“Our patients’ problems are so complex, our treatments so crude, ourselves so human.”
The Glass House is the third novel by husband and wife writing team, Anne Buist and Graeme Simsion. After three months as registrar on the Acute Psychiatric ward of the Menzies Hospital in Melbourne, twenty-seven-year-old Hannah Wright is hoping she will be able to mitigate the effects of the incident that led Professor Liron Gordon to reject her entry into the hospital’s psychiatric training program.
She has six months to impress, while treating the wide variety of admissions: pregnancy psychosis, suicide attempts, manic depressive, religious delusions, schizophrenic, histrionic personality disorder, anorexia nervosa, and PTSD; some are heart-breaking, some, like the manic, comical, although a colleague notes ”On the surface, he’s entertaining. Underneath, he’s battling a life-threatening illness”, one or two, professionally satisfying, and a few are sobering, serving as a warning: “All of us are at risk of mental illness. It can happen to any of us, out of the blue.”
Against a (sometimes distracting) background of power plays between her boss and the hospital’s new Director of Mental Health, well-meaning interventions by Child Protection, and patients’ family members with their own agenda, Hannah does manage to save some lives with a combination of training, past experience, luck, and intuition.
Well aware that she’s often seeing patients at a low ebb in their lives, Hannah tries to imagine them at their best, until another registrar points out that putting herself in their shoes, as well as assessing her patients more holistically, might prove more helpful or effective. And, of course, it’s a team effort that involves consultant psychiatrists, trainees, interns, nurses, psychologists, social workers, occupational therapists and the occasional student.
Hannah soon sees the value of the psych nurses’ input: “Increasingly, I’m trusting his take, and that of the other experienced nurses, on my patients. They spend more time with them than I do; I seem always to be on the phone to relatives, pathology or other hospitals and doctors. Not to mention doing paperwork.” And the time trap that paperwork is: “‘Time spent on accountability,’ Nash says, ‘is time spent away from patients. Someone should be accountable for that.’”
Discussion with her fellow registrars is always valuable for the sake of perspective. With the anorexia case, they acknowledge the associated stigma: “Would we say the same if it was sixteen admissions for asthma?’ A friend from school spent eighteen months in hospital after a motorcycle accident. We do think differently about mental illness.” More generally, they recognise the need do their best and then, if they are to survive, to detach, because “our patients will do what they will, we’re only a small factor in it.” Hannah examines the reasons she opted for this profession and certain incidents lead her to doubt her choice.
The cases that Buist gives her protagonist are intriguing and it becomes apparent that often there is no simple answer, that a mix of therapies might get the best result, or that it may require the right intervention at the right time; that the best result might not be wholly satisfactory and likely far from perfect.
Buist gives some of her characters insightful observations: “It’s tough to have your mistakes pointed out in public, and, god knows, we all make them. Review and criticism is part of every job. It can’t happen if there’s a culture of fear and humiliation – or schadenfreude”. Also “There’s a lot of pressure to treat what’s seen as urgent, and tangible. Obstetrics, blindness, drug abuse, plain life expectancy . . . plenty of work to do. Psychiatry’s seen as a luxury, as the medicine you do after everything else… Yet depression is one of the leading killers.”
This is also a novel that reminds us that those practitioners charged with the treatment of the ill and vulnerable are themselves human, and despite thorough training and expertise, may be plagued by very human flaws and failings, and their perceptions, attitudes and reactions to their patients’ presenting symptoms may be coloured by their own history.
Most chapters are prefaced by a description of the episode that results in the admission of a patient into the Acute Psych ward. The banter between the characters is often entertaining, and some of the dialogue is laugh-out-loud, if blackly, funny. Of course, Buist’s background gives each aspect of the story a ring of authenticity, so this portrayal of mental illness and its treatment, and of the mental-health system, is wholly credible, but also topical, laced with humour and quite thought-provoking. Recommended for anyone who thinks and feels.
This unbiased review is from an uncorrected proof copy provided by NetGalley and Hachette Australia.