2021

Empire of Pain by Patrick Radden Keefe #ABookADayInMay No.2

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Empire of Pain: The Secret History of the Sackler Dynasty: Amazon.co.uk: Keefe, Patrick Radden: 9781529062489: Books

Day two of this project will reveal two things that I had previously left unstated. My aim is to finish a book each day in May, but that doesn’t mean that I have also started that book. I did not read all 560 pages of Empire of Pain (2021) by Patrick Radden Keefe in one day. In fact, I didn’t actually read any pages at all – I listen to the audiobook, and finished the final hour of it today.

When I downloaded the book, I thought it was about the opioid crisis in America and the court cases surrounding it. And it sort of is about that, but opioids don’t even exist until we’re a considerable way through the book. While a large chunk of the end of the book is about attempts to address the terrible cost of opioid addiction through the courts, Keefe takes us decades and generations back in the first half of the book. He is documenting the Sackler family’s rise from nobodies to billionaires right from the beginning.

As I’m writing this quite late in the day, and it’s an enormous book, I’m not going to detail all that much of it. But Empire of Pain is certainly a book of two halves. The first is about Arthur, Mortimer and Raymond Sackler and their humble origins – and how Arthur Sackler’s genius for advertising led to him being the first to advertise medication directly to doctors. He was, indeed, the first in many fields of advertising – he basically appears to have invented the idea of medical advertising, which still has such a stranglehold on the American healthcare system.

This half of the book documents every rung of the brothers’ steps to success, as well as all their feuding and pride. Their various marriages, dalliances, children and personal tragedies. Arthur’s obsession with art collections is dealt with in astonishing detail. Everything is dealt with in astonishing detail.

In the second half of the book, the Sackler family and their in-fighting gets a little sidelined as Purdue takes centre stage. This company developed research into opioids which would then turn into Oxycodone – and Keefe shows us, again in rigorous detail, how the marketing of the drug in a completely ruthless way led, incrementally (Keefe argues), to the deaths of hundreds of thousands of people – and how the company sought to tarnish those who were lost as wilful addicts rather than victims of their determination to prescribe higher doses for longer to as many people as possible. The end of the book looks at how the untouchable family start to become hate figures, as the truth about their tactics and deceit becomes wider known. It also shows how they’ll probably get away with everything.

I’ve skimmed the surface of this book. It really is researched to an astonishing degree. It will leave you furious about the total lack of ethics behind this company, and the granular way in which Keefe unpacks their lies and manipulations, and the way that good lawyers will let you get away with everything, will certainly infuriate most listeners. Even if, like me, you thankfully don’t have any connection to the opioid crisis. (It is worth noting, though this comes late in the book, that Purdue weren’t the only company to market opioids aggressively – apparently they never had more than about a third of the market – so Purdue and the Sackler family are certainly huge in this arena, but not lone wolves.)

Is all the detail necessary? I will say that, like almost any book over 500 pages, it would have been better if it were shorter. In the first half, where the level of granular detail has no bearing on showing injustices, I’d say that two out of every three sentences is extraneous. We hear about the lighting that someone chose to hang above their artwork. We hear about the graffiti on an archaeological item that Sackler paid to ship to the US. There is seemingly nothing that Keefe learns that he doesn’t include.

In the second half these details feel more like they are building a court case – and, in this half, Keefe leans a little towards repetition. We hear the same lines repeated over and over again – for instance, that Purdue marketed Oxycodone as giving pain relief for 12 hours even though their own studies had shown it wore off after eight. That fact must have been in the book at least six times.

It’s hard to fault somebody who has done years and years of research, and risked the notoriously litigious Sackler family, so I will say that this overlongness doesn’t lessen from Empire of Pain being a masterful and extraordinary work. It doesn’t make for fun reading – but, since opioid addiction is now the leading cause of preventable deaths in the US, it fees like essential reading.

Five memoirs I’ve read recently

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Quite a large percentage of the non-fiction I read or listen to is accounted for by memoirs and biographies. While glancing at my pile of books to be written about on here, I realised that five of them fell into the category of memoir and autobiography – while covering an extraordinary range between them. And all by authors where I haven’t read anything else by them. Here they are…

My Father and Myself (1968) by J.R. Ackerley

I have four of Ackerley’s books, because I’ve always assumed I will enjoy his writing (and because they are delicious New York Review of Books Classics) – I took to Twitter to ask people which I should start with. While My Father and Myself didn’t win the poll, the replies were sufficient to convince me.

As the title suggests, this book is more or less equal parts about Ackerley and his father, Roger – a relationship that grows steadily more fascinating as the book continues. At times, they have a shocking openness, particularly around sexual matters – while there are other, major parts of Roger Ackerley’s life that his son had no idea about until after his death. I shan’t spoil what they are, because they are revealed rather late in this book – though I was already aware of them because I’ve read The Secret Orchard of Roger Ackerley by Diana Petre.

From the attention-grabbing opening line onwards (‘I was born in 1896 and my parents were married in 1919’), Ackerley is an excellent storyteller – particularly about the things that interest him. What most seems to interest him, for better or worse, is his own sexual exploits. There is an awful lot about the young men he encountered through life and what he did to them (and they to him). There is a startling candour in these passages. In a biographer, it would have felt unprofessionally prurient; in Ackerley’s own words, it seems like a lengthy attempt to understand his own fascination with this aspect of his life.

