The character in crisis is the bread-and-butter of fiction, so we shouldn’t be surprised to find mental health issues depicted on the page. But for those with insider knowledge – as service users, clinicians, academics and/or friends and family – the suspension of disbelief required to enter the world of the novel can be severely challenged when the topic is mental health. Our enjoyment can be compromised by a diagnosis of schizophrenia presented as split personality; psychotherapists who continually blur boundaries; or straitjackets in use on the contemporary psychiatric ward. As a former clinical psychologist turned novelist and book reviewer, I hope you’ll find me a sufficiently trustworthy guide to some novels that address mental health issues without setting your teeth on edge.
From my reviews of novels that feature mental health issues across the life span, from early childhood to old age, I’ve selected three debut novels published this year (one of which is my own) in which the main character is an adult of working age.
How to Make a Friend by Fleur Smithwick
As a shy, and somewhat emotionally neglected, child, Alice found solace in the company of her imaginary friend. Now in her early twenties, a car crash renders her comatose for three weeks. When she wakes up, who should she find at her bedside, but Sam, her imaginary friend from childhood, now grown up. As she tries to regain a normal life, Sam proves to be both a comfort and an embarrassment: no-one else can see or hear him and friends and family are bemused when she talks to him in public. Of course they’re concerned for her sanity but, as Sam develops his own identity, that could be the least of her problems. Sam becomes as dependent upon her as she is on him and, regardless of her own desires, he wants her for himself.
Alice’s relationship with Sam is reminiscent of the relationship many voice-hearers have with their voices. The novel works so well because, despite a somewhat outlandish premise, the author herself “never thought of as Sam as anything other than a sentient being”, which again has parallels with the way in which contemporary therapists now work with voice-hearers, accepting the validity of voices rather than dismissing them as was deemed good practice in the past. The novel is also very effective as an exploration of how manipulative characters prey on the lonely and vulnerable.
The Zoo by Jamie Mollart
High-powered advertising executive, James Marlowe, is delighted when he wins the brief to create a new campaign for an international bank. But his involvement in the corporate world comes at a heavy cost, as he becomes increasingly dependent on drugs and alcohol to keep the unethical nature of this endeavour out of mind. This distances him from his friends and family and, eventually, from himself, as a psychotic breakdown lands him in a psychiatric hospital, terrified by a collection of plastic and metal animals and figurines which he calls The Zoo. It’s there that the reader first meets him, and there that we sit alongside him as he gradually pieces together the sequence of events that has brought him to the lowest point of his life.
I found James’ psychotic experiences extremely convincing, articulating the physical, as well as the mental, torment which is often overlooked. (The author has said that he found the darkest scenes easiest to write.) His depiction of the hospital ward, although rather bleak, is also highly credible (apart from the references to ‘orderlies’ and doctors in white coats), with the relationships between patients more powerful than those between patients and staff, with some points of humour in the unwritten rules. (I don’t know where the author did his research, but the novel is set very close to home in Nottingham and Leicester.) This is very much a novel that explores the social and psychological origins of psychosis, as well as the dark side of consumerism in the modern world.
Sugar and Snails by Anne Goodwin
Middle-aged psychology lecturer, Diana Dodsworth has sacrificed her career prospects, and the opportunity for intimate relationships, in order to keep her past identity a secret. When she meets Simon at a dinner party, their connection over a shared interest in Cairo brings the promise of something more. Yet the conversation triggers unwelcome memories for Diana of the teenage decision that radically changed her life. As the relationship develops, she becomes conscious of the widening gap between the woman she is and the woman she feels she ought to be. Now she must make another decision to embrace the part of her she’s been at pains to deny.
Diana feels such a sense of shame at the core of her identity, that she’s constructed a false self to hide her secret behind. She’s the kind of person who could potentially benefit from psychotherapy services, except that past experience has left her very suspicious of any kind of help. She’s self-harmed since childhood (with a rather vivid and visceral description of cutting in the first chapter) and found the conflicts of adolescence almost too much to bear. Unfortunately for Diana, her involvement in mental health services in the early 1970s, when a course of aversion therapy (albeit sympathetically administered) from a clinical psychologist and a “good talking to” from a psychiatrist weren’t a great deal of help. In contrast, the contemporary strand of the novel shows how care packages for those with similar identity issues have improved (somewhat).
Bridging fiction with the real world, the publisher of Sugar and Snails, Inspired Quill, is donating 10% of profits to a relevant youth charity. A review copy is waiting to be claimed from The Psychologist.
All three novels are available in paperback and e-book versions – which will you read first?
Anne Goodwin is a former clinical psychologist and employee of Nottinghamshire Healthcare NHS Trust. Catch up on her website annethology or on Twitter @Annecdotist.
If you need someone to talk to, Samaritans are available round-the-clock, on 116 123 (UK)