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Review of "Against Medical Advice"

By James Patterson and Hal Friedman
Hachette Audio, 2008
Review by Christian Perring on May 19th 2009
Against Medical Advice

This non-fiction book tells the story of Cory Friedman, a boy with Tourette syndrome.   It is written by his father Hal and James Patterson, but bizarrely they make Cory the narrator, talking about his personal thoughts and feelings.  They authors say that they based the book on medical diaries kept by Cory's mother and Cory's recollections.  However, there's a big difference between writing one's own story and confirming the accuracy of someone else's account.  The writing is fluent, and reads like a narrator in a James Patterson novel; so it is eminently readable, but it does not make the story believable.  Listening to the book, one gets a strong sense of the authors making up the story, with drama and pathos being the main goals.  The feeling of fiction is increased by the publisher's promotion of the book.  On the front of the box containing the audiobook CDs is written "One family's struggle with an agonizing medical mystery," and James Patterson's website has a headline of "one family's struggle with a tormenting medical mystery," and Hal Friedman's website says the book is "the remarkable story of my son's 15 year battle with a number of medical mysteries," but there is no mystery: Cory has Tourette's and Obsessive Compulsive Disorder, which are diagnosed when he his is a young boy.  The publisher website describes the book as "the true story of Cory and his family's decades-long battle for survival in the face of extraordinary difficulties and a maddening medical establishment."  However, the book covers 13 years and the book gives the impression that Cory's doctors did what they could to help him, although his parents come to suspect that the medications he was prescribed made his problems worse.  Then there's the title of the book, "Against Medical Advice," which implies that the Friedman's took a strong stance against the stance of the medical establishment.  However, they didn't: the whole book is a tale of them getting and taking the advice of medical experts.  The only time they go against medical advice is in the opening scene of the book, where Cory visits a juvenile psychiatric ward for his drinking problems, gets admitted, and freaks out.  His parents work out that the only way to get him out immediately is to discharge him against medical advice, which they do.  But there is no strong anti-medical theme in the book.  The combination of all these distortions make it especially hard to trust the framing of the story.

The basic facts of Cory's medical history are simple enough.  When he was about 5 he started to physical tics and urges to say and do inappropriate things, together with some irrational fears.  Although he is first diagnosed with ADHD, he does not react well to Ritalin and soon he gets a diagnosis of Tourette's.  He is put on many medications including antidepressants, mood stabilizers, tranquilizers, antipsychotics, and more.  None of them work very well, but his doctors pursue the pharmaceutical approach nevertheless.  Yet the drugs had many side effects, especially in making Cory put on weight.  His life is difficult throughout his school career because he is different and strange.  By the time he is a teenager, he has made some friends, but mostly with other outcasts with problematic behavior.  They are not necessarily the best influence on Cory, and by the time he is a sophomore, he is addicted to cigarettes and he is drinking on a regular basis.  He gets into physical fights with his so-called friends and is extremely unhappy.  After falling asleep in his room while drunk and still holding a lighted cigarette, he nearly causes a major fire.  It is at this point that his parents take him to the psychiatric ward to deal with his drinking problem, but he refuses to stay, and they don't want to force him.  So they end up sending him off to a boot camp for trouble teens, which works amazingly well.  After that he goes to a specialized treatment center for people with OCD, where he is taught some relaxation techniques, and they help him control his behavior.  Finally he goes to an intensive prep school, but he hates it there and leaves after a month.  After some struggle with his high school, he is able to return and he does well.  His symptoms start to reduce, and it seems that he is one of the lucky individuals whose childhood disorder reduces or even disappears as he enters adulthood. 

The story certainly fits well with the pattern that has become apparent in the treatment of many other serious childhood mental disorders in the USA, with doctors being too quick to use medication, and indeed many different powerful medications at the same time, when there's no strong evidence that those medications are effective for children.  Yet the book spends no time discussing the state of knowledge about the effectiveness of the drugs in the treatment of Tourette's and OCD in children, and Hal Friedman gives no justification for his claim at the end of the book that the drugs that Cory was prescribed made his problems worse. 

So the reader is left with a story of personal struggle.  It is well told, yet the authors do not make Cory a very likable narrator.  No doubt it is terrible to have to fight the urges to say inappropriate things, to grab the steering wheel of a car when you are a passenger, and for your body to make you spasm and jerk in bizarre ways much of the time, especially when you have people around you reacting to you as if you were a monster.  But Cory repeatedly endangers himself and his family, and does not cope well with his problems, and it can be very difficult to sympathize with someone who has a substance abuse problem and is presenting a danger to others.  Furthermore, the opening scene in which he insists he does not belong in a psychiatric ward because he is not crazy makes him extremely unappealing -- he show a profound lack of sympathy and understanding for other people with mental illnesses.  The authors, by uncritically highlighting this scene, implicitly endorse his stigmatizing attitudes.  Yet the whole justification of this memoir is that it is meant to help people with Tourette's and OCD, presumably by helping people to understand how difficult it is to live with those conditions. 

For these reasons and more, Against Medical Advice is a problematic memoir.  Yet readers at Amazon.com mostly like it, and the fact that it is co-authored by James Patterson means that it is likely to get more readers than most memoirs of mental illness.  It is likely to be read by people who don't know much about Tourette's or OCD, and so it could be educational and may make people more sensitive to the pain that comes with stigmatized conditions. 

The unabridged audiobook is performed by Kevin Collins, who does a good job of keeping the energy level up and giving different characters distinctive voices.


© 2009 Christian Perring

Christian Perring, Associate Professor of Philosophy, Dowling College, New York.