Central Oregon Community College Nursing Program
NUR 206 Fall As Provider of Care
Nursing Care of Clients with Mental Illness

MENTAL HEALTH BOOK REPORT PROJECT

Authors over the centuries have given us vivid descriptions of the workings of human minds. Some of the most impressive descriptions of the struggles of people with a mental illness are recorded in the works of writers who either struggle with mental illness themselves, or have grown up in homes dominated by the waxing and waning of mental illness. Others simply employ their skills to articulately portray the emotional and psychological anguish and insights associated with mental illness.

For this project you are to read a nonfiction book with a mental health theme, with a biography or autobiography of someone with a mental illness, or family members dealing with the mental illness of those they love. As you read the book, make assessment notes:

1. How does the mental illness play out in the life of the character?

The Reimer's were married in 1964. Not long after they married Janet gave birth to two healthy twin boys whom they named Brian and Bruce. It would be only eight short months following the joyous arrival of the boys that the Reimer's would encounter the most difficult of circumstances that any parents could ever face. When Mrs. Reimer noticed that the boys seemed to be having difficulty urinating she became concerned. After speaking to the family doctor, Janet was urged to take the twins to the hospital to be circumcised due to a condition called phimosis, which is resolved following the removal of the foreskin. Bruce was the unfortunate twin who happened to be picked up and operated on first. There was a malfunction in of a piece of equipment that uses a needle and electricity that was not a standard piece of equipment used for this procedure, the boys penis was almost completely burned off leaving only its small withered and charred remains. Brian was never operated on and within a short period of time the condition cleared up on its own and he never suffered any further from it. It would be only eight short months following the joyous arrival of the boys that the Reimer's would encounter the most difficult of circumstances that any parents could ever face. When Mrs. Reimer noticed that the boys seemed to be having difficulty urinating she became concerned. After speaking to the family doctor, Janet was urged to take the twins to the hospital to be circumcised due to a condition called phimosis, which is resolved following the removal of the foreskin. Bruce was the unfortunate twin who happened to be picked up and operated on first. There was a malfunction in of a piece of equipment that uses a needle and electricity that was not a standard piece of equipment used for this procedure, the boys penis was almost completely burned off leaving only its small withered and charred remains. Brian was never operated on and within a short period of time the condition cleared up on its own and he never suffered any further from it. In the case of the Reimer family, Money was presented with the most ideal opportunity for his research that he could hope for. He had theorized for years that the sex of a child is not determined by nature but by nurture. That is to say that he believed that a child was not necessarily born male or female but neutral. He theorized there was a window of time, he referred to as the gender gate, that if a child of one sex was altered to the opposite sex they could be successfully brought up as their new sex. The Reimer case was a perfect opportunity to try to prove his theory. Not only did he have a child who was a fully intact male at birth but he had a control for his experiment in the form of the twin brother who was almost biologically identical. After meeting with Dr. Money the Reimer's thought about his plan to perform surgical sex change on their son Bruce. The decision was one they were told had to be reached quickly because according to Money's theory children are locked into a gender identity between the ages of two and a half to three years of age. At the time Bruce was 19 months. shortly after their return home the Reimer's stopped cutting their sons hair and Janet began to alter some of his clothing into more girlish pieces. They chose a name for their new daughter, following Money's suggestion of using the same beginning sound of the babies name, Bruce became Brenda. On Monday, July 3 1967, the change was made official when Brenda underwent sexual reassignment surgery at the age of twenty-two months. Brenda Reimer was told the truth about her birth at the age of fourteen. Immediately after finding out the truth Brenda began the transformation back to the male she always knew she was supposed to be. She let her parents choose her new name and on July 2, 1981 David was surgically altered to finalize his transformation. He was sixteen at the time. David met a lovely girl who was accepting of his past but he was in some ways a difficult man to be married to. Intimate relations, while made possible by phalloplasty, were sometimes interrupted by David having to retreat to the bathroom to vomit. While the phalloplasty gave David a somewhat functioning penis, the castration was irreversible and he would never be able to have children of his own because he had no testicles. Upon further research I found that David killed himself on May 5, 2004.

