Richard C. Keller
University of Wisconsin-Madison
Memoirs of struggles with mental illness have become one of the leading psychiatric genres of the late twentieth and early twenty-first centuries. Classics such as William Styron’s Darkness Visible and Kay Redfield Jamison’s An Unquiet Mind, as well as more popular narratives such as Susanna Kaysen’s Girl, Interrupted, Jim Knipfel’s Quitting the Nairobi Trio, and Nathaniel Lachenmeyer’s The Outsider provide fascinating insight into the experience of diagnosis, treatment, and in some cases internment for psychiatric disorders in a society both fascinated and repulsed by them. They tell us about important moments in the history of madness and medicine through the eyes of patients. Yet their proliferation is fairly recent, with one of the earliest such examples being Clifford Beers’s A Mind that Found Itself from 1908. Although a few similar accounts can be found for the nineteenth century, they are thinner on the ground. As a result most histories of psychiatry that cover this period rely on doctors’ and other official records, with at most a few glimpses of patients’ perspectives through case notes.
But another potentially fascinating window into the past is the psychiatric novel. The novel has the capacity to go where the memoir doesn’t, presenting multiple perspectives on the same set of encounters. And while nothing necessarily prevents historical scholarship from establishing a rich atmosphere for the stories it tells novelists make this their stock in trade. The combination of historical research and the expanded boundaries of fiction can make for emotionally engaging reading that sheds light on the past while also entertaining the reader. To be sure, historical novels about madness and psychiatry have often tended toward the potboiler—Caleb Carr’s The Alienist might be one example—but they have also included brilliant examples such as Margaret Atwood’s magnificent Alias Grace, whose publication led to a forum on the novel and historical evidence in the American Historical Review.
A recent addition to this literature is Sebastian Faulks’s Human Traces. The British author has proven himself as a historical novelist, largely through what critics have called his “France trilogy”: the novels Birdsong, The Girl at the Lion d’Or, and Charlotte Gray, which deal with the First World War, its aftermath, and the German Occupation of France respectively. Although some of the book takes place in Britain and France, Human Traces takes Faulks into new thematic and geographic territory. The novel tells the story of two boys, one English, one French, whose lives intersect and whose careers trace different paths for the treatment of mental illness in the late nineteenth century.
Jacques Rebière is the son of a Breton forester who is destined for a life in science. When we first meet him he is sixteen, dissecting a frog in his bedroom laboratory by candlelight. His stepmother calls him to the table, but before Jacques can sit he is instructed to take dinner to his brother in the stable. Olivier, a few years Jacques’s senior, is filthy, with long matted hair and beard, smeared with his own excrement, and speaking in nonsense. Several days later, when Jacques is visiting a local curé who tutors him in science, Olivier flies into a rage and destroys everything in Jacques’s room. Where Jacques replies with tenderness—he thinks that were the family to take Olivier back into the house, they could effectively manage his illness—his father’s response is to order Olivier chained to the stable wall so that he can do no harm. The stage is set for Jacques’s future: he will study medicine and find a cure for those who suffer like his brother.
Across the Channel, we meet Thomas Midwinter, the same age as Jacques, on the eve of his sister Sonia’s arranged marriage to young businessman. Brother and sister discuss their respective futures: hers in London as her fiancé struggles to build his business, and his desire to study literature, which his father sees as pointless. Sonia then convinces Thomas to study medicine. He has a knack for science, and his father will be likelier to pay for him to attend university if it will lead to a career in medicine; meanwhile, Sonia tells him, he can read the classics and take courses in literature in his spare time.
The novel fast-forwards three years. Thomas meets Sonia and her husband—whose business is not doing so well—in Deauville, France, where her husband thinks he can find clients. There Thomas meets Jacques in the hotel dining room, and they take a walk on the beach, talking until dawn about science, medicine, and finding cures for human misery. While Faulks would like to sweep us away with their mutual passion for ideas, the scene feels a bit forced: at one level, when Jacques tells us that Thomas has learned to speak fluent French in a single evening; at another, when the young men tell us that the year of their birth was the same that witnessed the publication of Darwin’s Origin of Species (Faulks might also note that in the same year, Freud’s family set off from Brno toward Vienna).
