Julie Holland (1)Besprekingen

Fantastic. So much information that I found myself taking notes half the time while I was reading. It's like an owner's manual for your body at all the stages of life. Loved it.

Holy cow. This was the most disgusting book I have ever read. The fact that someone as abusive, sadistic, narcissistic, and offensive as Julie Holland decided to write a memoir BRAGGING about these qualities astounds me. I knew I was in for a terrible ride when the first sentence talked about being surrounded by "insanity" and the next page thanked the NYPD. I highlighted everything that was offensive which ended up being around 60% of the book. I have 130 highlights and they were exclusively things that I found especially disgusting.

She spent the entirety the book doing any of the following:
- Laughing at people's worst days and sharing their trauma with the world
- Smugly kicking people out of the ER who she unreasonably deemed shelter-seeking and "not actually sick" (AKA not white, middle-class, employed people)
- Unnecessarily drugging patients for her own convenience and to get on cops' good sides
- Talking about how "butch" she is for being a heartless piece of crap
- Making massive generalizations based on diagnoses (schizophrenia, bipolar disorder, and sociopathy for the most part)
- Laughing at sexual harassment in the workplace
- Abusing her patients, going to therapy to try and figure out why she's so sadistic, blaming it on her non-existent daddy issues, and then deciding she's done with therapy even though she's still a sadist
- Equating mentally ill people with animals and talking about "T&Rs" or "zookeeper's guilt"
- Using words like the r-slur
- Seducing patients to get information from them

The lack of respect with which she discusses homeless people, incarcerated people, transgender people, and-- get this-- mentally ill people, is disturbing, especially as she details her interactions with said groups. She describes a transgender woman as "one humongous she-male!" and misgenders her throughout the entire story.

These were just a few of the things that stood out to me, but I could talk for hours about how disgusting this book was. I am furious that this was ever written or published and that someone like this worked in a psychiatric institution for so long. She deserves to have her medical license stripped and her name tarnished for life. I don't generally hate authors for writing bad books, but I hate her for being a bad person.

HORRENDOUS. If I could give this zero stars, I would.

Dr. Julie Holland is a psychiatrist and psychopharmacologist who worked in the psychiatric ER at New York's Bellevue Hospital from 1996 through 2005.

This memoir wasn't exactly the collection of wild stories the cover blurb seemed to promise, and it also wasn't quite the nuanced and thoughtful exploration of the treatment of mental illness that I was hoping for (although it does certainly have some of the latter). What it was, mostly, was, well, a memoir. Holland spends a lot of time talking about herself, her relationships of various kinds with other doctors, her own psychological issues, and the insights about herself she's taken from psychotherapy. Part of me can't help but find some of that a little self-absorbed or over-share-y, although I do appreciate her ability to be honest about her own faults, and those personal ruminations do both tie into the larger issues of mental health support and illuminate some of what it's like to do this particular job.

Whether it's quite what I expected/wanted to read or not, I did at least find this interesting as a glimpse into this world, with all its medical and emotional complexities. But, perhaps unsurprisingly, it's also pretty depressing, since it's crystal clear throughout that the systems we have in place for dealing with mental health crises and substance abuse problems are pathetically, horrifically inadequate (something Dr. Holland definitely appreciates, even if she's mostly fairly low-key about addressing it).½

One of my doctors recommended this, and Christiane Northrup is quoted on the cover, so this book seemed totally up my alley. But after finishing it and sitting with the information for a couple of days, I can't decide whether to recommend it.

The book is split into three parts. The second part covers dating, long term relationships, motherhood, and perimenopause. (Full disclosure: I did not read the chapters on motherhood and perimenopause.) The third part is a guide to using this information in areas like daily nutrition, sleep, and exercise.

Positives:

Any book that teaches women more about their bodies and cites research heavily in order to do so is a valuable tool of empowerment. Holland tells us that women's bodies are cyclical, and that fluctuations, especially in mood, are tied to that cycle and have a biological and evolutionary basis. She tells us that being "moody" is normal, and more than that, it is "the source of our power (1)." I was silently cheering at a lot of what she wrote in part 1, and I really learned a lot that I did not know.