2. What do the symptoms look like, both during acute episodes and during remission.?

He grew up angry, depressed, confused and extremely uncomfortable as a girl. She did not know her true gender until her parents revealed it to her at 14 when her life was spiraling out of control. She then transitioned back to male (David) as a teenager, married and although much more comfortable as a man later committed suicide. Brenda was an extremely reluctant girl. She didn't like dresses or dolls or any of the other things that a girl should. She wanted to play with trucks, roughhouse with her brother, and shave like her father. The girl in this study was not happy as a girl. She was absolutely terrified of her doctor. She was averse to gender reassignment. She played with boy toys, rough-housed, and had interest in girls. The thought of sex, and the very mention of sexual organs, made her uncomfortable and filled her with self-disgust. Despite these obvious manifestations of continuing masculine tendencies, Dr. Money repeatedly counseled the Reimers that they had to be unwavering in their child rearing, that they had to continue to treat Brenda like a girl, because she now was one. It did not take long for the first signs of the difficulties that lie ahead to make themselves known. At a very young age Brenda showed a considerable amount of resistance to things such as wearing dresses. Even as early as kindergarten Brenda showed definite signs of not being a typical little girl. Her teachers later reflect on her demeanor and behavior by saying that there was absolutely nothing girly about her. Brenda had little success fitting in with the girls at school. At the same time she was equally unsuccessful fitting in with the boys. At a very young age she found herself in a lonely and ambiguous place, something that would not change for many miserable years. As part of her treatment, Brenda and her brother Brian were taken by their parents for an annual visit with Dr. Money. The accounts of these visits are disturbing to say the least. Brenda, who already felt different from all of the other kids she knew, was further singled out by going on these trips that nobody else had to go on. Aside from the fact that these trips served in part to isolate and separate an already desperately lonely child, the sessions with Dr. Money grew increasingly intrusive and embarrassing for both children as they grew older. Part of Dr. Money's theory of gender identity in the case of gender reassignment cases was that there was a need for the patient to visually identify with male and female gender roles. While this may seem like somewhat logical assumption, what it ultimately boiled down to was Money showing young children graphically pornographic pictures of naked men and women and men and women engaged in sexual intercourse.

3. What strengths does the character use in his/her struggle with mental illness?

Most importantly, this story teaches readers an important, and often forgotten, lesson. As David put it, “You can’t be something that you’re not. You have to be you” (256).

Psychiatris Mary Mc Kenty

4. What supports work for the character, and which ones hinder?

* The Johns Hopkins doctor put in charge of Brenda's case, named John Money - forcing the children to play-act sexual behaviors as young as six . According to Brian, Dr. Money took some pictures of them engaging in this behavior. Dr. Money relentlessly interrogated Brenda about her sexual thoughts, her gender constructs, and occasionally showed her pornography. He would shout at Brenda and her brother, Brian, if they refused to comply with his demands. By the age of 13, Reimer was experiencing suicidal depression, and told his parents he would commit suicide if they made him see John Money again. * Mrs. Riemer was suicidally depressive, Mr. Riemer was an alcoholic, Brian was acting out behaviorally, The twin brother, Brian, later developed schizophrenia. * several psychiatrist who all had one goal in mind: to nurture her into a proper girl, in accordance to John Money’s instructions and belief. * Dr. Diamond believed that nature tramped nurture every time and that there was no way a normal baby boy could be ‘nurtured’ into a girl. He believed that ones true sense of being either male or female (or neither or both) was intrinsically hard wired into their brain. persuaded Reimer to allow him to report the outcome in order to dissuade physicians from treating other infants similarly * In addition to his lifelong difficult relationship with his parents, Reimer had to deal with unemployment and the death of his brother Brian from an overdose of antidepressants on July 1, 2002. On May 2, 2004, his wife Jane told him she wanted to separate. On the morning of May 4, 2004, Reimer drove to a grocery store's parking lot and committed suicide by shooting himself in the head with a sawed-off shotgun.[7] He was 38 years old * Psychiatrist Mary Mc Kenty, female only true friend Heather Lagarry

5. How do the character’s family and community respond to the person with the mental illness?

Money also asked the parents to do things such as to be naked in front of the twins whenever possible and also to have sex in front of the children to reinforce their gender identity. While the parents drew the line at having sex in front of their children, it seems odd that Dr. Moneys request did not raise concerns about the man that was treating both of their children in private sessions. It is probably worth mentioning that Janet Reimer did appear naked in front of the children from time to time, an act that they found hugely awkward and embarrassing. Her mother suffered from severe depression and her father had developed quite a problem with alcohol. Not to mention Brian, who in the midst of all of his sisters constant care and attention, was cast aside. Brian would also later say that he felt guilty when they were younger and in school because when given the choice between having friends and sticking by his socially awkward sister, he chose his friends, leaving Brenda with no one. Brian suffered from drug addiction and had many run-ins with the law. Eventually he killed himself.

6. What community resources are available to the character in your book?

City Child Guidance clinic – work with school
Local psychiatrists – Psychohormonal Research Unit in Baltimore once a year – counseling sessions with Dr. Money were not working so they contacted local psychiatrists

7. Find 2 viable community resources in your community or available to members of your community that might help your character.
Another noteworthy milestone for Oregon is that it’s the first state in the country to require coverage for puberty-suppressing treatments for some transgender adolescents. Starting on Oct. 1, 2014, the Oregon Health Plan will cover the cost of pubertal suppression evaluation, treatment and monitoring for youth enrolled in the health plan who are diagnosed with gender dysphoria. Puberty suppressors, also called puberty blockers, are medications that stunt hormone production and delay the development of secondary sexual characteristics, such as Adam’s apples or breasts, until a child gets older and can decide whether to make lasting changes.

