book review: Hesitation Wounds

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Hesitation Wounds by Amy Koppelman. The Overlook Press| November 2015| 192 pages| $25.95| ISBN: 9781468312188

RATING: ****/5*

Well-written novels about mental illness are few and far between. There’s Prozac Nation by Elizabeth Wurtzel and the classic The Bell Jar by Sylvia Plath. Many write memoirs. My favorite is Darkness Visible by William Styron. I met author Amy Koppelman through Twitter, an excellent source for connecting with authors. She sent me her novel Hesitation Wounds. I figured I’d be a strong match because I have depression and anxiety.

In Hesitation Wounds, a psychiatrist specializes in treatment-resistant depression. Sometimes meds just don’t work. When you’ve tried seemingly every medication and treatment plan with zero symptomatic relief, what can you do? You face despair and uncertainty. Dr. Susanna Seliger becomes the last resort for many troubled people. Of her practice: “When the MAOIs, TCAs, TeCAs, SNRIs, and SSRIs fail to get results, the patients are sent to me. And I zap ‘em. Or that’s what the movies would have you think. Electroconvulsive therapy (ECT), or, as it’s better known, shock treatment, is only shocking in that it doesn’t actually cause much, if any, physical pain. A patient’s emotional pain is an entirely different story.”

She makes every effort to avoid emotional attachment or involvement in how her patients feel but instead treats their symptoms. She maintains a professional detachment. She’s not there to talk and empathize. Dr. Seliger’s brother died and she feels quite a bit of guilt that she couldn’t save him. Koppelman elaborates: “You eternally seventeen. I try to figure out still. What I missed. Words I let pass, smells I didn’t recognize, unfamiliar tastes and sounds. Each an opportunity I failed to seize. Each a possibility to save you. Although now, so many years, so many patients later, I am aware that treatment is not without consequence, death without promise, visions without meaning. And handholding is merely that.” She now tries to save others from suicide. When a patient she allowed to break the emotional barrier [maybe he reminded her of her brother] commits suicide it throws Dr. Seliger into a spiral where she contemplates the relationship with her mentally ill brother and any warning signs she missed. Could she have stopped him?

“You can’t possibly know this because depression is an insidious disease. Robbing you of forethought, it makes you a reactive participant. Witnessing the world through the distorted prism of carnival glass leaves you feeling betrayed. The cruel nature of beauty. The unremitting groan of loss. You close your eyes and see him, cover your ears and hear. But that doesn’t excuse your actions. You should have said goodbye, Dan. Or at the very least let me know you had to go.”

Mental illness and its aftermath aren’t blatantly glamorized on these pages. The words remain open to interpretation. Dr. Seliger questions her profession and her past by allowing thoughts and feelings to gush upon the pages. Grief engulfs herself and leaves her in a quagmire of uncertainty and despair. And as readers we can feel it though we’re helpless just as Dr. Seliger remains somewhat helpless. She must come to terms with it in her own time and through her own distinct process. That’s the beauty of Koppelman’s rather poetic, journal-style writing. At times passages read as an open letter to Seliger’s dead brother. In order to understand herself she must splinter both her heart and her orderly thought process. Dr. Seliger must no longer resist what’s been holding her back from living freely with a level of contentment. That’s the trickiness with mental illness. It’s an up and down process for those who suffer with it and those who love those who live with it daily. This short novel packs a strong punch with lovely turns of phrase. Just like mental illness clear-cut solutions and fairytale endings do not exist. Managing the moment does. The mind remains a malleable work-in-progress. Koppelman writes with heartbreaking authority on the topic. It’s quietly effective, nuanced and moving.

Sarah Silverman earned a SAG nomination for her portrayal in the film adaptation for Koppelman’s second novel I Smile Back released this fall. I highly recommend the film. Silverman brilliantly depicts a woman struggling with her mental illness while raising her two children. One minute she’s packing school lunches, the next she’s snorting cocaine or crying on the floor. Honest and intense, it’s a must-see

–review by Amy Steele

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