The Final Exam

Daniel Mason is a Clinical Assistant Professor of Psychiatry, with research interests in the subjective experience of mental illness, the use of the humanities in treatment, and the influence of literature, history, and culture on modern medical practice. He received his B.A. in Biology from Harvard in 1998, and his M.D. from UCSF in 2004. A fiction writer, he is the author The Piano Tuner, The Winter Soldier, and the forthcoming A Registry of My Passage Upon the Earth, due out on May 5th.

Dr. Mason teaches a course at Stanford, PSYC 82: The Literature of Psychosis, which is described in the catalog as follows:

One of the great gifts of literature is its ability to give us insight into the internal worlds of others. This is particularly true of that state clinicians call “psychosis.” But psychosis is a complex concept. It can be terrifying and devastating for patients and families, and yet shares characteristics with other, less pathological states, such as mysticism and creativity. How then can we begin to make sense of it? In this course, we will examine the first-hand experience of psychosis. We will approach it from multiple perspectives, including clinical descriptions, works of art, and texts by writers ranging from Shakespeare, to the science fiction writer Philip K. Dick, to patients attempting to describe their experience. This class is not only for students thinking of careers in medicine, psychology or anthropology, but also readers and writers interested exploring extraordinary texts. There are no prerequisites necessary; all that is needed is a love of language and a curiosity about the secrets of other minds.

An essay titled The Final Exam, penned by Dr. Mason, appeared in this Sunday’s New York Times Book Review.  The timing of its publication coincides nicely with Earth Day last week, and the forthcoming release of his new book.  I trust you will find these excerpts from Dr. Mason’s essay as touching as I did.

“Back in January, at Stanford University, where I teach and practice psychiatry, I showed my students a slide of an oak tree from the edge of campus.  At first the photo seemed out of place. The course, ‘PSYC82: The Literature of Psychosis,’ is about the portrayal of psychosis in memoir and fiction, art and film; the lecture that day was a survey of psychiatric history. But there is growing evidence linking green space to mental well-being, and I have become increasingly concerned for my students, who, studies show, are experiencing depression and anxiety at record rates. I wanted them to get outside. The winter had been mild, a new round of rains had just passed through, and the woods were beautiful.  In the three years I have taught this course, this was the first time I thought to show such photos. But as the quarter progressed, I found myself returning to images I had collected over weekend walks. Photos of bay laurels from the Stanford hills, of turkey tail fungi fanning over mossy logs, of gleaming slime molds and iridescent ferns.

We were reading Lu Xun’s “Diary of a Madman” when the first case of Covid-19 was reported in Washington State, Philip K. Dick’s “Ubik” when the first case of community transmission was reported in California. On March 2, with nine cases reported in Santa Clara County, I began to record lectures on “King Lear,” so students could watch from their dorm rooms. We had made it to Edgar’s soliloquy when face-to-face classes were canceled. Onto Zoom we went; I gave my final lecture in the silence of my living room.

Class, it seemed, was over. Students began to leave, first on their own, then on the university’s order. There remained only the matter of the exams. Almost immediately people began to whisper of the possibility that winter finals would be canceled. I hesitated. However trivial a final may seem in the context of world events, canceling one means far more than canceling a test. A final exam is more than just part of the key struggle to retain some kind of normality in the face of chaos. A final represents an opportunity to synthesize knowledge, to bring together readings and concepts from across the term. If one believes in the significance of one’s material, then this synthesis is a critical moment of a course.

And so first I made the examination optional, then open book; the date of the exam was postponed twice. It was hard not to feel that I was negotiating with the growing epidemic. And then, as student after student emailed, describing challenges returning home, I realized it was time to admit defeat.  As I wrote my letter to my students explaining the cancellation, I paused. It’s a large class, and during the week’s upheaval, I wondered where they had gone: the students who came laughing into class together, or sat quietly in back; who shared stories of their own struggles with mental illness; who turned in recorded songs for their assignments; who introduced me to books I had never read. So instead of ending class altogether, I gave them one last assignment: Go outside and take a photo of the natural world we had talked about so often, and share it with others in the class.

Over the next few days, the photos continued to flow in, nearly 100, from the Central Valley, Hawaii and Indonesia. There were familiar campus ginkgoes, cedars in Brooklyn, polypore mushrooms climbing a tree in Utah. The assignment was called — because on the spur of the moment I couldn’t think of anything else — “The World Around Us.” And that was what the students had built.

The deadline was Friday; as I write this, the most recent photo to arrive was of a Muscovy duck swimming in Pastoral Pond Park, Montgomery County, Texas. At the end of the day, this is more than an exercise in finding connection during a time of struggle. As many have noted, the causes and effects of this virus are intimately related to the health of the natural world. Zoonotic diseases like Covid-19 may be linked to increasing deforestation and the sale of wild animals. Lungs and hearts damaged by atmospheric pollution are more susceptible to severe illness. And the woods and outdoor spaces are providing respite for the millions of people who can no longer go to school or work.

It is worth remembering, as this story unfolds, that we are being sustained not only by the neighbors who bring groceries, and the teachers who learn how to manage a classroom of rowdy kindergartners on Zoom, and the doctors and nurses and hospital staff who are risking their lives for a country that can’t, or won’t, supply them with enough protective equipment, but also by the oaks and fritillaries, the gardens and copses of cottonwoods that are so critical to both our physical and mental well-being.”