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In ‘Let Me Not Be Mad,’ a Doctor Is One of His Own Case Studies

There are always two experts in a consulting room, A.K. Benjamin writes in his magnificently unsettling new book, “Let Me Not Be Mad.” There is the patient, and there is the doctor — “one skilled in the particular experience of symptoms, the other in investigating them, first- and third-person accounts vying for the same conceptual ground.”

What happens when these accounts vie in one person — when doctor and patient are the same? Benjamin, a British clinical neuropsychologist, weaves together the stories of his patients’ “unraveling minds” with his own history of mental illness. Portraits of patients suffering from traumatic brain injury or dementia open up to reveal larger aspects of clinical practice, the brain and the kind of porousness Benjamin believes his profession requires. His interest isn’t merely in describing this empathy but evoking it, slightly coercively, from the reader (there’s an annoying yet undeniably powerful twist in this tale that I’m trying to sidestep).

“We are skull-jumpers,” he writes. “There is no limit to our identificatory capacity. Your face, voice, breath continue their unfolding, each now different from the last, changed beyond recognition in the two hours since we first met. Looking: more intimate than any physical examination.”

Benjamin’s narrative creeps along the borders of his case studies. His patients’ suffering recalls his own. He is moved by their resemblance to his family members. An older woman suffering from dementia — “names would stick on her tongue like peanut butter” — reminds him of his mother. A child horribly hurt in an accident calls to mind his own small daughter’s mysterious illness — and allows him to pan out and consider more general questions about the most helpful kinds of communication between doctors and parents of very young patients.

There is a conventional insistence that the personal not contaminate the professional in the therapeutic relationship; the life and experiences of doctors must not leach into their work. “When patients see our humanity, they leave us,” Lori Gottlieb writes in her recent book on her own psychotherapy practice, “Maybe You Should Talk to Someone.” In the case of Benjamin, we see how fully he is able to attend to his patients precisely because of his humanity, particularly his past (although it should be noted that he is writing under a pseudonym). He is sympathetic to their attachments to their illnesses: “We must somehow make our illnesses special — our own, that is — otherwise they remain terrifyingly separate from us.” And he shares the Scottish psychiatrist R.D. Laing’s conviction that psychosis can be intelligible, even profound. He reels off superbly sympathetic statements — “patients are often our imagined others” — with the kind of professional tenderness worthy of Oliver Sacks.

He is no Sacks. Something stranger is afoot. When one patient stops coming to appointments, Benjamin holds the slot for him every week, using the time to imagine and write down what might be happening in his patient’s life — what stresses, what secrets. He fills a whole journal.

The language suddenly changes, turns jagged and gnomic: “Death emerges as the real and only end; love its mirage, its white whale, its pantomime horse.” The sentences take on a galloping energy. This book about madness becomes itself the chronicle of a shattering breakdown.

Benjamin is in free fall. He sleeps two hours a night; his walk slows to a crawl. His signature suddenly changes. He believes he can feel the different regions of his brain activate. Walking across the London Bridge during rush hour, he imagines he can diagnose people as they pass: psychosis, panic, depression, O.C.D. He becomes “para-homeless” because of “an attachment problem.”

Certain sections are inevitably difficult to follow. There is a garbled chapter on a disastrous marriage. He alludes to threats, violent fights (some terrifying), but it is murky, and in a self-serving way. Benjamin dismisses his wife as a Gorgon and skirts specifics to hide behind inflated language: “The fragile truce is shattered. Within moments we are soaked in each other’s petrol, wielding giant flamethrowers.”

Still, he clings to his training for as long as he can, telling himself what he has told his patients: “If we don’t learn to love our deficits, we will only ever identify with what we can do.” His thoughts continue to unravel; his vocabulary grows sparse. “There is no ‘body,’” he jots down one day. “There is no ‘inside.’ There is no ‘my.’”

A phrase from Kafka’s “A Country Doctor” haunted me as I puzzled over this book — its curious performance of brazenness and prevarication. In the story, a doctor visits a patient with a terrible lesion writhing with worms — an affliction the author evokes with improbable beauty: The patient is “dazzled by the life in his wound.” Benjamin is dazzled, too, even as he suffers — there is so much uniquely, harshly human in his illness, he attests. It has cracked him open to a kind of holy compassion. Be advised: You’ll need a mighty tolerance for that Laingian mythopoeic perspective of mental illness to make it through this maze. But succeed and its conclusion feels like a benediction. “We are exactly as lost as each other: Even the most particular is happening to everyone.”


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