THE END OF MIRACLES

Dr. Monica Starkman is a psychiatrist who is a faculty member of the University of Michigan Medical School Department of Psychiatry in Ann Arbor, Michigan. She is a clinician and a scientific researcher. Many of her publications in the scientific literature highlight concerns and conditions of women, such as the first study of women’s reactions to the use of fetal monitoring during labor. She has served on the editorial board of the Journal of Psychosomatic Obstetrics and Gynecology. She is a recognized expert on the effects of stress hormones on mood and on brain structure. Dr. Starkman has also published in The New Republic and Vogue magazine. Dr. Starkman writes regularly for Psychology Today as one of their Experts.

“Starkman, a prominent psychiatrist, beautifully captures one woman’s journey through depression in this superbly well-written and gripping first novel, which powerfully reveals the complexity and strength of the human mind.”—Booklist

“For Margo Kerber, the novel’s stoic and sensitive protagonist, the path to motherhood has been troubled from the start. An unexpectedly joyful pregnancy (is) followed by a miscarriage. Afterward, when Margo’s body produces false pregnancy symptoms and cruelly tricks her again, it is clear that she’s been driven to a breaking point. Margo’s collapse, unraveling, and gradual recovery bring a conclusion of forgiveness and hope. Best of all is Starkman’s portrait of Margo―a flawed yet admirably strong victim of circumstance and biology who refuses to be a victim anymore.”—Foreword Reviews

“A powerful and emotionally gripping novel by one of the great psychosomatic medicine psychiatrists of our time. Highly recommended for all those fascinated by psychiatric illness, treatment, and the impact relationships can have on healing.”—Michelle Riba, M.D., M.S., Past President of American Psychiatric Association

1. The first chapter of The End of Miracles contains content that foreshadows and lays a basis for what is to come. What clues do you see there?

 2. How did you react to Margo and Steven as people after reading the first chapter? 

3. Margo has a strong capacity for imaginative fantasy. In what ways do events and fantasies from Margo’s childhood affect her feelings and behavior in the present? 

4. What do you think are the strengths and weaknesses of having such a capacity?

5. Work is an environment where a person’s personality  affects their behavior. In turn, the milieu of the workplace can affect a person’s behavior and the opportunity for personal growth. How did Margo’s personality and her work environment intersect? Did how she experienced herself in the work environment play any part in her reaction to her miscarriage?

6. Margo has an important relationship with Janie, the developmentally challenged young woman. What do we learn about Margo from this relationship?

7. Margo is hospitalized twice on a psychiatry inpatient unit.  Her experience is different each time.  Why do you think that might be?  How do the descriptions of the unit compare to what you imagined a psychiatric unit was like?

8. How did you react when you read the pages about Margo’s impulsive behavior with the baby? Did your feelings about Margo change?

9. Dr. Taynor tells Margo that she didn’t just want a baby, that she needed a baby. What do you think Margo might start thinking about after Dr. Taynor’s comment?

10. Does Steven change over the course of the novel? Does the relationship between Margo and Steven change over the course of time? If so, in what ways?

11. How did you feel about Margo and Steven as people after you finished reading the book?

12. Did you feel satisfied by the ending of the novel?

13. What do you think about Renee Lamarato’s reactions, initially and over time?

14.  Margo and Kate have a strong friendship. In addition to companionship, what else does Kate’s friendship provide Margo?  What do our best/good friends provide for us in addition to their companionship?

15. The novel shows the kind of challenges faced by a chief prosecutor. Did you learn something about the criminal justice system? Did the outcome challenge your own thinking about right and wrong and taking circumstances into account? If so, in what ways?

16. Women (and men) who have had pregnancy loss suffer deeply. The grief is deep, intense and long-lasting. Most feel it throughout their lives. They hope other people will understand this. Did The End of Miracles help give you a better sense of this?

17. People have said that The End of Miracles is very vivid, and that the reader has the sense of ‘being there’. If you agree, what did the author do in the writing and with the language that made it real to you?

18. What sections of the book were most engrossing to you? Moved you the most?  Elicited your curiosity the most?  Could have been eliminated?  Needed to be developed more?

19. Did the novel stimulate you to think about your own feelings about being a woman? Bearing a child? Your vulnerabilities?  Your strengths? Something else?

20. What do you think of Dr. Taynor’s clinical skills? Is she a person you would like as a psychiatrist or therapist for yourself or a family member if one were needed? What qualities/skills seem to you most necessary in a psychiatrist or psychotherapist?

21. The End of Miracles shows psychiatry and psychiatrists behind the scenes. Did it help increase your understanding of how they think, evaluate, and treat?

22. Many previous novels have portrayed psychiatrists as either idiots or evil. (One recent example is the evil Dr. Teleborian in The Girl Who Kicked the Hornets’ Nest.)  Do you have any ideas as to why this might be?

23. There is a lot of social stigma around mental illness, so it is often kept hidden and not talked about. Did The End of Miracles succeed in portraying the inner life of a person with mental illness? Do you the book might help reduce social stigma?