Holland talks extensively about the effects of birth control and anti-depressants on our hormones, and she gives a lot of specifics. She made me think differently about the value of marijuana as a more natural option than other drugs. The chapters on dating and long term relationships were really interesting, and informed a lot of experiences I had previously found confusing. The information on how our mood and body changes throughout our cycle is something I only started learning about with Toni Weschler when I tried FAM a couple of months back, so it's something I still know very little about. This book really increased my knowledge.

Overall, this book communicates a message of "You are totally okay and enough as you are," and it does so with a lot of research backing it up. That's a powerful message, and one that women can't hear enough. There's a lot of "women are x way and men are y way," and while that may be a problematic message (for reasons I explain below), it's also a reassuring one. Holland talks a lot about how understudied women are in medical research (most human and animal subjects are male), going as far to say, "Women are still, very simply, second-class citizens in the world of medicine (32)." Did you know that women's pain sensitivity fluctuates with where we are in our menstrual cycle? That eight of ten drugs removed between 1997 and 2001 were removed because they posed greater health risks for men than women, but they had only ever been tested on men in experiments (32)?

At the end of the first chapter, Holland says the following: "We are not men. We are women. We feel more deeply, express our emotions more frequently, and get moody monthly. It's normal. It's nature's way. And we don't necessarily have to medicate away the essence of who we are to make others more comfortable. In fact, once we better understand our bodies and our own moods, we will realize that as women we have many natural tools, for tackling all of the challenges of our busy, complex lives (33)."

Negatives:

This book fell into all three of the traps I was hoping it wouldn't. I fully acknowledge that the second negative is subjective, but the other two are pretty concrete absences for a book addressing the influence of the patriarchy on women's wellness.

1. If women are like this and men are like this, what do you mean by "woman"?
2. If the science is simple enough that I can understand it, I question its accuracy.
3. Fat shaming in the exercise chapter

1. What do you mean by "woman"?

In any book that says "women are like biologically and evolutionarily this," I need a definition of what women are. Are you talking gender, which is as least partially, if not completely, sociological? Sex, which was once believed to be a true dichotomy? Is a woman a person who has certain sex organs, like a uterus? Who menstruates from menarche to menopause? Who has secondary sexual characteristics like breasts? Who has more estrogen than testosterone? This isn't just semantics - this book is meant to inform and empower women, and it's important to define who the group "women" includes and excludes. Also, as a book like this would know, people who believe in complementary gender roles will use information about "women are biologically and evolutionarily like this" to support anti-women agendas and a false gender binary. The audience needs to know that this information won't be used to further disempower us.

I am sympathetic to the difficulty of defining a term like "women," especially since each of the research articles cited may define it differently. But I need the author to acknowledge that difficulty and try to give the best definition possible.

Holland addresses this on page 23, and to my memory, it is the only time she does.

"Obviously, we must be cautious in discussing differences between the sexes because there is large variation within each gender, and nurture and culture factor in nearly as much as nature does. There is interplay between our natural abilities and how we are molded to behave that is impossible to fully tease apart. Case studies of children with ambiguous genitalia who are raised to be male or female even though they possess the opposite genetic material are rare, but they do help to teach us one thing: the influence of biology cannot be underestimated. Often, our own balance of testosterone and estrogen levels dictates how aggressive we'll be in a pickup game of basketball (or if we'd ever be caught dead in a pickup game of basketball) more than anything our parents ever taught us (23)."

I'm glad this passage exists, but I expect more. Also, the problematic interchangeability of "gender" and "sex" in this passage is continued throughout the book. It wasn't a dealbreaker for me, but I can definitely understand how that would be enough of a reason for someone not to pick up this book.

2. The scientific catch-22

"Add to the cocainelike mix of dopamine and norepinephrine a healthy shot of endorphins, our naturally circulating opiates, nature's painkillers and stress relievers. So falling in love is pharmacologcally a bit like a speedball. But there's more, because experiencing intense infatuation, and especially love at first sight, is like taking a psychadelic drug, too (61)."

This is a really fun passage and the word choice is evocative and memorable. In contrast, interactions of hormones are really complex, and I know that the actual description of what happens with love at first sight would be dull and impenetrable. But I also know that this is far too simplified, so I have trouble knowing how much to trust it as true. This was the problem I had with most of the book. It was eminently readable, so I didn't know how much I could believe the science.

