Tag Archives: psychiatrist

Asylum: Patrick Mc Grath

“None of them noticed that she drifted through her days in a state of detachment and abstraction, functioning as she was expected to but not ever, totally there. None of them noticed but me. I was watching her.”

In Asylum, Patrick McGrath blurs the lines between those who treat mental illness and those who suffer from it. Perhaps, McGrath seems to argue, it’s even a matter of proximity…

Asylum is set at an institution for the criminally insane. It’s 1959 when psychiatrist Max Raphael, a dull, dispassionate, “reserved, rather melancholy” man brings his beautiful wife Stella, the daughter of a disgraced diplomat and his 10-year old son, Charlie from London to a walled asylum. Max is the new deputy superintendent, and the Raphaels take up residence in a large stone house just inside the walls. Max has his job and his patients to attend to, Charlie has school, but Stella doesn’t fit in with the other wives … what sort of life does she have within the confines of this “desolate” place?…

asylum

Stella is perhaps a trophy wife for Max, but they’re fundamentally mismatched. She’s bored, lonely, unhappy, sexually frustrated, and drinks too much. While the staff see the inmates as an entirely separate group of people, Stella, already alienated from the other hospital wives, resentful of the absolute power of the medical staff, doesn’t seem to be aware of a clear demarcation. Then she meets inmate Edgar Stark, an enigmatic artist who is restoring an old Victorian conservatory at the end of the Raphaels’ vegetable garden. Stark “functioned at a high level of intelligence,” but he’s subject to paranoid delusions, and years earlier, during a fit of violent rage, he murdered his wife, decapitated her and mutilated her head.

And if you think you know where this story is going, well you’re right. Even though she’s warned about Stark’s past, Stella heads straight for disaster.

The story is narrated, unreliably, by Dr. Peter Cleave, and we know through Cleave’s quiet, controlled narrative voice that something went horribly wrong with Stella. Interestingly, Cleave’s voice is so quiet, so controlled, that there are times when we forget that he is telling the story, and more importantly, that perhaps, just perhaps, he played a role in the events that took place.

The catastrophic love affair characterized by sexual obsession has been a professional interest of mine for many years now. Such relationships vary widely in duration and intensity but tend to pass through the same stages. Recognition. Identification. Assignation. Structure. Complication. And so on. Stella Raphael’s story is one of the saddest I know. A deeply frustrated woman, she suffered the predictable consequences of a long denial collapsing in the face of sudden overwhelming temptation. And she was a romantic. She translated her experience with Edgar Stark into the stuff of melodrama, she made of it a tale of outcast lovers braving the world’s contempt for the sake of a great passion.

The book isn’t simply the story of what takes place; it’s Dr. Peter Cleave’s narrative placed on top of past events. Here is a tale of illicit wild passion, of Stella growing increasingly out of control with the story told by Cleave’s  occasional, very occasional, clinical interpretation. It’s not that Cleave’s interpretation is incorrect, but it is inadequate, and just why his clinical interpretation of events is inadequate adds subtle psychological depths to the story. The way Cleave watches Stella and Stark echoes a behaviorist watching two rats in a laboratory–with one important difference; Cleave is not a disinterested observer, and hints of Cleave’s true feelings are buried deep in his narrative. He was opposed to Max’s employment at the asylum in the first place, and his decisions at vital points in the story bring his neutrality into question. It’s perfectly brilliant that Stella’s story should be told by an observer who is hardly disinterested. Edgar Stark, with his “restless, devious intelligence,” is Cleave’s pet patient, and Cleave, a sexually ambiguous character, is fascinated by Stella. There’s a section in the book when Stella and Stark have “urgent and primitive” sex on the ground. In the next paragraph, time has passed and Cleave questions Stella about her sex life with Stark. Interestingly, and hardly coincidentally, he says “I probed her gently,” a very telling, Freudian choice of words when he questions Stella to get the details. It’s a love triangle of sorts with all the physical passion between Stark and Stella, and Cleave a voyeuristic observer who holds limitless power at the asylum.

And that brings me to the book’s title: Asylum–a word that has more than one meaning–a place of refuge or an institution for the mentally ill. The ending packs a powerful punch with Cleave’s professional reasonableness teetering into creepy obsession.

