This is a fairly accessible book about hoarding disorder and the hoarding symptoms that attend many other diagnoses, such as obsessive compulsive disoThis is a fairly accessible book about hoarding disorder and the hoarding symptoms that attend many other diagnoses, such as obsessive compulsive disorder, obsessive compulsive personality disorder, ADHD, autism spectrum disorder, dementia, depression, anxiety and eating disorders. There is a huge amount of overlap between hoarding disorder and other psychiatric conditions. What distinguishes this condition from others in which patients accumulate objects, paper, matter of all kinds to excess is the extreme attachment sufferers place on things that are often of little to no value. There’s an intense resistance to parting with said items.
In terms of describing hoarding disorder itself, the book is basic (often stating the obvious). A key focus for the author, a psychiatrist, is on how hoarding fits into the DSM-5 (the American Psychiatric Association’s Diagnostic and Statistical Manual) categorization. Overall, it makes for pretty dry reading, even though there are short illustrative case studies inserted for clarification and human interest. Among the many topics discussed is the role of the law in dealing with severe hoarding that can endanger not only the patient but also children, pets (which are sometimes acquired in excess, too), and neighbours. The fire threat due to extreme hoarding is very real, but the clutter of the hoarder encroaching on common spaces in apartment buildings, infection, vermin, and offensive odours are problems as well.
The author addresses the pharmaceutical treatment of hoarding disorder, noting there’s a paucity of research on effective drugs for the condition, which prior to 2013 was classified under OCD and Related Disorders in the DSM-5. Drug treatment, usually selective serotonin re-uptake inhibitors, is far more likely to be successful for those whose hoarding symptoms are related to (or a sort of byproduct of) another condition, such as depression or OCD. (Depressed people may buy things they don’t need to lift their spirits and subsequently have no motivation or energy to dispose of objects that have accumulated unused. Those with ADHD may also buy impulsively, then lack focus to sort and clear out what is not needed. Often socially isolated, individuals with these conditions can become attached to objects in place of people.)
The main treatment approach for hoarding disorder is psychological: cognitive behavioural therapy. The author also briefly describes Compassion-Focused Therapy, which acknowledges the emotional state (the shame, distress, and stigmatization) of the patient. Influenced by mindfulness practices from Eastern religions, primarily Buddhism, it sounds like it has a lot of potential. Alas, yet again, there’s little research on the effectiveness of the therapy.
I acknowledge that this competently written but quite repetitive book may be helpful to some. Drummond provides ample information and organization resources. A glossary, notes, and an index are included. GPs may find some use for the text; family members of those with hoarding disorder, the patients themselves, and other readers—perhaps not so much. One thing that was stated over and over again was how little research there actually is on pretty much all things related to the condition. So, does this book comprise “Everything You Need to Know about Hoarding� as the title claims? I think not. Only some of what’s reported is necessary to know. A fair bit of the material is simply uninteresting, and some of the accompanying case studies/patient narratives just seemed superfluous. The reader does not require illustrations of very obvious points. Less would have been more.
Personally, I really don’t care about DSM categorization—its lists and lists of symptoms (pick three here and five there). So many symptoms are common to a multitude of mental health problems. I suspect I’m not alone in not finding much value in reading such lists. I wanted some insights into why—the psychology and brain science related to hoarding� or perhaps a few success stories. In the end, I found myself wishing the author had waited until there was some good research on hoarding disorder or something actually fresh and interesting to say. There are much more readable books on the subject out there, and I can’t recommend this one with any enthusiasm....more
33 Place Brugmann is a skillfully written and intellectually stimulating work of historical fiction centring around the residents of a small, eleg33 Place Brugmann is a skillfully written and intellectually stimulating work of historical fiction centring around the residents of a small, elegant apartment building in Brussels in the time leading up to and during World War II. Austen’s novel presents the German occupation of Brussels, antisemitism and the plight of Jews (focusing on one cultured Jewish family in particular) within that city, the operations of the resistance network that returned downed airmen to England, and the importance of art to civilization (one character is intimately involved in the transporting of the treasures of Britain’s National Gallery to mines in Wales, where they’re protected from bombing). Philosophy (Wittgenstein), mathematics (especially risk, chance, probability), and love also figure in this rich and sophisticated creation.
