Prior to reading this book, I had recently read Shanghai Girls  by Lisa See which is about two Chinese sisters and chronicles their lives from the horror of the Japanese invasion in China to the painful unfair  discrimination which they encountered  in this country during and after World War II. Hotel on the Corner of Bitter and Sweet  which is debut novel by Jamie Ford in a sense compliments the other book as it provides insight  into the fate of the Japanese living in the United States approximately during this time period. Most Americans, of course  know very little about this page of our history. This novel  provides a window into what happened when the Japanese families were ripped from their homes and jobs  and put in what were called internment camps by the government but prison camps by the  people who were involuntarily taken there. While the story was quite poignant and sweet, it did not have the complexity of story and the depth of characters, which I thought was present in Lisa See’s book.

The story is mostly told through, through the eyes of Henry, a Chinese American who was born in the United States to immigrant parents who expected him to speak English although they could not and maintain their Chinese heritage which  included a hatred of the  Japanese who had attacked their native country. As a youngster he was sent to an upper class white school in Seattle on a scholarship, which meant that he had to help out in the kitchen at lunchtime and clean the erasers after school. While doing this job he meets Keiko, a Japanese girl, also born in the US and sent to this school by her proud parents. They work together, become good friend and even develop an emotional bond which becomes disrupted when she, her family and her entire Japanese community is whisked away almost overnight. The attempt of these barely teenagers to hold on to each other in these impossible circumstances is quite touching. The Hotel Panama is one of the last remnants of the Japanese community and had bordered on the still thriving Chinese community. It is the place where so many of the artifacts of the now transported Japanese Americans have become eternally stored symbolizing their buried memories.

We don’t really get to know these characters of this book  as fully formed multi-determined individuals. We are actually introduced to Henry at a point in life where his wife has died and his son is ready to get married. We know very little about him other than that he has this burning memory of his early love at age 12-13 which is locked in his soul. We learn about this phase of his life as chapters flashback to this time .

The mood of the book is unfulfilled forbidden love which perhaps symbolizes the unfavorable lives of the community of people where their most prized possessions reside in this Hotel of Bitter and Sweet also known as the Hotel Panama.  The sadness of loss is also played out in the somewhat lengthy discussion of the Nursing Home death of  Henry’s s childhood close friend Sheldon. When the movie of this book comes out , the musical score  will be the soulful  sound  of legendary Seattle jazz musician Oscar Holden which was an important part of this story and  played in the background for most of the telling of this tale.

Handbook of AIDS Psychiatry by Mary Ann Cohen, Harold W. Goforth, Joseph Z. Lux, Sharon M. Batista, Sami Khalife, Kelly L. Cozza and Jocelyn Soffer, Oxford University Press, New York, 2010, 384pp, $49.95

Book Review originally written for and published in  the Journal of the American Academy of  Psychoanalysis and Dynamic Psychiatry

It is unusual for the Book Review Editor of this journal to request a review about a book that does not have psychoanalytic theory, dynamic psychiatry or the application of these ideas, as it’s main thesis. This book, which is about all aspects of AIDS, is such an exception. It is fitting that it be presented to the readers of this journal since this disease, more than any other modern day medical condition has impacted all aspects of psychiatry and mental health. Those of us who were practicing in the early 1980s, especially if you were doing hospital consultations, first saw this become known as a mysterious disease with dark spots on skin that was universally fatal. It then became associated with homosexuals and drug addicts The disease was believed to be highly contagious and caused by blood and sexual transmission. Medical personal became fearful of contracting the disease from patients. An accidental  needle stick while drawing blood or being nicked with a scalpel during surgery, which once was an inconvenience, now became a potentially fatal event. The disease weakened the immune system  and could lead to  deadly opportunistic infections. It ultimately was identified as being caused by the Human Immunodeficiency Virus (HIV). From it’s discovery in 1981 to 2006 AIDS killed more than 25 million people and is still counting.

