The world poses impossible questions and the future is in darkness, you have no claim on health or peace or the way that you feel things ought to be, you are required to live without knowing what comes next, you must carry on in hope as best you can, and you must begin by attending to one another.
Despite differences in lifestyle and temperament, the friendship between Arthur and Louis, begun as pupils at an Irish boarding school, has endured through university in Dublin to early adulthood in 1930s London. Arthur, a junior psychiatrist, has always been overshadowed by his friend, an unpublished writer with the flair and determination to live by his own rules. While Arthur is shy and socially awkward, Louis can charm anyone, including Arthur, such that the psychiatrist often finds himself sacrificing his own needs for the sake of his friend.
Fraudulent identity and failure
Failure is an appropriate theme for a novel fictionalising the writer famous – at least among contemporary writers – for the phrase Ever tried. Ever failed. No matter. Try Again. Fail again. Fail better. Although we witness Louis’ bouts of despair at his own limitations, it is Arthur’s apparent failure in every aspect of his life – professionally, at home, in his friendships, and even in his own therapy – that makes for the novel’s crisis. This isn’t without humour, such as when he companies his wife to a meeting of the Women’s Liberation League and only just manages to resist mansplaining (p177):
he wondered whether he should say something, not for his own sake but for the good of the meeting, because the mood was becoming feverish and it was surely counterproductive for these women to approach their cause in such a confrontational spirit.
Nevertheless, Arthur’s sense of inadequacy, which has dogged him since childhood, is deeply poignant. Perhaps he’s felt that the trappings of professionalism would save him, but he finds himself humiliated in both major and minor matters. His patients get worse, the nurses don’t respect him and the administrator finds time to chat to his junior colleagues but is always busy when Arthur is around (p198):
If a doctor’s signature was all the nurse had wanted, she could have asked either of them, and hadn’t she been closer to Arthur as she came into the room … And yet she had walked by as if it were assumed that even his signature on a form was not quite to be trusted. Perhaps this was one of those incidents that pierces deeper than you know at first, so that afterwards as the minutes go by you gasp and grit your teeth and then gasp again as you realise that here is going to be another memory that will never stop mattering, a lesion that doesn’t heal.
In myriad ways, Sam Thompson articulates that sense of fraudulence anyone in the helping professions must find a way to manage. Interventions fail to affect the desired improvement, or even make things worse. As the psychoanalyst Tom Main wrote in his classic paper The Ailment (1957), anxieties about the fragile boundary between sanity and madness leads to treatment deployed for the sake of the staff rather than the patient, a tendency satirised in Louis Molyneux’s (the fictional Samuel Beckett) novel.
Unfortunately Arthur feels constitutionally destined for imposter syndrome, the only alternatives modelled to him are haughty emotional distancing or the cruelty of his friend’s “helpless integrity” (p261). He even recognises the phenomenon in his own analyst (p210):
a limited man who cultivated his psychoanalytic mystique to seem impressive but had no better idea than his patients of how to live. His tricks were cheap, and once you had learned them he was at your mercy, yours to manipulate and fool.
While my reading suggests that ineffective therapists are more common than effective ones in fiction, Sam Thompson’s exploration of therapeutic failure is more thoughtful than most. After a promising start in medical medicine, Arthur has surprised his colleagues by moving into psychiatry, driven by an interest in the still relatively new and exciting discipline of psychoanalysis. (Melanie Klein, whose theories came to dominate British psychoanalysis, had moved to London in 1926 – and might be the speaker at a lecture Arthur and his future wife attend.)
Although psychotherapy isn’t routinely practised in any form at the hospital where Arthur has his first psychiatric job, he’s given permission to work with one of the more difficult patients, a largely silent man diagnosed with dementia praecox (now known as schizophrenia) called William Walker. Of course Arthur struggles with the countertransference (p82-83):
Small shivers went through his hands. Some psychosomatic discomfort was not necessarily a bad thing: it meant that significant events were taking place at the unconscious level of the analysis. Sweat crawled inside his shirt. The trick, as ever, was to turn the interaction to therapeutic ends … Don’t become defensive. If you assume that silence is hostility, that’s what it will become. Think instead that sitting here in silence may be the only form of communication open to Walker today. Never forget what an enormous task it is for someone in his situation to speak in a way that others can understand.
