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From Psychiatric Services, a publication of the American Psychiatric Association

The Optimists
Andrew Miller; New York, Harcourt Trade Publishers, 2005, 313 pages, $24 David S. Heath, F.R.C.P.

Reviewed by Dr. David S. Heath
Looking for diversion in good literature after a day's work in psychiatry, I would normally stay away from the topic of mental illness, and I would certainly avoid grisly subjects like Rwanda. However, two pages into The Optimists, I was hooked, aware that I was in the hands of a master prose writer and gladly carried along by the strong narrative thrust.

One is immediately oriented by a quotation on the first page, from the award-winning book Season of Blood, about celebrated BBC foreign correspondent Fergal Keane's experiences in Rwanda: "It was unlike any other event I have reported on and in different ways it changed everybody... . We had learned something about the soul of man that would leave us with nightmares long into the future."

The main character, Clem Glass, is a top British photojournalist who has just returned to London deeply traumatized by his experiences in Rwanda, and the reader sees the world through his eyes. This gives the book a feeling of ironic, at times humorous, detachment, and we also vicariously see with his original, visual creative sense. His psychological struggles, the various settings, and his sister's mental illness are all described with some of the freshest most piquant prose I have ever read. I was not surprised to read that Miller's first book, Ingenious Pain, won the prestigious International IMPAC Dublin Literary Award in 1997.

All the signs and symptoms of posttraumatic stress disorder (PTSD) are there, but they are described with such an original sparkling light touch that the book never reads like a case history: for DSM-IV 's "numbing of general responsiveness," substitute "his heart had locked fast the night he had straddled the dead with his lenses."

The narrative thrust is provided by one's quick engagement with Clem's predicament: how is he going to get himself out of this mess? Because of this character's interesting occupation, and because he is drawn sympathetically, we eagerly follow his attempts, sometimes tinged with humor, to repair his shattered life. He tries frequenting movie theaters in the afternoon, seeing an old flame, having sex with a prostitute, and drinking.

It is only after he visits a fellow journalist who was with him in Rwanda, an American named Silverman, that he gets onto the right path to healing. Silverman somehow ends up in Toronto, where he has built a voluntary career serving surplus restaurant food to the homeless outside downtown Union Station. Realizing Silverman has saved himself through altruism, Clem says "I need a Canada of my own."

After he returns to Britain, he then goes to take care of his recently discharged sister, a university lecturer recovering from a psychotic breakdown, whom we have met earlier in the book. Drawn less clearly, because we see her though Clem's eyes, her diagnosis is not clear—probably schizophrenia.

This book is full of insights and descriptions of recovery from mental illness and the experience of caregiving. For example, Clem is grateful for the way a family member talks to his sister "as if there was nothing wrong with her at all ... though he could not yet tell if that was good style or plain ignorance."

Clare is the only one who has received professional care, and mental health professionals are described realistically and positively. General practice psychotherapy comes off particularly well, with astute observations on the therapeutic relationship. "Clem tried to guess what it was that made her [his sister's doctor] someone to whom he immediately wanted to tell everything ... what was this atmosphere radiating from her skin." He decides "it is the ability innate or learned to take another person's difficulties as seriously as your own."

This book is a timely reminder of the struggles of a neglected group. In contrast to research and help in response to the problems of war veterans, police officers, survivors of motor vehicle accidents, and rape victims, discussing and responding to journalists' psychological reactions to witnessing violence, suffering, and bloodshed is a relatively new phenomenon.

The Dart Centre for Journalism and Traumas at the University of Washington in Seattle was opened in 2000 to educate journalists and editors about trauma issues related to journalism. Roger Simpson (1) , its director, attributes reluctance to talk about PTSD in the profession to the "culture of journalism": a combination of reporters' desire to be objective and uninvolved emotionally, some machismo, and the fear of editors' reprisal if the reporter admits to having a problem.

Novels can be used to shed a distinct light on the human mind and its problems. This one is likely to be particularly convincing in illuminating a neglected area but also has much to teach us about mental illness in general.

Dr. Heath is a psychiatrist in Waterloo, Ontario, Canada.

McLaughlin C: Stage 3-Interviews Refugees Related Issue, Post-Traumatic Stress Disorder. Available at

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