I don't really know how to resolve that problem, but it does help that Holland cites heavily.

3. Fat shaming

Fortunately, fat shaming was mostly limited to the exercise/body image chapter, with a little in the nutrition chapter. I understand that obesity has health risks, but the harm that fat-shaming causes to mental health (and to physical health, with things like doctor bias) seems like it far outweighs the benefit of constantly telling people those health risks. There is a way to talk about having a healthy level of activity without focusing on the size of people's waists, and this book did NOT strike that balance. If you have triggers around body image, I would skip this chapter.

The exercise chapter includes a section on body positivity and acceptance, and another section around accepting secondary female sex characteristics (hips and breasts) as normal. Yay! But it would also be great to not have fat shaming at all, or, if you're going to talk extensively about obesity, to address the concept of fat shaming and try and separate it from the scientific terminology and research.

Overall:

I'd recommend to treat the book as a reference, and to read in chapter-long sittings. I'd recommend being aware of the three negatives I mentioned, and reading critically. But every book is an interaction between the reader and the author, and I would say that if you read sparingly and critically, there is a lot to get from this book, both in terms of empowerment and information.

The premise: Women are moody by nature, and that is a strength rather than something to be medicated away.

I was hoping for practical, data-based suggestions for managing moods, but instead found disproven assumptions about differences between "male" and "female" brains and a too-heavy reliance on the author's personal experience and opinions (e.g, she ignores the risks of cannabis for those with underlying psychiatric issues and stereotypes SAHDs as lazy).

The suggestions that are here are of a very basic, common-sense nature. Many of them are fine, they're just better suited to a blog post than to a book that's 400-ish pages long.

This book rocked my socks off. I worked in the same professional mental health environment a few years earlier than Holland, overlapping her (in the same neighborhood) by a couple of years.

I know how being injured from a patient can have a deep and lasting effect on you. I was picked up, thrown into a wall and required stitches for a deep head wound. It still aches during cold weather. It was the beginning of my burn out in social work.

The only flaw I found was what she learned about the years of deinstitutionalization. I was working in the field for most of it. I turned off the lights in one of them. I worked in a couple of the community based options. Her explanation for their failure was far too simplistic.

Some of it was NIMBYism, yes. Absolutely. However, some of it was out of genuine concern for the individuals and their choices and wishes. For some individuals, their world became far more restrictive when they moved from an institutional setting to a community setting. I went to endless meetings with individuals who wanted their long term care to remain institutional and separate from the outside world. We're not talking about criminals here. We're talking about people who wanted control over their environment and they couldn't have that in the community based options.

In the outside world their medications were focused on controlling socially inappropriate behaviors. Some became the walking dead. Their personalities disappeared. When they were institutionalized the staff could deal with their odd behaviors (and occasional nudity) and the medical restraints were kept to a minimum. We could work with their socially inappropriate behaviors because we could see them and address them. That wasn't the case when they were stuffed to the gills with sedation.

Back to the book - Mostly I identified with Holland's lack of desire to advance within the field. More important, she knew when to leave the setting that was exhausting her of all sympathy. In the mid-90s the term was 'crispy-fried'. My own burn out was a simple lack of caring what happened day to day. I knew I had to exit the field.

I've read some of the other reviews slamming her for her attitude here - Just wait until you've worked in the system in NYC for a few years. It chews you up and spits you out.

I'm not sure why I thought this would be a good read. Maybe the title snared me as to expect quirkiness and such from the nature of those who drift into the Psyche ward of Bellevue hospital. I was disappointed. Though there are a few intriguing cases mostly the book is about Dr. Holland's life experiences. That said the title might will have been, "Dr. Holland, A Life."

We are taken through her experiences coming out of school and into the fray of a large hospital. But the book relates more to her coming of age, getting married, finding a mentor, having children, and a huge political squabble for power and control with one of her colleagues.

Interspersed she does talk a bit about how our healthcare system when dealing with the many in need of mental care is lacking. Also briefly referring to the private practice she developed and how prescribing the medications that drive psychopharmacology I found interesting. The entire book though did not have much to offer in any way.

