Little Earthquakes

March 1, 2023
A clinical psychologist moves through the stages of trauma recovery to make sense of her cancer diagnosis. In the third trimester of her second pregnancy, at age 36, Mandel was diagnosed with metastatic breast cancer. In her debut book, she builds on the trauma narrative therapy she undertook following her against-all-odds recovery. The first section is a relatively linear account of her diagnosis, metastasis, labor and delivery, and treatment and success. Across the remaining sections, Mandel positions a literary microscope over certain inflection points, including the symbolic complexity of cancer in the breasts, the management of chemotherapy's harsh side effects, the guilt of survival, and how her near death has affected her roles as wife, mother, daughter, and therapist. Throughout, her clinical background and specialty in trauma therapy shape her personal memoir into a sort of motivational tale for others working to understand and move past trauma. She offers insights about the adaptive nature of fear, pain, the desire for control, and the instinct to emotionally detach, and she discusses the benefits of practices like mindfulness and yoga. Both her recovery and her access to resources--financial, informational, medical, and human--make Mandel an outlier (privileges that she acknowledges), and a deeper probing of the depression that spurred her to narrative therapy is veiled by a consistent, sometimes grating note of optimism and triumph. Still, in attempting to find order and meaning in her own experiences of frailty and frustration, the author provides a salient example of how to untangle isolated traumatic events from ongoing suffering and worries. By the end, the validation and empowerment that she seeks jump from the page even as her narrative reaches the period of pandemic shutdown. Mandel includes a guide to narrative therapy and a list of resources for readers seeking further help. Sometimes overly rosy but nevertheless an encouraging story of trauma and how it affects one's understanding of self.

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March 20, 2023
Psychologist Mandel debuts with a bruising chronicle of her experiences with cancer. During her second pregnancy, 36-year-old Mandel was diagnosed with stage IV breast cancer, which has a mortality rate of 73% within five years. Immediately after giving birth, Mandel embarked on a course of immunotherapy and chemotherapy that she describes in unflinching detail (“I felt my throat close. I couldn’t breathe. I tried to speak but was only able to force out a tiny, suppressed grunt”). At first, Mandel was the rare patient to achieve “no evidence of disease” status within three months, but she struggled to believe her remission would last. Indeed, several years after the breast cancer cleared, Mandel received a brain cancer diagnosis, but resolved that “perhaps I’m in denial, but I’ve landed on the notion that I was a statistical outlier in the past, and there’s no reason to think I won’t be an outlier once again.” The author nimbly portrays the cocktail of emotions unearthed by the sentence “You’ve got cancer,” and paints her supportive family with staggering compassion. Her dogged fight for her life will awe readers.

Starred review from March 15, 2023
Clinical psychologist Mandel recounts learning, during the third trimester of her second pregnancy, that she had stage IV breast cancer. It was a shock. She had thought the little lump was just a clogged milk duct. Miraculously, after treatment, she seemed to be OK. Sure, she lost her long, blonde tresses. And yes, she experienced chemo-induced menopause. But it seemed possible that she and her husband, Derek, might get to live happily ever after with their newborn, Siena, and their four-year-old, Sophie. In the epilogue of her uplifting recovery story, she reveals that she is struggling now with tumors in her brain. Still, she remains remarkably upbeat, perhaps because she is a therapist who helps trauma survivors heal and recover. She also openly shares her feelings of insecurity, admitting, for example, to being upset one day when she sees some beautiful young women with long hair. She and her husband understandably struggle, but they stand by each other, and through mutual dedication and hard work in couples therapy, they relearn how to love each other. Couples dealing with cancer, or any other major setback, will find comfort in Mandel's beautifully written, moving memoir.

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