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Reading the reader reviews at Amazon.com of Weekends at Bellevue is almost as entertaining the book itself, because opinions about it are so mixed and so strong. Some praise her for an honest and unflinching look at a modern psychiatric hospital, exposing the problems as well as the good that the place does. Others condemn her for a self-serving and arrogant memoir that shows how badly people with mental illnesses are treated in hospitals. There are currently 8 pages of comments, while Paul Linde's Danger to Self: On the Front Line with an ER Psychiatrist, about San Francisco General Hospital, released at about the same time, has got only 5 comments, but all of them give that book five stars. So Holland has the ability to spark powerful reactions.
It is also worth comparing the book with MaryAnn DeLeo's HBO documentary Bellevue: Inside Out which is unfortunately hard to purchase but is sometimes available online. (It is available on VHS at Amazon.) DeLeo focused on the patients, interviewing them, and seeing how they did in treatment, following them over a period of several days or even weeks. Holland gives short vignettes of patients, with far less detail about them, telling us about her experience of treating them over a period of a few hours. She emphasizes that her job is to stabilize people and get them out of the hospital, and indeed one of the reasons she wanted to move onto a different job after 9 years was that she wanted the chance to spend more time with patients and help them achieve better outcomes.
What Holland gives is more of the culture of psychiatrists at an ER. These are ambitious and driven professionals, and the medical culture is aggressive and demanding. Her job was an unusual one, working on the weekends, leaving her the weekdays to entertain herself. She had a great deal of autonomy because she was in charge and able to work without interference over the weekends while other psychiatrists had to work with more interaction between them on weekdays. Holland also gives some details of her romantic and sexual life, both on and off the psych ward. Holland gives the impression that she and many other doctors are on the verge of mania most of the time. This frenetic style is enhanced by the dramatic writing style and the short chapters.
Holland herself reads the unabridged audiobook, and her reading actually plays down the grandiose qualities of the text, and minimizes the choppiness of the short chapters. It makes the book very enjoyable to listen to. Is it a sympathetic depiction of mental illness or does it make patients just seem strange and difficult? I'd say it assumes a compassionate understanding but this is hidden behind the gallows humor of dealing with stressful situations. Holland describes her own failings in her friendship with her best friend who has cancer, and many readers seem to take this to mean she is a terrible person. However, the pain of seeing a friend go through a terminal disease is easy to understand, and many people go into denial under such circumstances. So while Holland is certainly self-involved, it is also clear that she is a compassionate doctor. She is proficient at her job and she wants to do it well. When she goes into psychotherapy and when she becomes a mother, she learns to be more compassionate. These are hardly amazing revelations about contemporary psychiatrists, but Holland does spell out how it happens to her.
This is not the book to introduce readers to mental illness. However, for people who already know something about the topic and want to get a flavor of what goes on at Bellevue, Holland's book provides an additional perspective to other available descriptions of the psych wards there.
© 2010 Christian Perring
Christian Perring, Associate Professor of Philosophy, Dowling College, New York.