Hate the title. Love the practical information on medications. Didn't realize that mood changes could be beneficial in any way. Lots of repetitiveness.

Seemed to be a personal rant or confession rather than a cohesive narrative

This is a memoir of one doctor’s nine years spent on the night shift at the psych E.R.

I majored in psychology and really wanted to like this book. I’ve read other memoirs about “becoming a doctor” and was expecting interesting insights and some colorful and entertaining “patient profiles” (altered to protect identities, of course). But this memoir isn’t about Bellevue and the many patients who come there. It’s about Holland.

I cannot remember when I’ve read a memoir that is more self-centered. There is a little bit of interesting information regarding Bellevue’s psychiatric emergency room, but not enough to redeem it. The jacket blurbs applaud her candor; I found her inappropriate behavior disturbing for the doctor in charge of a busy city psych E.R. (in one episode she stops at a cocktail party before going to work the night shift; in another she describes her efforts to have sex with as many residents as possible). I suppose it’s a good thing that she chose to become a psychopharmacologist (i.e. she does not treat patients with psychotherapy but with drugs); she certainly doesn’t seem to have enough insight to be successful at the traditional psychotherapy techniques.

If it weren’t for the fact that the book satisfied a challenge for a game I’m playing I would have abandoned it.

I was intrigued by the premise of the book, but it continuously let me down. Julie Holland writes from a highly heteronormative perspective, as well as a gender essentialist one. She is also anti-polyamory (though I can't tell if she realizes it). At times, it's hard to believe this book didn't come out decades ago, especially when she is being downright sexist in the way she talks about both women and men. I won't call it a total loss - some of her information is interesting as far as just the pure facts go - but I wish it were presented by someone more up to the task.

This could have been a much more interesting book if Dr Holland had focused on more of her really challenging and interesting patients instead of on her personal growth as a medical professional. I very weary of her therapy and was very angry at her for her response to her good friend Lucy's death. The story is more about pharmacology in dealing with mental health than dealing with individuals. I skipped through the last chapters as the story was tiresome.Also, to the editor, why were some chapters so short, even though they were connected to the next one... ?

I loved the TV show ER, watched nearly every episode in its fifteen year run, especially Season 7 when they introduced the character of Kim Legaspi, and for an episode here and there would introduce a more psychiatrically driven plot point.

That's why I picked up this book. Because it tells one of the real stories of the Psych ER at Bellevue. And, of course, like always, this real life stuff was vastly more interesting than even what they put on TV.

The stories that Holland told in the book ran the gamut, some were heartbreaking, others were terrifying, and most of them were just plain weird. And yet the stories weren't really my favorite part of the book, but it was how Holland put the stories in context, sitting alongside her own therapy and her own life (sing and family). It gave a richness to the narrative, and much like a fictional story, I found myself caring for those Holland cared for and being pissed at those she got annoyed with. She did something not many non-fiction writers do successfully, made me care about the real people in her book.

Add to that the fact that it was a very well paced and organized book even though its narrative wasn't perfectly linear, I never thought of putting it down until I read page 308. A definite four stars.

I didn't like her, too macho. She did get better.

I enjoyed Weekends at Bellevue although I was surprised that it focused more on Dr. Holland and her personal experience & therapy vs. that of her patients. It was still interesting to read about how she had to harden herself emotionally, how important it is for psych doctors to have their own therapy so that they don't project onto their patients. The bits of information about the patient side is more generic. While she covers a few out-of-the-norm cases, you are left with the impression that many of their day-to-day patients, regardless of age, sex, or class, have had similarly traumatic experiences that brought them to this breaking point. The author briefly mentions how the mentally ill are treated so differently here in the US, vs. other countries where they are more integrated into society and cared for by not only their families but neighbors and friends in the community as well. I found myself wishing that there was more information on this topic and whether this might change anytime soon or not.

A little more Bellevue and a little less Dr. Holland would have made this a 4 star book.

A big part of the problem for this memoir (not primarily about the people who transit through Bellevue's Psych ER, but about the writer's personal development) is her use of the present tense. Consider this statement:

"I think of my job as a psychiatrist as being, in many ways, a seduction.... I use my feminine wiles to have my way with the patients..." (109).

