings gives a comprehensive study of the eye, including:

• evolution, looking at biological, chemical and social pressures
• the wide range of tasks for human eyes compared with other animals’ eyes
• how seeing and thinking relate to each other
• the history of scientific theories of vision
• colour-vision & colour-blindness
• attempts to produce artificial sight (sorry, no bionic eyes yet, just electrodes in your head).

Which parts would be of most interest to us, those interested in psychological aspects of vision?  Personally I was most intrigued by how much of what we see is what we want or expect to see.  Chapter 5 “Seeing and thinking” looks at how interpreting what we see involves making constant assumptions.

Then we learn about the role of the eye in social contact.  Animals spend a lot of time looking at how other animals look at them.  Primates who live in groups need to “read” each other’s expressions or possibly they would all collapse from fear and stress wondering what their fellows (particularly the dominant ones) might be about to do to them.  That’s why primates show the whites of their eyes while other animals sensibly try to conceal their eyes.

The epilogue “The invisible gorilla” reviews experiments which have shown just how much of what we take in is what we expect to see.
I enjoyed reading how patches of light-sensitive skin evolved into the wide variety of eyes in the animal kingdom.  Ings suggests that sight really got going when animals became more mobile and predatory.  Most animals’ eyes have developed sufficiently to spot food, predators and mates.  Humans, however, need much more precise and complex sight for tool handling and all our other wide-ranging activities.

As someone with below-average colour vision, I found the chapters on colour vision and the lack of it of personal interest.  Colour vision may have evolved significantly during recorded history; after all, it’s not that essential for survival, and we evolved from nocturnal mammals.  Studying colour vision could help our understanding of the key question – by what means do we focus our attention?

Do read this book.  You can then reflect on the fact that the more literate a population, the higher the rate of myopia!

Dr Sarno is Professor of Clinical Rehabilitation Medicine at New York’s University School of Medicine. In this book, he describes how pain has become an epidemic in Western society over the last 40 years or so. He asks whether we have suddenly become incapable of functioning properly.  If these pain disorders are not caused by structural abnormalities, then how can this epidemic be explained?

In the early 70’s, Dr Sarno started research into the validity of conventional diagnoses for neck, shoulder and back pain.  He concluded that all these were part of a pain disorder which he termed ‘Tension Myositis Syndrome’ (TMS) a painful but harmless change of the state of the muscles, tendons, and nerves.

To help patients understand more easily how pain could be caused by tension, he explained how particular personality traits could be conducive in developing TMS and lead to tension and anxiety. People who were conscientious, responsible, compulsive and perfectionist in their attitudes were more prone to TMS and especially those who had a non-confrontational approach and repressed their feelings in life.

By the mid 70’s Dr Sarno had seen thousands of patients. He found that the majority of neck, shoulder and back pain syndromes were psychosomatic. He explained to those patients that there was nothing really wrong with their backs – it was just a harmless condition to be treated through the mind rather than the body. Awareness, insight, knowledge and information were the magic medicines that would ‘cure’ the disorder.

Dr Sarno informs us that the purpose of physical manifestation of tension is to deceive.  Our brains have decided that certain feelings may not be as socially acceptable as having something physically wrong with us.  So the brain makes a few adjustments and instead of looking like a nervous wreck, a backache becomes more preferable.  In this way, people can psychologically avoid confronting certain unconscious (repressed) feelings such as rage, grief, shame, etc. Dr Sarno also found that TMS sufferers often develop specific patterns of pain which become conditional i.e. occurring at a particular time of day or with a particular posture, etc.

Dr Sarno has helped thousands of people to understand how emotions can cause such physical pain so that they can be successfully treated without surgery or drugs.

In conclusion, Dr Sarno reminds us that the mind and body are interconnected: we must not judge with the unconscious mind with the rules and logic of the conscious mind.

This book is a valuable contribution to enjoying a healthy and pain-free life.

The Mind’s Eye Interest Group’s main reason for these reviews was to find whether Ray Charles’ early loss of sight might have been caused, fully or partly, by the trauma of seeing his brother drown.

Neither the book nor the film make any suggestion of this.  No firm medical cause was ever established, but glaucoma was considered most likely. One eye was removed following great pain which in my view could agree with a diagnosis of glaucoma.

If the trauma had any major psychological effects, a conventional analysis would probably look to his heroin addiction and obsessive womanising.  However neither vice is unknown in the world of popular music, particularly when the majority of life is spent “on the road”.

Ray Charles’ blindness is treated just as one of a number of obstacles in the path of a young black man trying to succeed in that time and place.  The film shows some people taking advantage of his blindness during his very early career but Charles makes little of this in his autobiography.  Once he finds success, escorts and other support seem readily available.

I enjoyed the film more than the book.  The former takes a more critical view of Charles’ behaviour and lifestyle and also contains excellent music.  The book would probably be of more interest to fans of the man and his music.

Candace Pert, an American neuroscientist, has written this book shattering some of the sacred Western beliefs held by some scientists for more than 200 years.  Her pioneering research has demonstrated how internal chemicals, the neuropeptides and their receptors, are the actual biological underpinnings of our awareness.  They manifest themselves as our emotions, beliefs and expectations, and profoundly influence how we react/interact with our world.

The book painstakingly documents her research into providing scientific evidence of a biochemical basis for awareness and consciousness.  This validates what Eastern philosophies have known and have practised for centuries. The mind and body are one – the body is not a mindless machine.

It was through her enthusiasm, ambition and thinking ‘outside the box’ that brought about her shift from pure biological scientist to ardent advocate of the power of the mind and emotions over our general health and wellbeing.

The book is well written and will interest the scientist and layperson alike.