Medicine and memory

Personal: It’s a long time since I had any hands-on contact with medicine and medical research, but the experience of those years was to an extent formative. One develops a way of thinking, an addiction to hard work and long hours, and a type of compassion that combines disinterested detachment with focussed care for the individual. It also fosters a type of black humour that’s also found in (e.g.) the armed forces and among firemen. Quite a lot of the poems and songs I put into The Cat of Doom, which reflect that black humour, were written during my time in medical school and my early years after graduation. My past career has influenced my fiction in other ways, too, directly and indirectly. It’s interesting to reflect on the manifestations of that influence in my novels. Most obviously, Doug Carmichael, the protagonist of Perilaus II and its forthcoming sequel, Con, was like me a former doctor who took up fiction writing. (Though unlike Doug I don’t smoke, don’t drink whisky, and am rather more sociable!)

Review: In this context, I want to point people towards an excellent and insightful novel about mental health care. I read it almost a year ago but haven’t reviewed it until now.

Set in the time when the old-fashioned long-term mental asylums were being replaced by “care in the community” and more up-to-date hospital accommodation, Anne Goodwin’s Matilda Windsor is Coming Home combines first-hand professional knowledge of the change with empathy for the individuals caught up in it, and a scalpel-sharp evaluation of the officaldom involved. The responses of decent local people to the prospect of a mental health unit being built in their neighbourhood are presented credibly but with fine irony. This is a well written novel, but the delicious touches of humour hardly ameliorate the overarching feelings of compassion and anger.

Matilda (aka Tilly or Matty) has spent half a century in an asylum for “moral turpitude”, controlled by drugs and gradually – or perhaps suddenly – retreating into a fantasy world in which she’s an upper-class lady engaged in war work. Mentally, she hasn’t really passed the time of the Second World War. We’re presented with her troubled younger days during the 1930s and her life in the present, when she faces the prospect of being uprooted from her now “safe” environment thanks to the policy change. How do you “reintegrate” or “normalise” someone with her history? Dr Goodwin’s answer is blunt: you can’t.

Matty’s brother, Henry, to whom she was more mother than sister during his childhood, was permanently damaged when she was taken away and incarcerated. He’s spent his life trying to find her and now despairs of ever being able to do so, though he lives not far away from her. Again the author has a blunt, simple message: it’s not only the people incarcerated in old asylums that were damaged, it’s their families too. The system created rather than mitigated mental health problems.

Janice, a young social worker, is taken on as part of the team that prepares the long-term asylum residents for their “new life in the community”. In 1989 she meets Matty and becomes fascinated by her case and commits herself particularly to helping this “patient”. She runs up against official policy and, finding herself pregnant, is also – in a way – harmed.

The final section of the book, containing an irony worthy of Thomas Hardy, is heart-breaking. Matilda Windsor is Coming Home isn’t light reading, but it packs a powerful punch and stays in the reader’s mind long after the end.

Anne Goodwin, Matilda Windsor is Coming Home, Inspired Quill, 2021; ISBN: 978-1913117054

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