"In the KEYNOTE-100 (NCT02674061) study, Pembrolizumab was administered to two cohorts of patients with recurrent ovarian cancer: PD-L1 positive patients achieved better results than PD-L1 negative, in terms of median Overall Survival (24.0 months in cohort A, and 21.9 months in cohort B)."
— U.A. Matulonis et al. KEYNOTE-100

Bend and Scrape

Bourgeois sensibility remains the laughingstock of every 'Theory' from Psychoanalysis to Historical Materialism. (Such Theories, of course, frequently miss moments in which 'sensibility' has its revenge. . .) The bourgeois is naïve because, to him, the violence of the death squad, whose approach he never sees coming, surfaces from blue oblivion like a stroke. Though it seems what strikes him as truly incomprehensible about the death squad is its 'inefficiency.'

One imagines an alternative story in which our chief character, after years of pelvic pain and adnexal 'pressure,' presents to her primary care physician instead of Herr Doktor. When a biopsy shows she has the condition we're all worried about, she receives Keytruda because she saw an ad for it on television. The KEYNOTE-100 trial shows that, for an out-of pocket cost in the six-figure range, she could expect a median survival benefit of ~2 months. (Albeit, with such meagre results this appears not to have been adopted as standard-of-care for this condition.) The abstemious task of getting those funds together has its parallel in our chief character's low-cost late living in bombed-out Kyiv cooking up potato-peel pancakes. The death squad obliterates this careful calculus.

Savvier bourgeois medicine, with its practice of statistical optimization, promises an entire 'Quality-Adjusted-Life-Year' for a four-figure fee: statin therapy. The work of statins on atherosclerosis, that asypmtomatic disease, proceeds as if by an unconscious process. We are somewhat amused by how the 'better' medicine only achieves its ends imperceptibly, it bends and scrapes together a 'mortality benefit' only on the scale of a 'population.' One imagines our chief character safe at home, taking her statin QD, and there is no one in the world who can say for certain whether or not she will benefit from it. (The death squad also obliterates this act of dubious personal care.) Bourgeois medicine fulfils its promise to understand the physical body, serving up a refracted corpus, now a possession of 'Medicine' and out of (one's own) control. (This is a predicament for the Freudian analyst. The Historical Materialist says here: This is like those economic forces which, albeit totally 'in control,' are refracted into a death squad on the periphery of the economic body, but I suspect this is facile. This is more like the daily care that goes toward someone who doesn't appreciate it — Maybe there is a benefit, but who can say. . .)

Perhaps it's a semiotic stretch to link the auto-immunity of the expensive immune-checkpoint-inhibitor of marginal proven benefit (Pembro) to the semi-productive self-examination of our chief character's expensive psychoanalysis. (The adverse effect profile appears no less worrisome: "She dropped a tray of breakfast dishes one morning, between the kitchen and her aunt's bedroom, because she thought she heard Freud's thunderous voice, cursing her" (196).) Our chief character, who is introduced to Freud by the Wolf Man, has a significant analytic advantage compared to this famous case study, whose neurosis, Freud tells us, arises from his witnessing the 'Primal Scene.' The Wolf Man, though Freud once pronounced him cured, never escaped psychoanalysis in his lifetime. We think his relapsing condition is, in large part, due to there being nothing 'wrong' with his experiences, which were (remarkably) entirely conventional in retrospect. Our chief character's 'advantage' is that the scene she witnesses is slightly more 'problematic,' involving mother, aunt, and uncle. (This is a problem that can be 'worked through,' whereas the banal primal scene may not have ever been a 'problem.')

In fact, this situation appears to have more in common with the other medical condition under review in this essay: high cholesterol. It doesn't require an advanced degree to treat high cholesterol with a statin, neither is this case very taxing for an amateur Freudian who can point to an obvious culprit for our chief character's homo-eroticism and fear of male intimacy. Of course, our author, who is cleverer than this, has introduced an interesting complication — but this appears to be a mistake. The problem with 'Theory,' from Psychoanalysis to Historical Materialism, is that some of Theory's most compelling 'proofs' are precisely the obvious connections that even Bourgeois sensibility can suss out. The special explanatory power of Freudianism in this context proves itself in two moments of anagnorisis which, ironically, do not require Freudianism at all. The drawing-room Bourgeois already knows, in that moment of tactful foreclosure, that our chief character was sexually assaulted in the course of her childhood abduction. Like any bourgeois medical practitioner, he also knows that chronic pelvic pain adumbrates a story of violation. (It's a trick of storytelling that, this time, the routine course of events is reversed.) (The equivalent 'proof' for Historical Materialism is Bourdieu's sociological analysis that 'Distinctive Taste' is merely a mechanism for exclusion of the lower classes, which, after a moment's thought, any Bourgeois will tell you, "Of course!")