Not only did psychiatrists and mental health professional see the impact of this disease in our hospital work but those of us doing outpatient psychotherapy could not help but appreciate the effect of this pandemic on many of our patients. Homophobias, which could be multidetermined at any point in time, became greatly exaggerated because of fears of contamination from AIDS. There was a reexamination of all sexual behavior as people began to realize that heterosexual transmission of this disease was also a reality. Questions were being raised whether couples should exchange HIV testing results before engaging in sexual relations? Then there was the realization that AIDS was devastating the gay and bisexual community. We saw a grieving response that extended beyond immediate close friend and families. People throughout the country visited exhibits of  traveling AIDS quilts with patches made as a memorial to individual patients. There were forensic issues encountered by some of our colleagues where people were acting out their anger about being HIV positive by having unprotected sex . There were discussions among therapists of how to deal with a patient whom they  knew was HIV positive but was not telling his or her partners.

The NIH and the NIMH awarded huge amounts of grant money directed towards AIDS and HIV research in the past 25-30 years. As a result many of the psychiatrists practicing today were supported by these grants at some time in their career or were trained by people who had such support and were well oriented about the psychiatric and psychological aspects of AIDS.

All of this is what makes this 2010 first edition of the Handbook of AIDS Psychiatry such a valuable book. Psychiatrist Mary Ann Cohen, a pioneer in the AIDS field and her six outstanding colleagues have written a book, which includes just about everything we should or might want to know about HIV and AIDS. It is billed as a practical book, which it is, but it is also a definitive work on this subject with over 1500 references. Some of the chapters are adapted from an earlier book titled Comprehensive Textbook of AIDS Psychiatry edited by Drs. Mary Ann Cohen and Jack Gorman, published in 2008 also by Oxford. Seven of the contributors to the earlier work took on the task of developing this current book.

This is not an edited book. All the 14 chapters are written by some combination of the seven authors. Dr. Cohen was involved in all but two of the chapters. Drs. Battista and Soffer were listed as residents at the time the book was published. The first 13 chapters were each followed by multiple pages of references and the final chapter on resources had addresses, phone numbers and web sites.

The widespread imprint of this disease and the comprehensive approach of this book is illustrated in the first chapter where the authors lay out the setting and models of AIDS psychiatric care. They start with effective parenting and prevention of early childhood trauma and conclude with the sections on education, HIV testing, condom distribution, rehabilitation centers, chronic care facilities and nursing homes. They touch upon the prejudice and discrimination labeled as AIDSism which unfortunately is ubiquitous and is also discussed in other chapters in the book.

Chapters titled Biopsychosocial Approach and HIV Through The Life Cycle cover material with which a psychiatrist trained in the past twenty-five years should be quite familiar. However the authors are not content with just reminding the reader to take a comprehensive history in areas relevant to this disease, but they offer over 100 suggested questions in doing a sexual history, suicide evaluation, substance abuse history or a violence evaluation. The following are examples of a few questions, which you may not have thought to use:

1. (Taking a sexual history) How do your cultural beliefs affect your sexuality?

2- Are you aware that petroleum-based lubricants (Vaseline and others) can cause leakage of condoms?

3- (To an LGBT person) What words do you prefer to describe your sexual identity?

4- (Evaluating suicidality) Do you plan to rejoin someone you lost?

5- (Taking a substance abuse history) What led to your first trying (the specific substance or substances)?

6- What effect did it have on the problem, crisis, or trauma in your life?

While it is stated that little is known about the relationship between aging and manifestations of psychiatric disorders in HIV positive persons, the discussion and questions raised about this topic in these chapters seem particularly important as treatment is now allowing people with AIDS to become senior citizens.

In the chapter titled Psychotherapeutic Treatment of Psychiatric Disorders it was noted that the enhanced understanding of the conflicts and struggles of the HIV positive  patient afforded by psychodynamic psychotherapy  has been described by multiple authors. This modality of treatment may be especially suited for patients with a trauma history as physical changes in the body and relationship stresses can awaken conflicts triggered by early trauma and neglect. This history of childhood emotional, physical and sexual trauma as well as neglect is also reported to be associated with risk behaviors and is prevalent in persons with HIV.  Other major themes, which were identified, that could surface in psychodynamic work include fears about mortality with the erosion of defensive denial as the illness progresses and conflicts surrounding sexuality. There also was a review of interpersonal psychotherapy, CBT, spiritual focused care, and various group therapy formats.