We then move briskly through the next decade. Thomas starts his career at a British asylum where he is more custodian than caretaker. Faulks covers important ground here: we see lay keepers working with roughly the same authority as licensed psychiatrists, as they both primarily warehouse the mad and manage their numbers. They offer some “work therapy” and a few treatments here and there, but, perhaps with a nod to Foucault, their main job is enforcing discipline rather than healing the sick. We see that there are more women than men, an artifact of Victorian internment practices, and in a scene straight out of Dickens, a ballroom dance that sets the insane in a social venue. We catch glimpses of some of the doctors’ efforts to approach their patients humanely, but what the reader most senses is Thomas’s frustration with a corrupt system and his conviction that medicine could do better for these unfortunate patients. Meanwhile in France, Jacques has enrolled in the seminars of the great neurologist and theorist of hysteria Jean-Martin Charcot. Jacques is ambivalent about Charcot—he is torn between reverence for the neurologist’s keen insight and contempt for his vanity. At the same time, we see Sonia’s marriage collapse: her husband, utterly failing in his business, divorces her on grounds of her infertility in the same transactional manner in which he had married her a decade earlier.
The three stories entwine once again when Jacques marries Sonia, and the three set up shop in an Austrian Schloss in which they establish a clinic for the treatment of mental disorders. From the outset it is clear that Jacques and Thomas have their differences. Jacques is convinced that such disorders are psychogenic—that they have their origins in processes of mind, whether real or imagined. Thomas, by contrast, stands closer to Darwin. He seeks links to a harder biology, whether in heredity or in the cerebral lesions described by thinkers such as Paul Broca. The narrative tension comes to a head over the treatment of one particular patient in their clinic, a Fräulein Katharina von A. Faulks channels Freud in his rendition of Jacques’s case notes on Katharina. For nearly twenty pages, he treats the reader to a case study that draws on elements from Anna O., Dora, and Frau Emmy von N. in a classic description of emergent hysteria. Jacques is convinced that she is on the mend and is prepared to send her home when Thomas intervenes. Something about this case draws him in, and when he reads Jacques’s case notes, he explodes into action. He rushes her into emergency surgery, where the physician removes several ovarian cysts, and he begins treating her for the rheumatic fever that Jacques had dismissed as hysterical chills. Upon her recovery, Katharina and Thomas fall in love and marry, so that her daily presence in the clinic—no longer as patient, but now as Thomas’s wife—is a daily reminder to Jacques of the failure of his methods.
And at this point, finally, the reader gets to Faulks’s point. He is not so much striving for the creation of an atmosphere of reason amid madness, or the emergence of a science of the irrational, as engaging, in a sprawling fashion, in the Freud wars. Faulks has clearly done his research. In addition to the extensive case history, we get full transcriptions of both Jacques’s and Thomas’s lectures to public and clinical audiences in which they detail their respective approaches to mind. We have other clues as well. Like Freud (who is never mentioned in the volume by name), Jacques studies with Charcot in Paris; Thomas, meanwhile, corresponds with the pioneers of biological psychiatry, mostly in the German university hospital system. Their contrasting approaches are established about a third of the way through the novel, and they—along with Faulks’s stake in the outcome—come to fruition in the case of Katharina. When Thomas gives a public lecture about the role of biology and heredity in the development of mental illness, in which he uses Katharina as a key example, Jacques sees Thomas as “gloating” about his victory and refuses to speak to him for a year.
The anthropologist Tanya Luhrmann has written a brilliant ethnography of psychiatric residency that points to a profound tension that undergirds the mental health system like no other branch of medicine. Where orthopedic surgeons study different approaches to knee replacements and shoulder reconstructions, and radiologists learn about different imaging technologies and what they reveal, psychiatrists confront two diametrically opposed readings of the mind: the psychotherapeutic and the neurochemical. The former considers talk therapy the foundation of mental healing; the latter bases its interventions on pharmacological approaches. This tension tears residents in different directions: should they adopt the perhaps quicker, certainly more insurable, but also possibly riskier medical management of mental disorders? Or should they lean toward the more uncertain, longer term, and potentially fruitless weekly counseling sessions that set some patients free from their problems and leave others mired in them?