TransActive Education & Advocacy, a national group based in Portland counseling program through Oregon State University-Cascades Campus and is focused on LGBTQ (lesbian, gay, bisexual, and transgender, queer)

I have to say while I may have found parts of this book somewhat interesting, I have to say I did not enjoy reading it. I found it to be disturbing and incredibly sad. I did learn a great deal more than I would probably have ever learned about gender identity and inter-sexual individuals than I would have ever learned had I not read this book. Aside from the science I think this book has a bigger lesson. We are always learning and advancing in new ways and it is incredibly egotistical and ignorant to assume that we know unequivocally the solution to every situation. People who are in a position to influence the decisions of others and hold the power to irreversibly change their lives should not take the great responsibility lightly. Had doctor Money considered for a moment that he may be wrong in case of David Reimer he may have considered waiting to complete the irreversible castration. I think it is safe to assume that while David may have had a hard time growing up as a male without a penis, he would not have suffered nearly as much as he did being forced to live for 14 years as a female.

Enjoy your selected book and keep assessment notes as you read!

You will present you report orally, in the 4th or 5th week of the term according to the calendar which will be published later.

Central Oregon Community College Nursing Program
NUR 206 Fall
Mental Health Book Report
Grade Sheet

* Brief Synopsis of Book | 10 pts | * Symptomatology ( Nursing Mental Health Assessment of Client during acute phase) | 15 pts | * Strengths and Supports | 10 pts | * Community Responses/Resources | 5 pts | * Local Community Resources for your Client | 5 pts | * Personal Reaction to the Book you Read | 5 pts |

Total: _____ / 50 Pts.

Mental Health Book List

This is a short selection from thousands of titles that address mental health issues. It is NOT exhaustive, and will benefit from additional recommendations. Some books address a variety of mental health issues and could be categorized under a number of topics. The goal of this assignment is to expand your skills in assessing and caring for clients with mental illness, so if you're an expert in one area, choose a less familiar topic and a book you haven't read before for your focus this quarter. The book you choose should be a autobiography or biography of someone with a mental illness. No fiction, please. Copies of most of these books are available at the COCC library and at the Bend/Redmond libraries.
Enjoy!

MANIC DEPRESSION/BIPOLAR DISORDER Berger, Diane: We Heard the Angels of Madness Duke, Patty: A Brilliant Madness: Living with Manic Depressive Illness Hornbacher, Marya: Madness, a Bipolar Life Jamison, Katherine Redfield: An Unquiet Mind Simon, Lizzie: Detour, My Bipolar Trip in 4D

DEPRESSION/SUICIDE Heckler, Richard: Waking up, Alive Oates, J.C. What I Live For Plath, Sylvia: The Bell Jar (old, but a classic) Manning, Martha: Undercurrents Shields, Brooke: Down Came the Rain (Postpartum Depression)

SCHIZOPHRENIA Balter, Marie & Katz, Richard: Nobody’s Child Burke, Ross David: When the Music's Over: My Journey into Schizophrenia Holley, Tara Elgin: My Mother's Keeper Kaysen, Susanna: Girl Interrupted Lachenmeyer, Nathaniel: The Outsider: A Journey into my Father's Struggle with Madness. Lyden, Jacki: Daughter of the Queen of Sheba Nasar, Sylvia: A Beautiful Mind, the Life of John Nash North, Carol: Welcome Silence. Saks, Elyn R.: My Journey Through Madness Schiller, Lori and Burnett, Amanda: Quiet Room: A Journey Out of the Torment of Madness Sheehan, Susan: Is There No Place On Earth for Me? Siegel, Ronald K. Whispers, the Voices of Paranoia Steele, Ken. The Day the Voices Stopped Stryon, William: Darkness Visible

DISSOCIATIVE IDENTITY DISORDER Bryant, Doris and Kessler, Judy: Beyond Integration Casey, Joan Frances: The Flock Chase, Truddi: When Rabbit Howls Cameron, Marcia: Broken Child Stone, Gene: Little Girl Fly Away West, Cameron: First Person Plural, My Life as a Multiple

EATING DISORDERS Levenkron, S. The Best LIttle Girl in the World. Knapp, Caroline: Appetites

AUTISM Grandin, Temple and Scariano, Margaret M.: emergence, Labeled Autistic Mulchopadhyay, Tito Rajarshi: The Mind Tree Williams, Donna: Nobody Nowhere: The Extraordinary Autobiography of an Autistic Williams, Donna: Somebody Somewhere: Breaking Free from the World of Autism

ASPERGER’S SYNDROME Willey, Liane Holliday: Pretending to be Normal

GENDER IDENTITY Colapinto, John: As Nature Made Him, The Boy who was Raised as a Girl.

COMPULSIVE DISORDER Colas, Emily: Just Checking Wilensky, Amy S. Passing for Normal, a memoir of compulsion

BORDERLINE PERSONALITY DISORDER Reiland, Rachel: Get Me Out of Here