Is it meant to be read in the moment of the narrative, first person limited, or is it a more universal, still-true, first person omniscient declaration? If the former, it's a developmental statement; if the latter, a self-statement.

Either way, I don't see much evidence of the author's movement beyond this truth, and, like much of what she reports about her approach to psychiatry, concerns me.

While I really enjoyed the beginning of the book, I felt like I was slogging through a lot of it. I was looking forward to reading about the weird admissions and how a psych ER worked (or not, at times), but instead got bogged down in hospital politics and pettiness. Some on Holland's part, some on the other doctors' parts. I really appreciated her compassion with those who needed it and her toughness with those who probably didn't expect it. I liked Dr. Holland quite a bit, but wanted more madness (for lack of a better term).

I've noticed a lot of readers have given this book a negative review because they didn't like the author. I admit the woman has her share of flaws. But her honesty in writing about them is a big part of what makes this book so interesting.

Julie Holland does not claim perfection. She struggles with her emerging roll as a psychiatrist in the admissions section of one of the busiest psychiatric hospitals. She acknowledges she did not always handle patients as compassionately as she should have. And, as she shares some of the stories of her nights at Bellevue, we see why it's sometimes necessary for doctors to harden themselves against the constant heartbreak of mental illness.

Holland also shares bits of her personal journey, because, without that, the book would be nothing more than anecdotes of a steady stream of patients. We have to get to know the author on a personal level, in order to fully understand her experiences at Bellevue.

We don't get to know any one patient well. This book isn't about specific patients. Instead, this is about the system in general, our treatment of the mentally ill and the difficulties doctors have in navigating the system. Overall, I found this book a compelling read.

My cousin picked this book up and told me how interesting it sounded, so I decided to pick up a copy, too. What could be more fun than reading about a doctor in a loony bin? As it turns out, nothing could be more fun! I liked this memoir very much. Holland struck the perfect combination of on-the-job antics with her personal life triumphs and struggles. Holland also shed light on the plight of the mentally ill and how they are cared for and treated within the medical and legal system.

This was a very different kind of memoir for me to read and I loved it! I definitely recommend this book to memoir fans and anyone who is looking for an engaging and different read.

She's so matter-of-fact about her job, the patients became tedious.

The shift from descriptions of work and patients to more of an autobiography wasn't quite what I was looking for. I was more interested in Bellevue and ER mental health care delivery rather than in Julie Holland per se, but she's interesting for what that's worth, and sure, I guess it is true that she would be a hard person to separate from her work. Maybe that's the point. But just not quite what I hoped for.

I expected this to be a compelling book given the subject matter: a doctor working with the mentally ill at Bellevue. However, what I found was an excruciatingly self-indulgent whine-fest. I understand that this is a profession that will lead to bouts of burn-out and will require a morbid or dark sense of humor to get you through a shift but this doctor just seems desensitized and more worried about her problems than her patients. I would be interested to see a book from this author that focuses on the patients or the other staff members because her writing and observations were interesting when she focused on someone else.

I had been looking for this book ever since hearing an interview with the author on NPR's Fresh Air many months ago. The read was worth the extended wait. The author details her experiences during her 9 years working as a weekend attending physician in charge of the psychiatric emergency room at New York City's Bellevue Hospital.
She explains the difficulties of diagnosing the symptoms presented by the broad range of patients that line the waiting room during her shifts, whether voluntarily or by being brought in by the cops or EMS. Do they pose a legitimate threat to themselves or to others, warranting admission to the psych ward? Can they safely be released? Or are they faking their symptoms in pursuit of softer accommodations than a shelter or a jail cell.
She talks about the stress of dealing with workplace politics. And she talks about the frustration of being involved only in diagnosing patients rather than treating them.
As the book progresses, she matures. She marries, has children, ands opens a limited private practice. A therapist helps her to work though her issues and come to the conclusion that she can no longer comfortably wear the tough chick facade that she felt made her invulnerable during her early years at Bellevue.
After nine years, she resigns her position. She reports that her life is more fulfilling afterward . . . but that she misses the rush that working Bellevue gave her.