Aslyum was made into a film. It’s well worth watching ( I just watched it for the second time), and although the plot is fundamentally the same in the book and the film, there are some differences. The book, as usual, is more complex and subtle. Peter Cleave is a much more invisible character in the book than in the film whereas Stella is much more off the rails.

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Little Black Lies: Sandra Block

I read out loud to them: ” ‘patient voices regret over her past actions. States she would like to visit Children’s Hospital, or become a Big Sister to help other children. Her dream is to become an elementary school teacher or social worker to help troubled kids, as she feels she was not helped.’ Is that not unbelievable? She’s acting like Mother Theresa, and he’s falling for it, hook, line, and sinker.”

Little Black Lies a first novel from neurologist Sandra Block introduces damaged psychiatry intern, Zoe Goldman. For regular readers of this blog, you already know that I have a fascination with books set in asylums/mental hospitals and plots either written by or featuring psychiatrists/therapists. Since Little Black Lies focuses on psychiatry resident Dr. Zoe Goldman who is assigned a patient newly transferred to her care, I was, naturally intrigued. Plus .. book two featuring Zoe Goldman : The Girl Without a Name has an ETA of 9/15 … sign me up.

little black liesThe plot takes place over just a few months, but reaches back into the shadowy past of the protagonist, damaged Zoe Goldman. Zoe who’s in the middle of a long-distance relationship with a Frenchman, works in the psychiatric ward of a hospital where she sees and treats many “frequent flyers:” those with the “usual circuit: emergency room, psych ward, rehab, streets, and repeat. A cycle destined to continue until interrupted by jail, death, or less likely, sobriety.”

The book begins with daily rounds and Zoe’s latest assignment, a ‘new’ patient– 36-year old, Sofia Vallano who’s been institutionalized since age 14 for the murder of her mother. After the closure of another hospital, Sofia has been transferred for “further treatment and evaluation,” and of course the underlying question is: can Sofia be released into society or does she still represent a danger to others? Compared to the other patients in the psych ward, Sofia seems much more controlled. There are no violent outbursts, she is on no medication, and, rather conveniently, she claims to remember absolutely nothing about the death of her mother.

And there is Sofia Vallano, perched on the bed, reading a magazine. I’m not sure what I expected. Some baleful creature with blood dripping from her eyeteeth maybe. But this is not what I see. Sofia Vallano is a stunning mix of colors: shiny black hair, royal blue eyes, and opera red lips. Something like Elizabeth Taylor in her middle years, curvaceous and unapologetically sexual. They say the devil comes well dressed.

Zoe juggles a number of personal problems with the demands of her professional life. While she performs well at work (in spite of constant friction from her boss) she really is a bit of a mess and takes three different medications: Adderall “So I keep my mouth shut most of the time,” Lexapro “So I don’t jump off the Peace Bridge,” and Xanax “So I can sleep.” Plus she’s in therapy. Zoe used to suffer from horrendous nightmares, and when those nightmares return, she begins to question her past. While holes rapidly develop in the constructed history of her childhood, Zoe hits a stumbling block when she tries to question her adoptive mother who now suffers from dementia.

The fragility of memory is a central theme of the book. On one hand there’s “model patient,” Sofia, who murdered her mother as a teenager, and now under Zoe’s supervision, she conveniently claims to remember a vital component to the crime. With Sofia’s imminent release on the table, Zoe isn’t buying Sofia’s sudden surge of memory or her professed desire to turn her life around. While trying to get to the bottom of Sofia’s story, in a parallel quest for the truth, whatever that truth may be, Zoe tries to uncover details about her own past–initially through therapy and then through some good, old fashioned detective work.

While I guessed the book’s central secret, this was an entertaining read that explores the ephemeral nature of memory. So much of our early memories become a construct for our adult selves, but what happens when that construction is fabricated? While Little Black Lies is an eminently readable book, complex therapy options including hypnosis, day residue and dream rehearsal enter the plot. Interesting secondary characters are included in Zoe’s support network: an adoptive brother and two workmates: idiom obsessed Thai Dr A. and Chinese-American Jason (the dialogue between Zoe and her fellow doctors is energetic and feels authentic) . If this is indeed the first in a new series, then it’s a good start. It’s going to be intriguing to see where the author takes her main character. Will she remain focused on hospitalized patients or will she branch out into her own practice? The subject matter offers a wide range of possibilities, and for therapy junkies (like me) Sandra Block’s Zoe Goldman promises an interesting new series.

