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Submitted Literature


By Patrick McGrath


McGrath’s novel is narrated by a psychiatrist, Charlie, who slowly deteriorates mentally following the death of his mother. It examines the complex relationships he is embroiled in with his own brother, his ex-wife (with whom he beings having sex with again, despite his new relationship) and his daughter. This complexity of personal relationships made further difficult by his burgeoning relationship with the strange and damaged Nora, who he feels needs psychiatric treatment that he cannot provide. Charlie retreats further into his own psyche following the death of his mother – his childhood issues with her permeate every element of his life and profession.  Charlie’s increasingly fractured memories cause both distress and confusion.

This is a multilayered tale. Charlie, it transpires, tried to treat his ex-wife’s brother Danny for PTSD following the Vietnam war. Indeed, his marriage ended following Danny’s suicide.

The novel contains much on clinical PTSD and psychotherapy for this, but also on the generic trauma of life and loss, the psychological effects of which can be far reaching in individuals who fail, due to semi-abusive childhoods, to develop necessary mental resources to cope.

Nominated for Costa Book award but lost to Sebastian Barry’s The Secret Scripture.

Key Themes:

  • Post Traumatic Stress Disorder
  • Professional / Occupational Stress

Significant Quotes / Pages

3 – Novel opens with a summary of Charlie’s childhood:

“My mother’s first depressive illness occurred when I was seven years old, and I felt it was my fault. I felt I should have prevented it. This was about a year before my father left us. His name was Fred Weir.  In those days he could be generous, amusing, an expansive man – my brother, Walt, plays the role at times – but there were signs, perceptible to me if not to others, when an explosion was imminent.  Then the sudden loss of temper, the storming from the room, the slamming door at the end of the hall and the appalled silence afterward.  But I could deflect all this.  I would play the fool, or be the baby, distract him from the wave of mounting boredom and frustration he must have felt at being trapped within the suffocating domestic atmosphere my mother liked to foster.  Later, when she began writing books, she fostered no atmosphere at all other than genteel squalor and heavy drinking and gloom.  But by then my father was long gone.”

4 - "I am, as will be apparent by now, a psychiatrist.  I do professionally that which you do naturally for those you care for, those whose welfare has been entrusted to you. My office was for many years on Park Avenue, which is less impressive than it sounds.  The rent was low, and so were my fees. I worked mostly with victims of trauma, who of all the mentally disturbed people in the city of New York feel it most acutely, that they are owed for what they’ve suffered.  It makes them slow to pay their bills.  I chose this line of work because of my mother, and I am not alone in this.  It is the mothers who propel most of us into psychiatry, usually because we have failed them.”


27-8 – PTSD group therapy post-Vietnam

“I suppose I was no different from tens of thousands of young Americans then, disgusted not only by the political establishment but all social institutions, orthodox psychiatry not least, and committed to the idea that without radical change our society was done for.  Central to this movement, if that’s what it was, was out opposition to the war.  For this reason I was determined to do what I could for men returning from Southeast Asia with severe psychological damage, what was once called combat fatigue, and before that shell shock.

[…] They looked old beyond their years, sitting forward with elbows on knees, or with legs flung out, an arm over the back of the chair, eyes turned up to the ceiling and a cigarette always burning between their fingers.  They startled easily and sought refuge in street drugs and alcohol, and their symptoms would later be tied to posttraumatic stress disorder – a term that didn’t exist then.  They’d seen their buddies die and wanted to know why it wasn’t them.  They felt defiled.  They felt, many of them, that they were already dead.”


37 – “No safe place. Danny seemed to have gone on a sustained rampage after that. I think he went beserk. He was lucky to have survived. But it was the aftermath that mattered. In Danny’s nightmares, the Vietnamese he’d killed rose up from the earth and came after him. Night after night they came back, night after night he was pursued by the running corpses of his victims until he awoke in a sweaty suffocation and could still smell their bodily corruption in the room. Sometimes the smell lingered all day long. Later he talked more about the loss of his buddy. He said he didn’t try to replace him, instead he became cold and isolated, embittered to the point of numbness. This grieving man withdrew emotionally, as do all of us who grieve. Robbed of a friendship that had been the one tender sound, the single grace note in a cacophony of violence and insanity and death, he shut down his humanity. Better not to feel.

It was also clear he was drinking heavily, alone, every night, so as to mentally climb down from the state of combat readiness in which he spent most of his waking hours. He couldn’t help it. In his mind he was still in the jungle. So his morose, apparently resentful presence was at least in part the function of a chronic hangover.”

Reference: Patrick, McGrath. 2008. Trauma. Bloomsbury, 2009


- Charley Baker
Date Review Submitted: Thursday 30th July 2009