‘The Good Father’ by Noah Hawley

I recently read The Good Father by Noah Hawley, a book that attracted me because of its focus on parenting and personality development.  The eponymous good father, Dr Paul Allen, is a rheumatologist whose son, Daniel, is accused of murdering a presidential candidate. As a child, Daniel’s parents divorced, and his father moved to another city and started another family: his presence in Daniel’s life was largely distant and sporadic. The novel deals with how this father tries to defend his son and find out the truth about what happened, while he also deals with his own guilt and sense of responsibility for the trajectory Daniel’s life has taken.

Like other books before it, perhaps most obviously ‘We Need to Talk About Kevin’ by Lionel Shriver, this premise brings the nature-nurture debate to light: are our characters born or made? How important is parenting when it comes to personality development, particularly if that personality is deemed to be disordered, or even criminal? Is a very common occurrence, such as parental separation, enough to make someone commit a crime when thousands of other people who experience the same event do not become criminals? These are the questions that the book wrestles with.

I find in my own work as a psychiatrist that there is an emphasis on motherhood and parenting. There are good reasons for this: mothers are usually the primary caregivers and attachment figures for children, and there is good evidence that maternal mental health has a profound effect on a child’s mental health and security. When a child is taken to see me, it is usually the mother who brings the child along, while the father is often at work. However, I always try to meet the father too as whatever their role, they are a huge part of a child’s life too. When I talk with young people, they talk about their fathers as much as they talk about their mothers, and sometimes it is the fact that fathers aren’t as present as they could be that preoccupies young people – and this is one of the central issues of Hawley’s The Good Father.

While reading the book, I found myself wondering what I would do – as a mother – in this situation. I wondered whether men and women, fathers and mothers, deal with stress and grief differently. We traditionally expect men to externalise their emotions, to need to do something, whereas women tend to internalise more, although these stereotypes are not necessarily true. This novel is interesting because it does focus on the role and emotions of a father: Daniel’s mother plays only a very small role in the book. While Dr Allen does experience many strong emotions, including guilt and denial, he also uses his usual coping mechanisms of intellectualisation and logic – useful in his medical role – to avoid dealing with his true emotional journey as he tries to find out what happened to his son. This is mirrored for the reader by some short chapters which are quite factual with little emotional content. We do however start to see more of the emotional impact on Dr Allen as he has to accept that there is a limit to what he can control, and it is at this point that the book really captured me and was genuinely moving.

I have written before about Donald Winnicot’s concept of the ‘good enough mother‘, a well known concept in psychology. Mothers do not have to perfect, they just have to be good enough at giving their child what he needs, and recognising that this changes over time. At some point, a mother has to stand back and allow their child to become independent, make choices, and learn from the consequences of them. I wonder if this theory is what Hawley had in mind when he chose to call his book The Good Father. Ultimately, Dr Allen is not so much concerned with whether he has been good enough, but in a much more black and white way, whether is he a good father. By inference, if he is not good, then he must have been bad. In the same way, Daniel must be either good or bad. This is what keeps the reader interested: will this father be able to reconcile with himself and accept doubt and shades of grey? Will we find out the truth about whether his son was good or bad? Or is he, like most people, somewhere in between?

You can find out more about the author at www.noahhawley.com

*This book was an Advance Reading Copy provided by Random House/DoubleDay (US publisher). The book is published in Australia by Hodder & Stoughton

Let’s stop splitting midwives and obstetricians…

I’m pretty fed up with reading stories in the papers from those who are either pro-midwife or anti-midwife, and as a result, anti-obstertrician or pro-obstetrician. When I wrote an article recently for Mamamia.com.au, I was shocked at the amount of comments it received, many of which were telling tales about ‘horrible midwives’, and others hitting back at these comments. Some were downright nasty, and others accused me of making up the story. Yes, my article talked about a particular interaction I had with a particular midwife whose views I didn’t agree with, but that wasn’t the point of writing it.