Review copy

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Chance by Kem Nunn

The essential feature of a shared psychotic disorder (folie à deux) is a delusion that develops in an otherwise healthy individual who is involved in a close relationship with another person (sometimes termed the “inducer” or “the primary case”) who already has a psychotic disorder with prominent delusions and who, in general, is the dominant in the relationship and is thus able, over time to gradually impose the delusional system on the more passive and initially healthy individual.”

Regular readers of this blog know that I have an interest in fiction involving therapists–add that to noir and you’ve immediately got my attention, so when I read about Kem Nunn’s new book, Chance, I thought I’d probably like it. I was wrong, I didn’t like it; I loved it.

chanceEldon Chance is a middle-aged San-Francisco based forensic neuropsychiatrist, whose life, until just recently was going extremely well. Married for over 20 years to “aspiring photographer,” Diane, and the father of a teenage daughter, Nicole, his life seemed enviable. But Diane’s affair with “a dyslexic personal trainer ten years her junior,” has led to divorce proceedings. Their pricey home is up for sale, Nicole will no longer be able to attend her expensive private school, and Chance has moved into a tiny apartment, so tiny, it can’t house his expensive antique French furniture set which looks ridiculous jammed into its new surroundings. Things aren’t quite bad enough apparently … Chance receives a notice from the IRS that he owes over 200,000 in back taxes and fines.

Chance considers selling his fancy French furniture to a nearby antique shop he frequents. Problem is that because it lacks the brass metalwork, it’s not considered complete and he can only get 50-60 thousand for it. If the furniture had its original metalwork, however, the set would fetch around twice that according to antique shop owner Carl. Carl, however, employs a giant of man, an incredible craftsman named D (whose bald head sports a huge tattoo of a black widow spider), and according to Carl, D can replace the metalwork to Chance’s furniture so cleverly that no one will be able to tell the difference. With the metalwork intact, the furniture can be sold for top dollar.

Normally a very cautious person, Chance, pressured by necessity and now unmoored from the supports of his previously structured life, begins to make a series of bad decisions–one of those decisions being, of course, to sell the furniture with the newly attached metalwork crafted by D, and while that is fraudulent, Chance’s mistakes go further than that. We know he’s going to head for disaster from the way he thinks about the female patients who come his way. Bear in mind that he’s not dealing with mentally healthy women when he finds himself noting their attractiveness, their sexuality and possible availability. One of his patients is a substitute teacher named Jaclyn Blackstone who appears to suffer from a dissociative identity disorder. While Jaclyn is estranged from her violent, jealous husband, Oakland homicide detective, Raymond Blackstone, she claims that a second personality, “Jackie Black,” engages in rough sex with Blackstone. Dr. Chance finds himself attracted to this patient, but which one tweaks his interest: Jaclyn or Jackie?

Chance can dissect human psychological problems in a few sentences and produce neatly written reports that will appear as evidence in court cases, but as it turns out, he sucks at predicting human behaviour or avoiding disasters in his personal life. Involvement with the elusive Jaclyn combined with the threat of physical danger sends Chance to D, a disciple of Nietzsche, initially for advice, and then for assistance as Chance becomes increasingly drawn into the dark secrets of Jaclyn’s world. Unlike Chance, D doesn’t live inside textbooks and knows that sometimes you have to be prepared to back up your position with violence.  As D tells Chance, “there are no victims just volunteers.” D, who has a thing for exotic weaponry, sees where Chance is heading and warns him:

“Ever heard of The Frozen Lake?”

“I’m not sure what you mean.”

“Then you haven’t heard of it. It’s the thing you want so badly you’ll go to the center of a frozen lake to reach it.”

“Where the ice is the thinnest.”

“But you won’t think about that. Everyone else will, just not you.”

