What Book to Read?

My book club suggested we all read a book to do with mental illness, so I chose Salley Vickers’s 2006 novel about a psychiatrist and his patient. But having read it, I’m not sure it really is about mental illness after all.

Dr David McBride is recalling a life changing experience he had with a patient, Elizabeth Cruikshank, who had attempted suicide. At first, as he tells it, she refuses to speak about what led to her action.  McBride has his own secret sorrow: the death of his elder brother in a traffic accident, and he is able to show her considerable empathy. This eventually persuades her to talk at length to him about what made her try and kill herself. In the course of their discussion, McBride realises some important truths about his own life.

There are many related strands in this story. The main one is an exploration of the nature of love and loss. There is love between couples, but also between friends and family. When is what we call love merely a sense of need or obligation?  The epigraph at the beginning of the book is from T.S. Eliot’s The Waste Land; it provides a prompt for the title of the book, which is further taken up in a discussion of the nature of self as experienced internally by someone, but perceived differently by others. There is even a discussion of how the explanation by quantum physics of physical reality throws light on human consciousness.  The lines are also linked to an incident in the gospel of Luke where Jesus appears to two of his disciples on the road the Emmaus after his crucifixion (Luke 24, 13-35). This in turn is linked in the story to a painting, The Supper at Emmaus by Caravaggio, showing the disciples’ astonishment at recognising Jesus. (There are two Emmaus paintings, one painted in 1601 and the other in 1606.) The life and works of Caravaggio are in turn important in the story. Another theme less directly linked is the debate among psychiatrists and analysts between intervention in the brain by drugs or surgery on one hand, and talking cures on the other. Vickers is herself trained as a psychoanalyst but this doesn’t make her oppose the use of drugs; in fact McBride, who favours the talking cures, is forced to conclude that his way of helping people sometimes makes things worse. These strands all add up to a moving and thought-provoking novel.

Vickers seems perfectly at ease in these tricky areas. The plot itself is quite simple, and even a little predictable. It’s the conversations and reflections that make this book so interesting. I’m not a fan of marking books – especially library books – so I usually stick bits of paper in to record passages I like or want to go back to. This book was soon so bristling with bits of paper that they lost their usefulness. An unkind critic could say – as was said of Julian Barnes’s The Sense of an Ending – that it is ‘more a series of wise, underline-worthy insights than a novel’, and perhaps there is some truth in this. Consider the following. ‘I have wondered sometimes if compassion isn’t the most dangerous enemy of promise because it so readily wears the mask of virtue.’ Or Elizabeth, ‘torn between her perceived duty and her unperceived heart.’ Or McBride’s lament: ‘Poor all of us, if we but knew it, blindly crawling along our parallel lines, unmindful that all around there are others as much in need of comfort and consolation.’ Or his wonderful rant to his wife: ‘You can fuck around in your physical person, that I cannot help or change. But you may not fuck about with me in any other sphere.’ These quotes are some that appealed to me; another reader would probably choose quite different examples. And although they seem disparate, and even a little contradictory, all relate to Vickers’s plea for honesty in relationships, found through rigorous self-examination and freedom from self-protecting constraints. But I can’t help wondering if such honesty is really attainable, or even completely desirable. Either way, I hope I’ve said enough to show why I don’t think this is a book that is primarily about mental illness.

As McBride is remembering these incidents, I couldn’t help wondering how realistic it is for him to have such perfect recall of the complex and emotional conversations he is recounting. Vickers gets adroitly around this; not only has McBride written most of the conversation down soon after it took place, but also he says ‘I believe now that truth is more than the accurate recall of events, but something more elusive, less accountable.’ This is probably so, but it is also a neat solution to this problem of fiction.

I have one minor and petty gripe with the production of the novel. The blurb says that the cover image is a detail from Caravaggio’s The Supper at Emmaus (1601). It isn’t, though another edition has a detail from Caravaggio’s Death of the Virgin – which is also discussed in this book. But given how important The Supper at Emmaus is in the story, you’d think they could get that right.

You can read more about Salley Vickers here. ‘Salley’ is an Irish word for a willow, for which Salley is named.