Recently, there has been huge debate in the media about homebirths, fuelled perhaps by the tragic death of a mother in Victoria while birthing at home (reported here in The Age) and Danni Minogue’s failed home birth (which required her to be transferred to hospital – reported here).

Recent laws passed here in Western Australia regarding recognition of the unborn baby as a legal life led to statements from the WA Australian Medical Association (WA AMA)* calling for the criminalisation of mothers who insist on a home birth despite prior knowledge of pregnancy complications (reported here). This week, there was a story highlighting the lack of obstetricians available in Western Australia and suggesting that more GPs (as well as midwives and specialists) need to be trained to help cope with the growing number of births each year. This led to letters in the papers suggesting that we don’t need more doctors, just midwives…you get the idea.

The two camps seem to be divided by their philosophy of birthing as either a ‘natural’ event or a ‘medical’ event. Those who feel it is ‘natural’ blame the medicalisation of birth for causing more intervention and resulting physical and emotional trauma.

The only thing that this polarisation does is risk alienating mothers, who are often confused and vulnerable about such a major life event as having a baby, and make them feel that they have to choose between the options and wave their flag firmly in one camp. It also splits staff in both the public and private health care sectors, causing overt and covert tension between ‘nurses’ and ‘doctors’ rather than encouraging cohesive team work and coordinated care for patients.

I am a doctor and of course recognise the value of medical intervention in pregnancy. Personally I would not choose to have a home birth, but I do not believe in unnecessary medical intervention either. I have had obstetric-led care for my three pregnancies, and have been very happy with it. However, I also see a midwife at every antenatal appointment, and my two labours so far have been largely managed by fantastic midwives. I have also had potentially serious medical complications which have required medical input, but have every confidence that even if I hadn’t chosen to be managed by an obstetrician, I would have been referred to one by my midwife when the complications became known.

Perhaps it is because I am medically trained that I believe that while childbirth is natural, it was previously a major cause of morbidity and mortality of newborns and mothers, and still is in many developing countries. In 2010, Australia had a maternal mortality rate of 5.1 deaths per 100000 live births, but the rate in Afghanistan was 1575.1/100000 and Malawi 1140.1/100000 (reference here). Our access to good, integrated midwifery and medical care makes childbirth as safe as it can be.

We need — and have — great midwives and great doctors who all work towards making our pregnancies and births as safe and enjoyable as possible. Let’s stop asking people to choose and be grateful that we have such easy access to both.

*While I have been a member of AMA WA, this statement does not represent my views.

Me on mamamia….

I had an article published today on mamamia.com.au – you can read it here.

I wrote the post not long after my first child was born – over two years ago now, and finally submitted it a few months ago to mamamia. It’s essentially the story of an experience I had on one night in hospital after my daughter was born, and my feelings of powerlessness after an interaction with one particular night nurse. It’s been really interesting reading the comments on the article, particulalry to hear about others’ experiences – good and bad. I do want to point out that I am definitely not ‘anti’ hospitals or ‘anti’ midwives at all, but rather I wanted to share one experience that I had to highlight how hard it can be to ‘speak up’ and follow your instincts when you are exhausted and vulnerable.

I have had lots of positive experiences too and with my second child, my experience was far better. The midwives caring for me at the moment with my third pregnancy are great and I am having my third child in a hospital too. With each child though, I am of course more experienced and secure with my plans and choices.

Do feel free to comment – it’s an important area to discuss I think…

 

 

Highlights of the Perth Writers Festival

I have just spent a lovely weekend at the Perth Writers Festival, which was held on the grounds of the University of Western Australia, a great spot. I’ve only ever been to the odd event here and there at writers’ festivals, but this time I went for the whole three days. There was a great mix of sessions from emerging and established authors, as well as some more thought provoking and ‘political’ sessions on religion, food and ethics.

