The End of Miracles - A Review

What is it like to have depression with psychotic features?

What is a day like inside a psych ward?

What is the psychiatrist thinking?

Sometimes the best way to explore questions like these is in a story. So here is Prozac Monologues' first review of a novel.

Monica Starkman is a psychiatrist at the University of Michigan whose expertise includes psychosomatic disorders, stress, and women's issues around fertility, miscarriage, and obstetrics. In her debut novel, The End of Miracles, she turns her clinical experience to the story of one woman, Margo Kerber, a long-infertile woman who finally conceives, tragically miscarries, and then... unravels.

The author takes her time in Part 1, letting her readers get to know Margo as a well-functioning adult who has some stresses, some conflicts, and a few vulnerabilities. The groundwork is laid carefully. We witness some impulsive behaviors that presage later events. We admire her professionalism, recognize her strengths, and feel for her sorrows.

Part 2 is the unraveling. The cracks in Margo's competent exterior widen and then swallow her. After the miscarriage, we witness her mind's valiant effort to create a tolerable "reality," an effort that ends with hospitalization. (The psych ward, by the way, is on the nice end of the range in which these things come.) We listen in on the case conference where Margo is discussed. Starkman puts us in the chair of the medical student whose supervising resident helpfully whispers explanations of the diagnostic issues being discussed. This technique is used again as the assistant prosecutor and chief prosecutor discuss her situation from their perspective. We learn the game plan of the psychiatrist who continues to treat her. And we mark Margo's progress as she reflects on the issues she faces and the changes she makes.

Psychosis is such a charged word. It seems to attack one's sense of self. I mean, if you can't trust your own mind, what can you trust? The horror of the notion is fearful. That horror turns into a fear of those who experience psychosis that is not proportional to the risk they pose. Fear layers on top of fear, and it's just plain hard to talk about it.

Many years ago I also started a novel as a way to explore the question, "What is psychosis?" behind the safety of fiction. Sometimes you know it when you see it. But on the edges... Try Googling that question and you find jargon that refers back on itself. I asked my therapist once. She gave me the textbook answer, delusions, hallucinations, loss of touch with reality... Then she asked, "Are you psychotic?" And I got scared. "How would I know?" I said. For some reason, that ended her line of inquiry and at the time I was glad that she didn't follow up.

Starkman's novel is a public service, putting flesh and bone, story and respect on the strange places a mind can go and from which it can return.

It is also a riveting read.

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