Short. Sharp. Shocking

<strong>Trauma</strong>

Patrick McGrath

<em>Bloomsbury, 224pp, £15.99</em>

Patrick McGrath's latest psychologically astute novel is a haunting account of what happens when our basic human need for security is violated. It is published at an intriguing time in the world of psychiatry. With wars being fought in Iraq and Afghanistan, with the eyes of the world on Zimbabwe, Darfur, or Sichuan, and with the twin towers a not-too-distant memory, the current thinking about how to treat anyone who has endured trauma is hotly debated. The general view about treating sufferers of post-traumatic stress disorder is that supportive psychological debriefing and psychotherapy offer the surest road to recovery. However, American research last month suggested that people who do not talk about traumatic experiences can fare better than those who undergo a talking therapy. Charlie Weir, McGrath's psychiatrist narrator, would strongly beg to differ with this latter view. But sadly, where his own mental equilibrium is concerned, Charlie finds it hard to practise what he preaches.

Rather in the manner of physician heal thyself, Charlie has arrived at a position of some professional renown within psychiatry via an immensely damaged childhood. His memories are of rejection and abandonment, with a depressive mother who openly preferred Charlie's brother Walt, and a violent, flaky father who eventually leaves. A recurring dream is of his father holding a gun to Charlie's head - a concise motif within the novel for a number of its themes: aggression, repression, displacement.

As an adult, Charlie is also haunted by the suicide of one of his Vietnam War-veteran patients, Danny, and in particular his sense of responsi bility for that death. This guilt triggered the breakdown of his marriage to Agnes, who was also Danny's sister. Largely self-aware, Charlie does suffer from the odd blind spot (as in his drive years later to resurrect his relationship with Agnes, which mirrors his earlier attempts to "repair" his relationship with his hostile mother - a woman who didn't want him); he also feels an under-resisted compulsion to heal others. This makes Charlie drawn to the damaged Nora, and leads to his mother's damning accu sation that Charlie likes nothing better than to interfere in "other people's private business".

McGrath has returned to the territory he so chillingly charted in a previous novel, Asylum: that of psychological extremities. Trauma is a gritty exposé of life on the hinterland of sanity - a world of flashbacks, nightmares, alcohol abuse and depression. In some sense it reads like an elegantly presented case study, with just the right amount of explanation of clinical terms and techniques to open up the narrative for interested laymen. For the alert armchair therapist, the clues to Charlie's psychology are there in the opening, when he reveals his belief that he was to blame for his mother's depressive episodes.

Punctuating Charlie's story are therapy sessions with some of his patients. Their material illuminates themes pertinent to Charlie: of repressed memory, the need for safety, and the search for absolution. Another intriguing aspect of the narrative is that Charlie is humanly unreliable as a narrator: he can remember only what hasn't been repressed and clings to those memories that confirm his existing beliefs. So, very slyly, the literary novel turns into a mesmerising thriller as we try to detect quite what childhood trauma lies beneath Charlie's increasingly fragmenting exterior.

Just as I felt the novel's publication to be timely psychiatrically, I was also moved to view it as an oblique commentary on a particular aspect of American life today as seen through the prism of the recent past. It is set mainly in 1979/80; the twin towers are just being built. The sight of them peppers the literal narrative but also hints at future tragedy. In his work with veterans, and in particular their sense that they "didn't have to be there", Charlie regards 1970s America as playing the part of "a mad god eager to devour its young, the willing slave of its own death instinct". I am uncomfortable putting words into McGrath's mouth, and the intimation is certainly not laboured, so I may be wide of the mark here, but I leave you to fill in the 2008 blanks, so to speak, should you choose.

What I am confident in saying is that McGrath is that rare yet essential thing, a writer who can expose our darkest fears without making us run away from them. He does this using intimate, everyday prose, having constructed out of human frailties a character-driven plot full of suspense. Trauma is above all a very grounded piece of work, with carefully plotted themes and counterthemes. Thus, his form beautifully illustrates his meaning: that safety and security are paramount for healthy human existence.

Lucy Beresford's first novel, "Something I'm Not", is published by Duckworth (£12.99)

This article first appeared in the 07 July 2008 issue of the New Statesman, British childhood