Initially, I found the novel fragmented and rather slow going due to the presentation of multiple points of view, but I’m glad I held on. It’s an ambitious work, perhaps too much so. I did not understand the author’s purpose in including so many abstruse passages from Wittgenstein’s Tractatus. Most were well beyond me. Furthermore, the central character, the completely colourblind ethereal young artist Charlotte, did not convince, a major flaw in the work in my view.
In the end, though, I felt rewarded and changed by reading this. With its mixture of realistic and surreal elements and its European flavour, I can imagine it as the basis for a motion picture. This is unusual historical fiction. It won’t be for everyone, but I do recommend it.
Many thanks to Net Galley and the publisher for providing me with an advance reading copy of the book....more
After setting this novel aside for a few days, I found I had no desire to return to it. I experienced Smith’s preoccupation with words/semantics/meaniAfter setting this novel aside for a few days, I found I had no desire to return to it. I experienced Smith’s preoccupation with words/semantics/meanings here very heavy handed. For example, would a mother need to explain the meaning of the word “trust� to an obviously precocious child? I doubt it. Furthermore, Smith is a lot more interested in gender than I am. I found her decision not to identify the biological sex of her central character, Briar, simply annoying. The world-building in the novel is weak, and, frankly, I don’t think Gliff is anything special at all....more
An undemanding, pleasant read about a divorced couple who reunite over the few days around their 33-year-old daughter’s wedding. This is a kind of faiAn undemanding, pleasant read about a divorced couple who reunite over the few days around their 33-year-old daughter’s wedding. This is a kind of fairytale for grownups, with a not entirely sympathetic narrator (the rigid, rather chilly ex-wife). Do men like the warm-hearted, patient but boundary-deficient ex-husband actually exist? I’m doubtful, but I was willing to suspend my disbelief for the time it took me to read this short novel....more
“I want you to feel comfortable, even if a lot of this can be uncomfortable. I want you to feel as if we’ve sat together and I’ve told you a story in “I want you to feel comfortable, even if a lot of this can be uncomfortable. I want you to feel as if we’ve sat together and I’ve told you a story in person, sitting across from one another, face to face. There are no fancy words here. This is not literary. I’ve gone through some hard things. You may have gone through some hard things. You may know somebody who has gone through some hard things. I’m still going through them, and you, or somebody you love, might be, too.�
David A. Robertson is a prolific Cree author from Manitoba, Canada. I’ve been aware of him as a writer of children’s and young adult works for some time, but this memoir is my first experience of his work. In an informal, conversational, and often meandering style, All the Little Monsters addresses Robertson’s mental health challenges, primarily with intense anxiety about physical ailments (what used to be known as hypochondria). The not-so-little-monster voices of his thoughts whisper over his shoulder about minor physical symptoms—most generated by anxiety itself. They tell him that death is imminent if he doesn’t take cover.
Robertson has been given an array of psychiatric diagnoses—generalized anxiety disorder, obsessive compulsive disorder, depression, and panic disorder—conditions that amplify or sometimes morph into each other. He does not state this, but these are all APA DSM (the American Psychiatric Association’s Diagnostic and Statistical Manual) labels based on lists of behavioural symptoms. If I understand correctly, Robertson has been on alprazolam (aka Xanax) for some years—information which I initially found quite concerning. Benzodiazepines are intended to be used for a brief period, not long-term, as they very quickly create physiological dependence. There’s evidence that they’re associated with cognitive issues, as well as mood and substance use disorders when taken long term. Coming off them is widely known to be devilishly difficult. The author is hopeful he’ll be free of this medication one day.
