The Doctor Is In.

Harlem Hospital MDs use literature as a vehicle for studying psychiatry

On a recent Friday morning, in the seventh floor conference room of Harlem Hospital's Department of Psychiatry, Dr. Olubansile A. Mimiko has the rapt attention of nine of his fellow psychiatry residents. He is presenting a case study of Charles Milton--nicknamed Ache--a serial killer who is on a murderous rampage through Harlem's Striver's Row. Dr. Mimiko concludes that a childhood of poverty, abuse and neglect at the hands of his mother turned Ache into a killer. "Ache's mother's tyrannical, sadistic and harshly punitive method with her son left him with scars that made him incapable of trust, love or affection," explained Dr. Mimiko.

His diagnosis of the patient: paranoid schizophrenia and antisocial personality disorder, making him a clear and imminent danger to others. Despite his razor-sharp analysis, Dr. Mimiko has never met Ache. That's because, fortunately, he isn't real. He is a character in Grace Edward's novel No Time to Die (Bantam, 1999). Dr. Mimiko's dissection of Ache is a purely theoretical exercise, part of the Journal Club, a course for senior psychiatry residents at Harlem Hospital. The psychiatrists-in-training review both scientific and popular literature, including novels and memoirs by black authors, to understand how psychology, biology and society combine to shape human behavior.

"We appreciate literature as a vehicle for studying psychiatry," says Dr. Henry L. McCurtis, acting director of the department of psychiatry, who teaches the course. "Artists tend to look reality in the face and not blink. They help us understand human nature."

Dr. McCurtis, who describes himself as an "avid reader," started the course in 1982 with his colleague Dr. James Curtis, who was then the director of the department. Over the years, residents have read and analyzed characters from a number of well-known books by African American authors, such as The Color of Water, by James McBride; Possessing the Secret of Joy, by Alice Walker; and both Paradise, and Beloved, by Toni Morrison.

Dr. McCurtis arranges the course around certain psychiatric topics using books, as well as scientific studies, to support his points. For instance, No Time to Die was part of a discussion of attachment theory, which emphasizes the importance of intimate human relationships, or attachments, in shaping childhood development. "Ache is an example of the worst thing that can happen in the attachment phase," Dr. McCurtis says to his students about Edwards' character. "As psychiatrists we need to think about ways to help foster positive attachments and reduce some of the recessiveness of a maladaptive attachment."

Last year the residents looked at Beloved to better understand anxiety disorder, in this case, as a result of slavery. "This book offers a beautiful example of post-traumatic stress, what it does to the mind and how it has historical and transgenerational effects," says Dr. McCurtis of the 1998 Pulitzer Prize-winning novel. "It also helps the students look at the experience of African Americans from the perspective of trauma and explore what is required for healing to take place."

Next up, the residents will read and discuss Push by poet and first-time novelist Sapphire. "Push illustrates resilience as a result of mentoring," concludes Dr. McCurtis of the 1996 story which features a girl who endures unimaginable hardships, including becoming pregnant by her father, before she is helped by a teacher. I want the students to understand that people find a way out of no way. Incest doesn't always have to end in an ugly and traumatic way, and I want to use the book to illustrate that."

The bottom line for the residents is translating what they learn in the Journal Club into the real world. "An author writes books from real experiences, from what he or she sees in the community," says Dr. Mimiko. Originally from Nigeria, he plans to practice community psychiatry when he finishes his residency training. "At the end of the day, I can use writers and their books to help me understand my patients and see them, through the eyes of the artist, in the context of their environment."