Archive for August, 2013

Bad Habits of Expectancy

August 26, 2013

larkinlandI have been reading Andrew Motion’s Larkin biography, and also Martin Amis’s selection of Larkin poems. Aside from the odd Dr Seuss-style tautology (‘How slow they are! And how much time they waste/Refusing to make haste!’) I agree with Amis – the man was ‘instantly unforgettable’. Who could forget the final stanza of ‘Money’:

I listen to money singing. It’s like looking down

From long french windows at a provincial town

The slums, the canal, the churches ornate and mad

In the evening sun. It is intensely sad.

Here Larkin does more than capture a feeling – he takes you into another world.

Amis also says that ‘Larkin cleaved to a Yeatsian principle: ‘seek ‘perfection of the work rather than perfection of the life’.’ There was little perfect about Larkin’s life, indeed. His father was a supporter of Hitler, his mother an agitated codependent. He never married and had maybe five or six fraught and difficult love affairs. He lived for thirty years in the Yorkshire seaside city of Hull, running the university library – he didn’t even go to the interesting part of Yorkshire, although, having said that, I can’t exactly see the guy in LS6. Amis writes that ‘Hardly anything in Larkin’s letters is as swimmingly grim as the little clump of words and numerals in their top right hand corners: Flat 13, Elmwood Avenue, Belfast. 200 Halgate, Coddingham, East Yorkshire. 192A Halgate, Coddingham, Yorkshire. 172 London Road, Leicestershire.’ Larkin became a national treasure not despite of, but because of, his relentless gloom – he stood for a particular kind of British sentimental mediocrity, what Hitchens called ‘the world of wretched, tasteless food and watery drinks, dreary and crowded lodgings, outrageous plumbing, surly cynicism, long queues, shocking hygiene, and dismal, rain-lashed holidays, continually punctuated by rudeness and philistinism.’ In his novel The Pregnant Widow, Amis gives the name ‘Larkinland’ to the state of loneliness and sexual misery that his protoganist falls into, and I recall a joke going around on Facebook, to the effect that a Larkin memorial walk in Hull had to be called off at the last moment – because the weather was sunny.

As Amis has noted, Motion’s biography is boring because Larkin did so little with his life: Motion is forced to pad the book out with in-depth material on the restructuring of the University of Hull’s library, along with numerous administrative matters, which you don’t normally get in a literary biography. Larkin’s was a life lived mostly on the interior. Motion is writing the story of an inner life. Which isn’t to say that Larkin didn’t ever want a life. His correspondence is full of yearning for sex and something momentous about to happen. From ‘Next, Please’: ‘Always too eager for the future, we/Pick up bad habits of expectancy. Something is always approaching; every day/Till then we say’.

There’s a lot in Motion about Larkin’s love affairs. For decades he had an on-off affair with a lecturer in Leicester, Monica Jones (who, from this obituary, was more animated and beautiful in her day than Amis and Hitchens will admit) but he cheated on her, kept her at arm’s length and did not cohabit with her until he had no choice. Motion makes this sort of arrangement sound unusual. But categorisation is a guy thing and many men live out their lives in such a way. They don’t commit because, well, something better might come along, you need to keep your options open and, in Larkin’s case, there was his dread of fatherhood. But it’s that compartmentalisation that makes Larkin’s life seem so sordid and creepy. Sooner or later you have to throw yourself into something.

Another thing that comes up, in Motion and in Amis, was Larkin’s provocative conservatism in later life. He was a bellicose Tory who came to write jeering quatrains and letters on sensitive subjects, in tones so ugly that I don’t want to quote them on this site. The debate on Larkin’s politics has been done to death and I won’t go into it here. Poetry matters, politics does not. And politics is often the expression of some internal pathology. Larkin was getting old and, as Motion says: ‘He knew that what might sound like the bites and barks of an independent spirit were in fact the howls of a prisoner who had reached ‘the end of choice’.’ ‘The world was a better place when I was young’ – the reactionary’s battle cry. Maybe that should be ‘The world was a better place because I was young.’

What overwhelms the poems and the biography is Larkin’s fear of death. Preoccupation with mortality dominated life and work. ‘Next, Please’ – written in his twenties – has the narrator as everyman on a shore waiting for the ships of opportunity and happiness that are on the horizon. ‘We think each one will heave to and unload/All good into our lives, all we are owed/For waiting so devoutly and so long/But we are wrong’ – the boats pass by. ‘Only one ship is seeking us, a black-/Sailed unfamiliar, towing at her back/A huge and birdless silence.’ Death is all you’re owed.

Decades later, Larkin returned to death in ‘Aubade’, where he dismissed all possibilities of coming to terms with this scary mystery – ‘This is a special way of being afraid/No trick dispels.’ Religion doesn’t appeal: ‘that vast moth-eaten musical brocade/Created to pretend we never die’ but the more rationalist view (‘No rational being can fear a thing it will not feel’) does not help either because it forgets that what we fear is nothingness itself: nothing to think with.