Robertson traces the roots of his anxious state to his childhood experiences and explains that his condition is intimately connected with his indigenous identity. The latter doesn’t figure much in this book, having apparently been addressed in an earlier one, Black Water. This memoir also isn’t strictly chronological. In the first half, time markers are often lacking, and later on there are unexpected shifts back and forth in time, which disrupt the smooth narration of significant events. I found it challenging to understand how the author’s condition progressed and took hold. I think his editor might have helped him eliminate distracting asides and the repetition of ideas. It’s possible that a decision was made to leave the book as is—to reflect how the anxious mind works. Whatever the case, as a reader, I would have liked to see some sections pared down.
Robertson had a nervous breakdown in 2010, and although he points to four classic life stressors (a new job, moving house, the birth of his fourth child, and the publication of his first book), it is a mystery to him how these worked together to create the tidal wave of physical symptoms that had him twice transported to hospital by ambulance for what he’d soon realize were severe panic attacks. A second breakdown occurred in 2020 after his beloved father’s death.
The author writes that as a young child he had difficulty sleeping, would sometimes pad about the house at night, pull aside the curtains to gaze at the stars, attempt to count them, and feel immeasurably small. He also mentions that as a boy he feared being pursued by fiends, particularly in the basement of his grandparents� home. Being overweight and bullied did not help matters when he reached early adolescence.
The accidental death of a popular, well-liked grade-eight classmate seems to have had an outsize impact on his younger self. He writes that after the student’s untimely death, something changed for him: “I was obsessed with my relationship with eternity, due to a fragile mortality. . . I could tumble into forever at any moment. I could get into a car accident on the highway. I could get cancer. I replayed moments of my life where I’d almost died, and wondered why I hadn’t.�
It was the death of his grandfather from ALS in 1998, when Robertson was 21, that appears to have jumpstarted Robertson’s hyper-vigilant scanning of his body, a practice which has continued unabated over the years. For a time, every muscle twitch was perceived as a harbinger of motor neuron disease.
As the above contributing influences make clear, the core problem for Robertson was a deep, pervasive fear of death. Having skimmed the first few chapters of Caroline Crampton’s recent book, A Body Made of Glass, I think it’s possible that clinical hypochondria can grow more easily in a physiologically/genetically susceptible individual who faces a life-threatening health condition. In Caroline Crampton’s case, it was a diagnosis of Hodgkin’s lymphoma when she was 17, which was followed by years of aggressive therapy. Robertson, too, faced a major health issue beginning when he was roughly the same age.
In his late teens he had been troubled by a racing heart. He made several visits to his primary care physician and was repeatedly—and, to my mind, negligently—dismissed as having some sort of cardiac equivalent of “growing pains�. In his twenties, Robertson found himself in the emergency department of the hospital nearest the field where he’d been playing ultimate frisbee with friends. His heart was clocked at over 200 beats a minute and wouldn’t normalize with standard medical treatment. He required an emergency procedure called cardioversion in which the heart is stopped and then restarted using a defibrillator.
In spite of this episode, Robertson’s doctor—who had already failed to send his patient to a cardiologist to receive appropriate Holter (heart) monitoring—now informed him it’d likely be another two years for his condition to be investigated. At considerable cost, the author’s parents took him to the Mayo Clinic in Minnesota where the irregular heart rhythm was diagnosed in two days as supraventricular tachycardia, “a fast and erratic heartbeat that affects the upper chambers of the heart.� An “average, everyday heart,� he informs us, “beats about 60 to 100 times per minute�, but during an SVT episode the beats accelerate to 150 to 220 times a minute. While Robertson would ultimately undergo SVT ablation (in which an extra node sending out additional beats is knocked out), benign but disruptive PVCs (premature ventricular contractions, which cause a sensation of a fluttering or skipped beats) have continued to plague him and regularly provoke psychological distress.
