Throughout human history, few people have been more consistently feared and abused than the insane, and our misunderstanding of mental illness has typically determined how sufferers are treated. From ancient times – when psychological disturbances were attributed to demonic possession – to attempts in recent centuries to place insanity under the umbrella of medicine, where it belongs, the story of mental healthcare in the western world is fraught with misdiagnoses and crackpot therapies: purging and bloodletting, shackles and straitjackets, trepanning and lobotomies.
I touch on some of these misconceptions in my novel Dark Water, set in 19th-century Boston and Nantucket, Massachusetts – and on the open waters of the Pacific Ocean, where my narrator, Hiram Carver, takes up his first position as ship’s doctor on USS Orbis in 1833. Among the officers is a man who will obsess him for the rest of his career: William Borden, the Hero of the Providence. Years before, Borden saved several men from mutiny and led them in a dinghy across the Pacific to safety. Now he breaks down, in what seems like an irretrievable slide into insanity. Carver meets Borden again as assistant physician at the Charlestown Asylum for the Insane in Boston, where he devotes himself to Borden’s cure, convinced that it depends on drawing out the truth about that earlier voyage.
Carver rejects the usual forms of coercion when approaching his patient, pioneering an early form of talk therapy that will plumb the “dark water” of the mind. He faces all the challenges of working in a pre-Freudian age, prior to a developed concept of the unconscious, and before the advance of neurology and what we now call psychiatry. While writing Dark Water I took a look at how other books, both fiction and non-, have conceptualised mental illness and its treatment. Here are my top 10:
1. The White Hotel by DM Thomas
In this sly novel about Sigmund Freud, the father of psychoanalysis appears both as a character and author of the fictional study of Frau Anna G, who is tormented by “storms in her head”. The imperious Freud explains away his patient’s obscenely violent fantasies (which make up the early sections of the book) as the aberrations of a conflicted psyche. The novel’s shattering vision of the insane mass killings of the modern age, however, resists such neatly localised answers.