Faulks gives us a glimpse into the emergence of this problem in a setting a century older than Luhrmann’s, at the birth of the psychiatric profession itself. It could be a fascinating story if Faulks were not so manipulative with the reader, and had he not decided its outcome so clearly in advance. For one thing, he presents the reader with too little of a story—something of a feat in over six hundred pages of novel. There’s a great deal of research here, but little excitement, as if Faulks has immersed himself a bit too much in the science and too little in storytelling. It might be interesting to see Jacques and Thomas struggle a bit more in making their careers, for example, instead of moving through the system as anointed ones, opening a relatively luxurious private clinic in their early thirties. Likewise, did they have to be so connected to the top of the profession? Faulks has a tendency to name-drop here. Not only is Jacques a student of Charcot, but one of his fellow students is Pierre Janet. When Thomas hires an assistant, the successful candidate didn’t merely come out of the German system, but was a student of Alzheimer. Both read innovative new work and assimilate it into their own improbably quickly, adopting ideas that took years, if not decades, to make it into the therapeutic mainstream. Even Sonia’s divorce—no easy thing in the 1880s in Britain—is surprisingly smooth, merely a plot device both to demonstrate her loyalty and to link Jacques and Thomas through familial as well as intellectual bonds.
The other issue is that Faulks has stacked the odds in favor of an as-yet nonexistent neuroscience at the expense of psychotherapy. He combines an almost farcical characterization of psychoanalysis with a too-prescient account of biological psychiatry in a manner that predetermines the outcome in favor of the gene rather than the unconscious as a principal determinant of mental disorder. And this is where Faulks may be too clever by half. A triumphalist approach to history mandates that the story turn out in a specific way. But contemporary psychiatry’s emphasis on medical management of disorder brings with it a great deal of uncertainty—an uncertainty that should make the reader somewhat skeptical about Thomas’s smugness. In an era in which leading psychiatric medications—which draw on the biochemical foundations of the nineteenth century that Faulks sketches here—that barely beat placebo in clinical trials and are linked closely to suicidality, the reader may wonder about how clear the outcome of this nineteenth-century struggle of ideas really is.
Ultimately, the book raises questions about the task of historical novelists. Should they write from the present or attempt to write from the past? Historians themselves of course always write from the perspective of the now (despite frequent claims to the contrary), so perhaps we should not expect anything different from novelists. But in engaging so fully with a mission to discredit analysis and to claim early victories for biological psychiatry, Faulks misses the opportunity to muddy the waters. The period he covers—from about 1875 to the beginnings of the First World War—was rife with ambiguity about how best to approach the mind and its pathologies. Faulks is less than honest about sexist and racist implications of much of what Elaine Showalter has called “Darwinian psychiatry” in the late nineteenth century, something that his redemptive reading of such tendencies obscures. In addition, Faulks borrows substantially from late twentieth-century discoveries and theories and moves them back a century, ascribing them to his characters, so that Thomas has a near-contemporary—and almost entirely unbelievable—insight into schizophrenia, archaeology, and anthropology, for example. Other historical novels that cover similar material—I’m thinking here of Pat Barker’s magisterial Regeneration trilogy—are certainly influenced by present-day issues: late twentieth-century British concerns about sexuality, class, and masculinity are ubiquitous in Barker’s work. But Barker presents her material with a subtlety and ambiguity that is sorely lacking in Faulks’s novel. Rather than skewing the history, such an approach renders Barker’s characters—both historical and invented—in an altogether more sympathetic and credible light. Readers seeking an understanding of the past through fiction—and one that explores the same dilemmas in the emergence of modern understandings of mind—would do well to consult Barker before Faulks.
Sebastian Faulks, Human Traces (New York: Vintage, 2008 .