With D as a guide to the netherworld of violent encounters, physical confrontation and surveillance, Chance follows Jaclyn down the “rabbit hole,” and one of the big questions is: who can he trust? Is D, with his penchant for violence, a fantasist? And what about Jaclyn? Who is she really? What happened to her last therapist? Is she, as Chance’s fellow therapist suggests, just “finding one man to save her from another?”  Chance deals with various mental issues all day long–but in the past there’s been a nice clinical line between him and the patients he evaluates as part of the report process for insurance companies and court cases. His life has been admirable, clean, ordered and now it’s in chaos, spinning out of control, and D advises Chance to change his role:

People talk about self defense. Self-defense is bullshit. I’m defending, I’m losing. I want the other guy defending while I attack. Doesn’t make any difference how many people I’m fighting. I want them all defending because that means I’m dictating the action. I’m the feeder. As long as I’m the feeder, I win. I don’t care if it’s a dozen. Right now, this cop is the feeder. You’re the receiver. You need to turn that around.

Chance is a fantastic noir novel–that’s not to say that it isn’t flawed because it is. The novel is padded with patient evaluations and a few pieces of diagnostic information, and if you (unlike me) don’t like novels that include therapy, this aspect of the plot may have no appeal. The ending is dragged out, and there’s one knife lesson scene towards the end of the book that seems ridiculous, but frankly I don’t care; I thoroughly enjoyed the book for its psychological complexities, its setting, its characters (D Rocks!) and the entire way that the book exemplifies the noir genre. Kem Nunn is termed an author of “Surf Noir,” but Chance, a very cinematic novel, is set in San Francisco–a city, with unconventionality practically a by-law, that is a natural setting for noir. Chance has spent over twenty years building his life and his reputation, and now his life is in disintegration, falling around him like a house of cards. He’s tempted by money; he’s lured by sex–add corrupt cops, Romanian gangsters and a run down massage parlor in Oakland, and suddenly he’s in so deep there may not be a way out….

Chance imagined himself no stranger to the machinations by which people went about establishing the architecture of their own imprisonment, the citadels from whose basement windows one might on occasion hear their cries.

Review copy.

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The Sleep Room by F.R. Tallis

“I did not recognize the sound at first. It arrived as nothing more than a subtle incursion: something seeping between the accumulated layers of silence.”

One of the benefits of experience is that we grow to know what we like, so while after reading some plot outlines, I tend to steer away from certain books, I am attracted to others. The Sleep Room had an unappealing cover, but the storyline checked a lot of boxes for me:

  • written by a psychologist
  • set in a mental hospital/asylum
  • treatment/therapy for mental problems
  • anything to do with sleep and dreams

British author F.R. Tallis was new to me, and in spite of the fact that the book had its attractions, I approached it still with some doubts because, after all, you never know just how well written a book will be until you take that chance and open it.

The sleep roomThe Sleep Room is outstanding. Suspenseful, compelling, and atmospheric, this has to be the creepiest book I’ve read in a long time, but far more than that, this is also a very intelligent story which questions the validity of medicating mental problems, which is, as it turns out, a preferred method in this tale, over the snidely dismissed ‘talking cure’ of Freudian therapists.

It’s 1955, and the novel opens with James Richardson, a young psychiatrist working in London, interviewing for a job with Dr. Hugh Maitland. To Richardson, Maitland is a hero of sorts–an eminent psychiatrist regularly published and the head of “psychological medicine at Saint Thomas’s.” Richardson is particularly interested in sleep studies, so he leaps at Maitland’s offer of a job at Wyldehope, a remote hospital located in Suffolk for ‘special’ cases. This sounds like a dream job: 24 beds “two wards and a narcosis room,” supported by nine nurses, a caretaker and his wife. In addition, Maitland in vigorously opposed to Freudian methods:

Freudian techniques are hopelessly ineffective. All that talk. All those wasted hours. Three hundred milligrams of Chlormazine is worth months of analysis! Don’t you agree? Dreams, the  unconscious, primitive urges! Psychiatry is a branch of medicine, not philosophy. Mental illness  arises in the brain, a physical organ, and must be treated accordingly.

Maitland’s anti-Freudian stance matches Richardson’s beliefs, so he takes the job, agreeing with everything Maitland says, thinking that this will be the first step in a brilliant career. Apart from occasional relief from local doctors, Richardson will be the only doctor on staff–a situation Richardson initially questions, but then he’s reassured by Maitland, who’s a rather domineering character, and after all a senior doctor, that all of the treatments are handled expertly by the nurses, and that the work load will not be unmanageable. While the patients are divided into male and female wards, Maitland is obsessed with the patients in The Sleep Room:

I will always remember entering the sleep room for the very first time: descending the stairs that led to the basement, Maitland at my side, immaculately dressed, talking energetically, cutting the air with his hands, the door opening and stepping across the threshold that seemed not merely physical, but psychological. The nurse, seated at her station–a solitary desk lamp creating a well-defined pool of light in the darkness–the sound of the quivering EEG pens and, of course, the six occupied beds. All women–in white gowns–fast asleep: one of them with wires erupting from her scalp like a tribal headdress.