It’s a great poem but not the last word. I’ve just read Stephen Dobyns’s Common Carnage. Dobyns could have taught Larkin a few things about life and death. From ‘To Keep One’s Treasure Protected’:

All day I have been trying to imagine the ones

who withhold themselves – arms folded across chests,

or hands buried deep in their pockets. The ones

who remain a few steps back from life, who feel

possessed of a treasure which they don’t wish

to offer the world, as if they wore their smiles

on the insides of their faces. Is this an attempt

to save themselves for the truly important moment?

Or could it suggest that the world isn’t good enough?

Or are they trying to be complete in themselves –

both lover and loved, consumer and consumed,

as if one could be complete without the world?

This captures Larkin as nothing of Motion can. ‘Our bodies are coinage,’ Dobyns says. ‘Spend it. Fling the coins upward, hear them jangle on the street.’ In ‘Crimson Invitation,’ he takes on what Larkin might have called ‘specious stuff’ – the line from Marcus Aurelius that goes ‘observe in short how transient and trivial is all mortal life; yesterday a drop of semen, tomorrow a handful of spice and ashes.’ And Dobyns asks us to consider ‘all that comes between, the fleeting, the sweet, never to be repeated, never to happen again.’ For that reason, he is a better poet than Larkin was.

Classic Books: Bodies

August 12, 2013

mercurioThere are few worse feelings than making a mistake in a new job. At best, you will be shouted at and you will waste time and money. If you do an important job, like a soldier or a surgeon or police sharpshooter, at worst someone could lose their life because of your incompetence. It’s this devastation of guilt and culpability that Jed Mercurio confronts in his medical classic.

Bodies is a novel drenched in work. Medical hours are hard, particularly at junior level: rest becomes a sin, leisure a dream, and Mercurio’s narrative is etched in sweat, stress and the vivid magical scenes that come when you’ve gone long enough without sleep for the doors of perception to swing open a little. James Kelman said that something like ninety nine per cent of fictional characters are independently wealthy – well, that’s not the case in Mercurio’s fiction. His nameless narrator is a newly qualified hospital doctor struggling with hundred-hour weeks. In this passage, the exhausted medic for the first time expresses his fear and tiredness and sense of terrible responsibilities:

Shuffling to the tap I run water over the tiny wounds and with my other hand extract shards of glass. Blood pinks the stream as it swirls down the plughole. The cold water numbs the pain and the bleeding eases off and I still want to be a doctor, I still want to do the job and that means staying in this world because it’s the only one there is, but I’m crying, crying like I haven’t since I was a kid, with tears flooding my face and snot drooling from my nose while on the ward normal business continues, it all continues, it all continues.

I’m twenty-three years old.

Inevitably, working nights under a ton of flu and doing ward round on a broken toe, the doctor makes a mistake – failure to notice a pulmonary embolism – that leads to a woman’s death. Broken with guilt, the narrator’s first instinct is to confess, but his SHO convinces him to fake the notes and move on. ‘We all make mistakes,’ the SHO explains. ‘Because we happen to be doctors, our mistakes have larger repercussions, but the process is the same.’

Reluctantly, the narrator does as he’s told, and the decision kickstarts a process of unsettling personal change. When we first meet Mercurio’s protagonist he is a conscientious Christian in a sexless engagement with an office worker. After his manslaughter of the patient he calls the Breathless Lady, the narrator dumps his girlfriend, abandons his faith and becomes a womanising opportunist of the nurses’ floor. It’s not just guilt. Stephen King’s doomed medic Dr Louis Creed, in Pet Sematary, tells his wife that ‘as a doctor, I know that literally anything can happen to human beings.’ No novelist proves that better than Mercurio. Bodies is a book of terrible things happening to bodies. An early grotesque flashpoint comes when his narrator treats a meningitis victim whose hands, feet and genitals develop gangrene and need to be hacked off by the surgeons. The things the protagonist sees jolt the narrator away from pure spirituality and towards an ultimately kinder and stronger creed based on physical safety and physical love. We are matter. No one can stress this enough.

Bodies is also a novel about the power of the community – what Mercurio calls the interior: ‘a city within a city with its own speed limits and language and even its own weather.’ For Mercurio the hospital is not just a place of recovery but its own internal subcivilisation with autonomous culture and rituals and rules. The narrative has this impersonal feeling – we never know the protagonist’s name, the patients are referred to by nicknames and joshing gallows humour (‘Blue Numbers’ ‘Young Headache Man’) colleagues go by their first names and senior doctors by initials (‘I’ll call him Doctor T’) giving the impression that we are reading a suppressed clinical report, something burned from a hard drive.

