There are many novels that eloquently
describe the experience of mental illness. This is one of them.
However it is much more than that. It is also a complex novel with
many sub plots. Richard Mason’s great grandmother spent her
childhood in a British concentration camp during the Anglo-Boer war
and several members of her family died in captivity. The novel
jumps between the present day and the past when the suffering of
the civilian population at the time of the war are brought to light
through the discovery of a journal.
However there are two main interests for doctors. The first raises
the issue of the difficult decisions relatives have to make when
they decide whether to put their elderly loved ones into a nursing
home. The second relates to the experience of the elderly person
herself (Joan) who gradually develops Lewy Body Dementia. We see
this experience through Joan’s eyes including her feelings of anger
and submission as she tries to gain comfort from her internal life,
which then becomes external in the form of hallucinations, while
she investigates her family’s past with the help of a teenage boy
who befriends her. Joan gradually loses the ability to distinguish
between reality and imagination. We also see the experience from
the point of view of her daughter Eloise, who has a failed marriage
behind her and is the busy manager of a hedge fund that is running
into major difficulties through an ill advised investment she has
made.
But despite all this misfortune, this is a good novel to read and
it is worth making the effort after the rather slow and complex
start.
The title comes from a wonderful description of old age by Philip
Larkin:
Perhaps being old is having lighted rooms
Inside your head, and people in them, acting.
There is hope at the end but I do not want to spoil anyone’s
enjoyment of the book by giving away what happens. There is one
rather nagging inaccuracy when Joan’s GP treats her with Clozapine
without any involvement from secondary services and without any
blood tests. The businesslike and rather sinister nurse, Sister
Karen, administers the medication to Joan without her consent or
knowledge. But real life can be too complicated for plot
fluency.
A recommended read or all doctors, medical students and care
workers who look after the elderly.
Dr. Bob Adams