The writing sessions I enjoyed most came courtesy of writers Rohan Wilson, Favel Parret, Janette Turner Hospital, Craig Sherbourne, Craig Silvey, Jo Nesbo, Johan Harstad, Charlotte Wood, John Birmingham, Eliot Perlman and Cate Kennedy.

I also went a particularly harrowing session by Nigel Brennan, a photojournalist who was kidnapped in Somalia, and a more delightful and hunger-inducing session on good food by Matthew Evans

The only down sides? The 15 minute wait for coffees, and the very rare Perth rainshower during Women of Letters which meant a move from the beautiful outdoor venue to a tent! And of course the amount of money I spent on a huge pile of new books…

If you went along, I’d love to hear your thoughts…

Now they say that exclusive breastfeeding for 6 months is NOT recommended…

I have just read this article in the Guardian and sighed when I read it. It refers to an article published a couple of weeks ago in the British Medical Journal (here is the article, but it requires a subscription/payment to read it all) where a research group (Fewtrell et al) questioned the policy in the UK to recommend exclusive breastfeeding of infants for six months. Just to be clear, exclusive breastfeeding means that for the first six months, an infant is given breast milk only: no solids, no formula, just breastmilk.

This follows the WHO guidelines, and the Australian government recommends the same. I should emphasise that the researchers are not recommending formula over breastmilk, and they are talking about the introduction of solid food, not formula.

What are they worried about? Well, the researchers are worried about links between late introduction of solids and iron deficiency, a potential increase in food allergies, and of coeliac disease.

I’m sure that this is going to confuse mothers even more. Any new mum knows that they are bombarded with a huge amount of advice from friends, families, and experts. I know that when I had my first child, I spent a lot of time consulting baby books and the internet for every little thing. But with my second child, I didn’t have the time, or inclination, and used a much more intuitive style of parenting.

I didn’t manage to exclusively breastfeed for six months, despite knowing that it was recommended, and despite having every intention to do so. My first child started solids at about five months, but my second was grabbing food from my plate at four months and I knew she needed more than breastmilk. I didn’t believe that something magical happened at six months of age that was missing at five and a half months, and so I did what I thought was best for my children – which is what mothers have been doing forever.

I’m curious about how many mums do actually manage to breastfeed exclusively for six months. I am very pro-breastfeeding, and had every intention of doing so, but for us, it didn’t work out and I did start solid food earlier (even though I continued breastfeeding for about a year with them both).

Did you manage?

Doctors and writing: stranger than fiction?

I’ve had an article published today in the Medical Journal of Australia called Doctors and writing: stranger than fiction? It’s available here on eMJA, but it does have a paywall so is only for subscribers unfortunately. It’s in the paper version too which may be more readily accessible, especially to those of you in the medical field.

It’s been quiet here otherwise, but I should be more active soon. I’ve been trying to write the first draft of my second novel, and also been busy organising a new website which will be coming soon. On top of that, I’ve been a bit sick as I’m pregnant with my third child! I’ll post details of the new website when it’s available.

Doctors who…

I’ve recently come across a website that may be of interest to both medics and writers. It’s called ‘Doctors Who…’ and is an initiative of Varuna, The Writers’ House in the Blue Mountains of NSW. You can see the ‘Doctors Who’ website here.

Varuna, the house, was previously owned by writers Eleanor Dark and Dr Eric Dark, a medical practitioner, hence Varuna’s interest in the link between medicine and writing – an area that I too am very interested in.

I found out about this website through a post on Twitter announcing a creative writing competition for medical students and doctors hosted by the MJA and Varuna. You can read more about this competition here, but if you want to enter, be quick as the closing date is soon. I’ve sent an entry in, even though short stories are not usually my strongest form of writing, but I need to keep sending my work out there.

There are links on the ‘Doctors Who…’ website to doctors who combine their medical work with other interests including advocacy, creativity, innovation and creativity. There are some big name writers on there, including Peter Goldsworthy and Nick Earls – worth a look.