His hospital bosses cover up mistakes because they want to protect the hospital and the NHS from expensive civil litigation. Juniors do not report misconduct because they can be denied references, rendered unemployable or suspended for years at a time. It’s not a conspiratorial novel, Mercurio’s characters mostly do the wrong thing for the right reasons, but their negligence wrecks lives. There have been shocking revelations about appalling experiences in NHS hospitals and care homes (certainly for someone who has received nothing less than first class care every time I have been ill) but some defenders of the system have been cagey on speaking out because they fear that to do so might give ammunition to people on the other side of the argument who prefer a US-style private insurance model. The debate that follows illustrates Orwell’s quotation:

Whenever A and B are in opposition to one another, anyone who attacks or criticises A is accused of aiding and abetting B. And it is often true, objectively and on a short-term analysis, that he is making things easier for B. Therefore, say the supporters of A, shut up and don’t criticise: or at least criticise ‘constructively,’ which in practice always means favourably. And from this it is only a short step to arguing that the suppression and distortion of known facts is the highest duty of a journalist.

Bodies is a great medical novel, but the storyline could have been set anywhere. Mercurio is writing about institutions. He is also writing about the ageless human drive to belong somewhere. Anyone who has worked long term at any organisation has a measure of professional and personal security, you see it on their faces and in their movements – they have somewhere they can go, where everybody knows their name, they have their place at the campfire, as James Hawes put it. By speaking out against medical negligence Mercurio’s narrator risks not only professional ruin but a kind of personal annihilation. It’s that risk and its consequences that lift Bodies from a procedural classic into a great novel about the human condition.

Self’s the Man

August 8, 2013

There is a ludicrous piece on mental illness in the current Guardian Review, symptomatic of a debate that is beginning to unclip itself from reality’s moorings. It’s by the novelist Will Self, who makes several big assertions: first that ‘no fixed correlation has been established, despite intensive study, between levels of serotonin in the brain and depression.’ He also states that ‘big pharma has moved into markets outside the English-speaking world and effected a wholesale cultural change in [our] perception of sadness (rebranding it, if you will, as chemically treatable ‘depression’), simply in order to flog their dubious little blue pills’. In the next para, he gets more direct, naming ‘the fiction of depression as a chemical imbalance that can be successfully treated with SSRIs.’

This is a big idea: that the concept of depression has to some extent been invented by a Big Pharma conspiracy, working with the medical establishment to push barrels of chemical relaxants as treatment for hypothetical conditions. Self’s probably aware of the literary antecedents of this big idea, notably Huxley’s Brave New World. Or maybe I’m being too hard on him, and he thinks this is a natural evolution rather than corporate skulduggery: ‘the tail can begin to wag the dog: rather than arriving at a commonly agreed set of symptoms that constitute a gestalt – and hence a malady – psychiatrists become influenced by what psycho-pharmacological compounds alleviate given symptoms, and so, as it were, ‘create’ diseases to fit the drugs available.’

I don’t think anyone in the psychiatric profession, not even the psychiatrists that Self critiques, would deny that antidepressants are over subscribed. Access to talking therapies is a long process and something has to be done to cosh immediate symptoms. The mental health nurse Phil Dore, when I tweeted this, said that ‘I regularly see living disproof that SSRIs can’t help depression.’ I’d go farther: I think there are people walking around and breathing who would not be if not for medication.

I also struggle to think of a branch of the medical profession that is so demonised as psychiatry. The same paranoid rhetoric is not levelled against oncologists or thoracic surgeons, even though bad things happen on any doctor’s watch. The Scientology-like hatred of an entire branch of medical science helps no one.

To declare certain psychological conditions as ‘fiction’ seems edgy and interesting, in the pages of the Guardian Review, but the flipside to Self’s argument is that anyone who claims to be suffering from depression is simply trying to get attention and needs to get over themselves. We have spent years getting over this philistine reflex, and here it is back in a Shoreditch rebrand.

Let’s agree that antidepressants are overprescribed, that they are never a whole solution, and that there are problems with the gigantic drug companies. How then do we treat mental illness (and Self does say that mental illness in general does exist, calling it ‘an extremely frightening phenomenon to observe – let alone experience.’) What is the best way of tackling such awful problems? Self offers nothing. He links closed mental health units to the cliché of Victorian bedlam, but in the same para, complains about the ‘care in the community’ policy of the 1990s. He offers no solutions. He just writes sentences like ‘This in itself, Davies might argue, explains why there are more and more new ‘diseases’ with each edition of the DSM: it isn’t a function of scientific acumen identifying hitherto hidden maladies, but of iatrogenesis: doctor-created disease.’ Seriously though, doesn’t Self realise that all this stuff was done by R D Laing back in the 1970s and it was widely recognised as idiocy even then?

Here’s an idea. Why don’t the broadsheet newspapers commission one of the great mental health bloggers out there to write something about mental illness. Sure, Zarathustra and Molly Vog aren’t big creative names and haven’t won any awards. But they do at least have the virtue that they know what they are talking about, and have many more interesting things to say, too.

Photo illustration by Mindy Ricketts

Stock mental health photo