The six patients are undergoing Narcosis (deep sleep) treatment with the goal of keeping the patients asleep for about 21 hours a day. Each patient is woken up–but perhaps it’s more accurate to say each patient is ‘disturbed’ every 6 hours and taken to the toilet, washed, fed, and given more drugs. Enemas are administered in case of “falling bowel activity.” One of the arguments for Narcosis is that patients could be given more ECT (Electroshock) therapy when they are asleep, and Maitland’s patients receive weekly ECTs with the controls set “at their uppermost limits.” Maitland sees little difference between the patients, is disinterested in the details of how they became damaged people, and describes them collectively as schizophrenic.

“Of course,” Maitland continued, “the great advantage of administering ECT while patients are asleep, is that they experience no anxiety–which means one can prescribe longer and more intensive courses.”

Maitland returns to London leaving Richardson in charge. For the most part, the patient care–especially for those in the sleep room–is on auto pilot with Richardson monitoring the sleeping patients and their bodily functions.  The patients who are not undergoing narcosis are also bombarded with medication, and any failure to “respond” leads to a doubling of medication, so even those not asleep are like zombies. Richardson is naturally curious about the patients and the circumstances that brought them to Wyldehope, but this is not a subject up for discussion, and “case histories were entirely irrelevant.” It’s not so much that it’s a secret as much as it simply doesn’t matter, but then neither does a “cure” seem to be part of the agenda. In fact, as time goes on, Richardson, who is plagued by headaches and disturbing dreams, begins to suspect that Maitland’s goal is to see how long people can be kept in this vegetative state.

Richardson isn’t exactly comfortable with his duties, but his doubts and questions are answered or dismissed so smoothly by Maitland, that he bows to his authority and reputation. However, once Maitland is gone from Wyldehope, Richardson is left in charge, and some bizarre things begin to occur. He feels a presence in his isolated room, items disappear, a patient complains that his bed moves back and forth making sleep impossible, and a nurse is terrified to stay in the Sleep Room alone at night. Since the patient population is delusional, perhaps some of this can be explained away. Richardson’s discomfort grows even as he attempts to quell his growing alarm, and he is forced to acknowledge “the idea of the dead returning to annoy the living.” Yet as a doctor, he knows all too well that if he begins to acknowledge any supernatural presence he places his professional standing in jeopardy.

A psychiatrist cannot admit to seeing things that cannot be explained. As soon as he does so, he crosses the line that separates himself from his patients.

As events spiral out of control, Richardson wonders what happened to his predecessor. The atmosphere at Wyldehope, a rambling mansion, glows darkly with the sense of impending doom–especially so when Richardson, continually observing those in the Sleep Room, discovers that the sleepers are dreaming in synchronicity.  

The Sleep Room is an entertaining, suspenseful page turner which questions the poisonous structure of professional hierarchy, the prevalent attitudes towards female sexuality, and the power of dreams.  This well-crafted book, told through Richardson’s eyes, moves smoothly from skepticism and the solidity of scientific facts to sheer terror of the unknown and the unexplainable. There are some real names here, and the treatments, as outlandish and barbaric as they seem to the modern reader, were the MO of the day, and the character of Maitland appears to share some basic commonalities with Dr. William Sargent. We may finish the book and reassure ourselves that mental patients in the western world fare better these days, but an uneasy feeling remains that pills have become a replacement for therapy. Author F. R. Tallis, a psychologist, certainly seems to know how to push those reader buttons, and the narrative moves along very cleverly by feeding with hints such as “it is ironic–given what happened next” which left this reader eager to continue and very annoyed by any interruptions.  Some of the issues raised by the plot are left unanswered, but it’s easy to connect the dots and come to one’s own conclusions. The final chapter overworked the book’s premise, but in spite of that minor flaw, this is a helluva creepy read.

Review copy

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