I suspect this novel belongs to the (somewhat dubious) genre of 'prize-winning fiction' because, in addition a pretty-good chapter in verse, it communicates a commitment to a project of 'Liberal Humanism' in the face of the Holocaust. However, as we have shown above, one problem for Holocaust literature is that this message may be undermined by excessive emphasis. We don't need Liberal Humanism to sympathize with our chief character, whose diverse talent, traumatic history, and tragic love are fitting qualities for a Heroine in the Wagnerian opera she herself may have sung. The attempt at transsubstantiation of our chief character with the slum-dwellers rounding-up around her, doesn't overcome this problem, "Though most of them had never lived outside the Podol slum, their lives and histories were as rich and complex as Lisa Erdman-Bernstein's. If Sigmund Freud had been listening and taking notes from the time of Adam, he would still not have fully explored even a single group, even a single person" (250). Because we have sympatized so much with Lisa, in the end it becomes impossible to understand the event from the 'right' perspective. Either we attribute to the crowd all Lisa's "rich and complex" histories, in which case even Bourgeois sensibility can recognize good upbringing, or we skip this attempt at attribution, and they remain as uknowable to us as they did before. So we have perhaps read an excellent drawing-room novel about a remarkable lady (Summers in Baden-Baden! Bourgeois sensibility is always having the last laugh,) but not what one would call a 'serious' work of 'Holocaust literature.' The project of Liberal Humanism, if we credit it with continued existence, would be the attempt to see the untermensch through the eyes of the Nazi, and yet to not have lost the capacity to bend and scrape. ( )

Sigmund Freud attempts to treat a woman suffering from hallucinations that set explicit sexual acts in the foreground while mass death events are occurring in the background (drowning, fire, falling, buried alive). Getting into this novel is a bit of an uphill climb, since it's front-loaded with the hallucinations part but, on the far side of that, Sigmund goes to work as he tries to rationalize what's been shared, looking for the symbols he can tie into his patient's life and history.

There's a bit of a trick going on here, first hinted at and then increasingly evident (if you know your history, or you've just been reading the LT tags). The rising tension is mostly due to predicting what's coming rather than the plotting, although the hallucination element adds some ominousness. Its climax includes the most gut-wrenching description of this particular scene I've ever read, although I understand Thomas has Anatoly Kuznetsov to thank for its power. The final section ends on a mercifully happier note, the only one available. ( )

This is a tough book. Partly, it is the 'post-modern' style of the narrative, wherein actual events and non-fictional material is interlaced within the writing. Partly, it is the intense sexual fantasy in the (supposed) sessions between the main character and Freud that might put people off, and the knowledge we have of the doom awaiting those who lived between the wars of the 20th century. Or it might have been the iterative views of what is portrayed, each one changing the one before like a psychological Rashamon. How can we trust the narrator? How can we trust the portrayal of Freud, just reaching his ideas about the connection between love and the death wish?

And all along there is love, in various forms, and death, natural and otherwise. Ultimately, we follow the main character all the way from trauma and pain and love to barbarous death, and something more.

An excellent novel for those open to its method and frankness. ( )

Ha!
This book. This book... I gave this to a girl who became my wife for 12 years...
At the time I had not read the book, nor knew what the book was about at all.
I did not find out that I won the girl due to the sexual fantasy until half a dozen years later. . . ( )

Harold at Twice-Told raved about this novel, but it was Emir Kusturica's interets in bringing it to the screen which inspired my reading. I felt it contrived and flat, though the premise is engaging: the prescience of hysteria. The bits that Thomas stole are the best in the book: shame on you, Donald. ( )