The author attributes some of his debilitating health anxiety to having had his heart problem blown off for years: “Doctors had told me things were normal before when I didn’t think they were, and I had been right—things had not been normal. I was positive . . . that my irregular heartbeat was not from growing pains. It felt dismissive and, frankly, condescending . . . Going forward, due to my experience with SVT, my entire mindset changed significantly. I could not trust doctors. I could only trust myself. I knew my body better than anyone . . . no one knew the right answer but me.� He often thought nonspecific symptoms (e.g., headaches and stomach trouble) pointed to dire diagnoses that medical professionals were missing.
Robertson counsels patients suffering from anxiety to resist the temptation to google symptoms, as a snowball effect is likely to result; anxiety will only ramp up. While I take his point, I question the assertion that “the best rule of thumb is to trust the doctor, trust the pharmacist, trust the psychiatrist. They’ve considered the dangers, the mild side effects, and they’ve decided that those often-small risks are far outweighed by the benefits.� In fact, I am not confident that it is always the case that physicians have adequately assessed the dangers of the medications they prescribe or appropriately inform patients of drug risks. A person can go to his primary care physician, report symptoms of anxiety or depression, and have a script for a psychotropic drug in less than 15 minutes. These are not benign substances. They often have black-box warnings. In some patients, mood can even be further destabilized by the substance that’s supposed to treat it, or patients end up having another drug added to address the side effects of the first. And so it goes. It seems to me that better advice might be for people in mental distress to take an informed, trusted, clear-thinking friend or family member to the doctor’s appointment with them. This person can then insure that inquiries are made about about alternatives to medication and clarify the potential risks of any psychotropic drug being considered. Anxious or depressed people are not in the best shape to take in information or make major decisions that can further impact their mental equilibrium.
Robertson describes how his anxiety has manifested in many situations. Several times he expresses deep regret and sadness about the impact his illness has had on his family. His wife, Jill, has been his rock. She is perhaps the one who first spoke back to the “little monsters�. Seeing her husband in a state of paralysis, she calmly instructed him that she was giving him the shopping list and he was going to the supermarket because the family needed to eat. He did it, and it was a turning point.
A key message that Robertson communicates is the need for community. His psychiatrist, a specialist in health anxiety, put him in group therapy, a move he initially wasn’t too keen on. The other patients all had their idiosyncratic health preoccupations, but the mechanisms were common to all. Robertson mentions the use of exposure therapy (not unlike what is done with those who are phobic). Group members were able to cheer each other on as they made small steps towards freedom from deeply entrenched anxiety-directed behaviour.
Robertson offers many coping strategies to his readers, from breathing techniques to affirmations. My sense is that his book is geared mostly towards a young adult audience. This is, as the review’s opening quotation from Robertson states, not a literary work. It is, however, friendly, warm, and encouraging. I don’t think I was the ideal reader, but I do think the book has the potential to reach young people in need.
Thank you to Net Galley and the publisher for a free digital advanced copy of the book. My review is based on the final published version of the book....more
To state the obvious: cats are not small dogs. They only began to live alongside humans about 20,000 years after members of the canine species developed a “close-knit� bond with our distant ancestors. Felines, unlike dogs and people, are neither social nor hierarchical. They were taken on and accommodated by humans, in spite of mutual mistrust, to kill the mice and rats that plagued early agrarian settlements. Cats have never been fully domesticated, and the author suggests that a basic mistrust persists to this day. Even cat owners sometimes find themselves experiencing a deep “atavistic fear� when Fluffy suddenly transforms into a fierce little tiger.
Some of the problems that people have with their cats are due to the very different behavioural programs of the human and feline species. Misinterpretations are common. Too often we project our own arrangements and desires onto them. Besides making a case for veterinary psychiatry, the author’s goal in writing the book is to reduce human misunderstanding of cats and help readers develop empathy for animals with very different needs. He informs us about those needs and invites us to put ourselves in a cat’s place, “not to think like a human pretending to be a cat, but to see the world through the eyes, brain, emotions, and cognition . . . of a cat.� This, he intimates, is a tall order. For one thing, we’d have to have whiskers and be able to process the information they provide. Still, the author really does get one thinking about how different we are.