Unfortunately, Arthur’s patience is not rewarded. When – boundary violation alert – he accedes to Louis’ request to sit in on the sessions, the patient effectively sacks him in favour of his friend. Louis meets Walker for an hour a week over several months until, having acquired all the needs for his novel, abruptly stopped seeing him. Even Arthur, with his limited experience, knows that therapeutic endings need to be more sensitively managed, although he ends up doing something similar himself.
Although there’s scant support within the hospital for Arthur’s therapeutic endeavours, he does have the dubious benefit of a training analysis (with – second boundary violation alert – the analyst he’s found for his friend). Sessions are conducted, not in Venn’s consulting room, but while tramping around the London streets. This might be a reason for Arthur finding the sessions inauthentic, although he also blames himself for neglecting to disclose a piece of biographical information right at the start. Later (p46) he rationalises that he can make this information the gift that will convince his analyst that progress is underway.
The sterility of this particular analytic pairing is underlined in this novel by some astute observations of the “preposterous enterprise” itself (p40-41, 43, 253):
Our profession wants to think of itself as a science … and no-one will admit that we are in fact an organised religion. Cults of personality, deference to authority, rampant factionalism, ruled by doctrine and dogma.
rebellion was useless, because the rules of analysis would always prevail, making denial into evidence more positive than confession … He had stumbled into a world that, for all its institutes and clinics and conferences and learned publications and distinguished careers and bitter rivalries, might as well be the delusional system of a paranoid psychotic. Having no basis in anything real, it was only pretending to exist.
Arthur still had his doubts about the enterprise, with its simple faith that to put a name to your cage was to make yourself free.
1930s mental health care
Mental health care, apart from private psychotherapy, is delivered within hospital settings in the 1930s. Although Arthur is employed within institutions catering to the less disturbed patients, for whom there is hope of a cure, he doesn’t encounter some grisly treatments, including the “wet pack” (p165), which I’m glad to say I hadn’t come across before.
He finds his visit to the large “lunatic asylum” particularly discouraging: the inmates dressed in clownish uniforms; the doctor’s role reduced to pen pushing; the lack of privacy, except in cases of unmanageable violence when patients confined to single rooms, sometimes for weeks on end. This warehousing of human distress is such that “anyone might go insane for want of anything else to do” (p216). Arthur fears he (p215):
would fare poorly as a patient, he knew, because he was not nearly good enough at reading the intricate, unspoken signals that governed the social life of a ward like this: the near invisible insults, bargains and kindnesses that made the difference between peace and violence.
Fortunately for him, he’s not obliged to find out, although he does have a momentary experience of what psychosis might be like (p123):
it was as if he had slipped on the step between the dream and the waking world, so that he scrambled out of bed not knowing where he was, not knowing his name, only knowing that it was an emergency and he must take action at once … He was surrounded by a jumble of forms, bodies in space without meaning. He had forgotten the words for the electric lamp burning above, the darkness beyond the glass and for his own hammering heart muscle.
As you’ll appreciate, if you’ve persevered this far, I found much of interest in Sam Thompson’s second novel, making it another contender for my novels of the year, as well as a welcome addition to my list of fictional therapists. Thanks to JM Originals for my advance copy.
In some ways, Henry found it reassuring. This was a madhouse after all. But the poor man, boogying to a solitary rhythm, would attract derision outside. Someone should restrain him. Was it light reflected from the Christmas tree, or was that glitter in his hair? Was there alcohol in the punch?
At least Henry’s role would be minimal: passing the patients’ gifts to the Mayor. Then home to sanity. Yet his face froze as glitter-man sashayed over, grinning as he offered his hand. “Thanks for coming, Santa, Santa’s Elf. I’m Clive Musgrove, charge nurse. We spoke on the phone.”