The chapters on psychiatric aspects of  stigma of HIV/ AIDS  will also be of  particular interest to the readers of this journal who are usually quite involved in dealing with subtle nuances in psychotherapy. Victim blaming, addict phobia and homophobia also called heterosexism are discussed in this context. While clinicians usually don’t have any trouble identifying stigma when they see it, there are scales which can be administered in both research protocols and clinical settings.

Dr. Cozza is the lead author in the chapter concerned with psychopharmacologic treatment issues. It is the longest chapter in the book and can best be summarized by their conclusion that the prescribing of psychotropic or any other class of medications to HIV positive patients taking ART is a complicated undertaking. The chapter provides an explanation of this statement in a narrative style as well as with some detailed tables showing the propensities of various medications to cause inhibition and induction.

Although psychiatrists are usually not involved with the treatment of physical symptoms or the actual administration of therapeutic drugs for  medical conditions, if they work with patients with AIDS they will be discussing various symptoms and complications. Dr. Goforth and Cohen put together two chapters which clearly explain symptoms of AIDS, as well as the medical illnesses associated with them. They review fatigue, sleep disorders, appetite problems, nausea and vomiting with a complete differential diagnosis and intervention options. The full range of endocrine problems, dermatological disorders , HIV associated opthamalogical diseases, malignancies, liver and kidney disease as well as the potential symptoms of these conditions are covered.

The one chapter, which was written by four authors, was titled Palliative and Spiritual Care of Persons with HIV and AIDS. This not only covered a discussion of the management of pain, other physical symptoms, behavioral symptoms including violent behavior and suicidality but it offered a review of models for spiritual care. The work of Breitbart and colleagues with cancer patients using meaning  centered interventions based on Victor Frankels ideas was introduced as was Kissane and colleagues description of a syndrome of  “demoralization” in the terminally ill which is distinct from depression. It consists of a triad of hopelessness, loss of meaning and existential distress expressed as a desire for death. A treatment approach for this state is outlined. This chapter concludes with a review of the role of psychiatrists and other clinicians at the time of death and afterwards. This includes a discussion of anticipatory, acute and complicated grief.

Although HIV disease and AIDS is no longer the mysterious disease which people are afraid to talk about and healthcare workers dread seeing patients with, nevertheless it is a very serious illness which cuts across all specialties and has great relevance for psychiatrists and other mental health professionals. It is estimated that more than one million people are living with HIV in the USA. Even now with retroviral treatment available, this disease is expected to infect 90 million people in Africa resulting in a minimum of 18 million orphans. Needless to say, this book should be translated into many languages and should be available internationally. This book gives us a full background about AIDS and allows psychiatrists and other mental health professionals to have this fund of knowledge at our fingertips. Also, if and when there is another deadly virus that appears on the scene, our profession will have a model and a valuable compendium of how to approach it, which is something we did not have thirty years ago.

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Summer’s Lease by John Mortimer, Penguin Books, 1988

If you want some good summer light reading, this book is for you, especially if you will be vacationing in Italy and renting a lovely villa. This is just what Molly Pargeter, the main character of this book did with her husband and her three girls.. Her father, a columnist for a British newspaper and a self proclaimed ladies man also came along. Not surprising, Molly found more than she expected, hence your summer mystery. Molly usually handled all the details of their summer rental and naturally has a great deal of curiosity about the owner of the villa and his family. She is also s dying to find out why did the owner specify that he wanted renters with three children, all girls. Then there is the strange occurrence of the water being unexplainably being drained out of their pool as well as of the pool of a neighbor’s pool. The difference being, in the later case the dead body of Mr. Fixit, the handyman was found at the bottom of it. This book was published 22 years ago but it still makes a good summer reading now in the 21^st century. John Mortimer is a veteran British author who has successfully written for the movies and television. The book will fit nicely in your summer bag, pocket, Nook or Kindle and give you a good summer read.