Some of the psychopathology cases in the book appear to be due to organic processes: hypersensitivity hyperactive syndrome (which is akin to human ADHD), dissociative syndrome (loss of contact with reality), and bipolar dysthymia (a close parallel to human bipolar disorder, in which a cat behaves in alarming, unconstrained ways due to sudden changes in mood: charming one minute; wild the next, with no control over its claws or bite). These conditions require a lot more research. For treatment, psychotropic medications are used along with therapeutic behavioural and environmental interventions.
One of the first cases presented is that of “Lucifer�, a young cat who kept attacking his elderly owner’s hands and ankles. He’d been rescued along with his siblings from a den below a school playground. Having spent his earliest days out of doors, Lucifer was now was in an apartment, a confined space, lacking the minimum necessary for equilibrium as a predator. A cat deprived of stimuli has to invent them. With no options for his hunting instincts, he redirected them at anything that moved, including his owner.
The prescription for Lucifer involved stopping all punishment, including threats and a raised voice. So fundamental is this guideline that it is stressed multiple times throughout the book. Unlike dogs who sometimes respond to such correction, coercion only aggravates, hurts, and scares cats. It can entirely destroy the human-feline relationship. (Having said this, I should add that the author is empathetic towards owners who are understandably distressed by attacks or frustrated by ongoing incomprehensible behaviour. His non-judgemental listening encourages them to open up about their reactions.) To interrupt an unwelcome action, owners are advised to use a squirt gun or a plant mister. It acts as an “stimulus disruptor� and makes a sound similar to a cat hissing.
Lucifer also needed wand toys/lures, a cat tree, and several small feedings a day. Outdoor cats—e.g., ferals—consume up to 12 mice in a 24-hour period, and many very small meals can make a positive difference in some cats� lives. (I know some vets who’d likely disagree with this and be concerned about insulin resistance/diabetes.) Plug-in (synthetic analog diffusers of) “familiarity� pheromones are also sometimes recommended. In Lucifer’s case, a psychotropic drug was prescribed for a brief period to settle his impulsivity.
The Interpretation of Cats is, in part, a plea for veterinary medicine to address the mental and emotional suffering of animals by accepting animal psychiatry as a worthy specialty and investing in research that will improve animals� psychological health. The author does write about some of the drugs he has used to successfully treat troubled cats, but I don’t recall him pointing to any studies that support these pharmaceuticals as safe and effective. He mentions fluoxetine (Prozac) to settle impulsivity and selegiline (Anipryl) for stabilizing mood in a seemingly bipolar cat, but what and where is the evidence? Medication, we are told, saves some animals from euthanasia, which is good, but not good enough. Over the years, I’ve read enough about human psychiatry, the pharmaceutical industry’s suspect practices, and the negative impacts of psychiatric medications on humans to be skeptical about approaching the psychological suffering of companion animals in the same way.
I learned a huge amount from this richly informative and compassionate work. It’s helped me understand cats both past and present. Having said that, I’m disappointed that the book was not better edited—or perhaps better translated. Whatever the case, there are a number of careless errors. The neurological condition Charcot-Marie-Tooth disease is incorrectly described as degeneration of the neuromuscular plaque instead of the “neuromuscular junction�, and “dysrhythmia� is used in place of the correct term “dysthymia�. (This isn’t a book about the cat’s heart but about its emotions.) The author’s discussion of a specialized type of technology known as tractography (which has been used to image nerve fibres in the cat’s brain) lacks sufficient detail to be comprehensible. There are also many instances of poor word choice as well as vague, muddy, and incoherent prose.
This is a solid 3.5 book. Having learned so much, I hesitate to round that rating down. However, the four-star designation comes with my real reservations about the quality of the writing....more
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