More interesting to me was his perspective on his parents’ marriage – people say that nobody knows a marriage except those in it, but constant onlookers can perhaps have a more even-handed view. His mother put up with a lot; his father was not a monster, but lived by a set of principles that combine curiously and don’t benefit many people, including himself.

Honesty and accuracy are not the same thing, of course, and Ackerley’s striking openness sits intriguingly alongside the limits of his self knowledge. It’s a fascinating read, often uncomfortable, but mesmerising too.

Diary of a Lone Twin (2019) by David Loftus

To talk of the death of one’s twin to surviving identical twins is almost impossible; the break of that bond is too painful and shocking to describe, too unbelievable to imagine.

Loftus was in his 20s when his identical twin brother died, not long after they had celebrated their birthday together. Three decades later, he takes us through the diary of a year – a year where nothing significant happens in relation to that death, but which is as good an opportunity as any to continue processing the grief, seeing what has happened to him over the years.

As you probably know, I have a twin brother (Colin, who is also reading Loftus’s memoir), and the idea of losing him is as unbelievable as that quote at the beginning suggests. My life doesn’t make sense without him. And that’s the world David Loftus was thrust into, from a brother who was also his best friend. We don’t learn at first how he died, and Loftus measures out the parts of that story throughout the first half of the book. It feels oddly like a thriller, as we piece together how it happened – eventually discovering that it was shocking medical malpractice.

Of course, Diary of a Lone Twin is not an objective account, nor should it be. Rather than simply a description of what happened, it is Loftus’s thoughts on life without John – and how it might have been different. It’s also about his recent second marriage, about his son, about his career as a food photographer. At times, it felt like other things were crowding out the story of John and its aftermath (I could particularly have done without the pages about how much he hates cats). But, even with the padding, this is a very engaging attempt to describe the unthinkable.

Delicacy (2021) by Katy Wix

I listened to Wix reading this extraordinary memoir – about cake and death, as the subtitle says (and isn’t it a brilliant title for that?). It looks through the significant moments of Wix’s life through the prism of cakes that she associates with each of them. And it’s about the deaths of her father, her mother, and her best friend.

I first encountered Wix as a contestant on Taskmaster, and she appears in almost every good British TV show of recent years. While she is extremely funny in character roles, her personality and comic sensibility is rather different on her own terms – it is still funny, but it is equally melancholy. In her narration, there were plenty of lines that would have made me laugh if I’d read them on the page, but she delivers them with calmness, almost a sadness, which makes them effective in a very different way. A possible exception is the chapter on a personal trainer, which does have moments of poignancy but is more unabashedly hilarious than other sections of Delicacy.

As well as discussing the loved ones she lost, in difficult and painful ways, Wix also writes about her career – the highs and the lows, and particularly about the way that she has been expected to look and behave as a woman in the industry. She doesn’t name many of the productions she’s been in, so it’s not a tell-all in that sense, but she is still very candid about the treatment she experienced. And there is a moving, tense chapter on a possible reunion on a project with a bully from her early life.

As you can perhaps tell from this overview, I don’t remember any of the specific cakes that Wix associates with different moments of her life. As a framing technique, it isn’t especially relevant – but if it helped her produce a book this good, then hurrah.

Sidesplitter: How To Be From Two Worlds at Once (2021) by Phil Wang

Another comic I first encountered on Taskmaster, and a memoir published in the same year – which I also listened to as an audiobook read by the author. Wang spent the first 16 years of his life in Malaysia, and the second 16 in the UK – so this book is about a life split down the middle in years, but also in terms of identity. He writes of feeling not Malaysian enough for Malaysia and not British enough for Britain.

The book is divided into different categories – food, nature, language etc – which gives Wang opportunities for covering a vast amount of material. There is definitely some serious stuff about racism in here, and about the differences between cultures and the difficulties of trying to ‘be from two worlds’ without either of them suffering – but it’s also a very, very funny book. Wang’s writing is much more punchline-driven than Wix’s, and a lot of the book would feel equally at home as stand-up. I definitely recommend you try the audiobook, if you read Sidesplitter, because it really requires Wang’s insouciantly optimistic voice.

Raining Cats and Donkeys (1967) by Doreen Tovey

Definitely the most uncomplicatedly fun book on this list, it’s one of a series that Tovey wrote about having Siamese cats and a donkey. It opens with:

Charles said the people who wrote this bilge in the newspapers about donkeys being status symbols were nuts.

At that moment we were in our donkey’s paddock dealing with the fact that she’d eaten too many apples, and I couldn’t have agreed with him more.

It’s representative of the entirety of this short memoir. The book is a collection of self-deprecating stories that show how complicated life can get when you fall in love with spirited pets. The stakes are not often particularly high, and that’s what makes them so entertaining to read – because things might go awry, but at the end of the day Doreen and Charles will be happy together, contentedly accompanied with a menagerie of animals.

Tovey is very good at conveying the characters of the two cats, Solomon and Sheba, and Annabel the donkey – without ever making the mistake of making them too twee or fanciful. She is a keen observer of genuine animal behaviour, in its ruthlessness and obstinacy as well as its more gentle moments, and describes them with humour and affection. My edition was given to me by my friend Kirsty and Paul, and has an earlier handwritten dedication from 1968: ‘For Alan, as a Bedside Book (to encourage earlier bedtimes). I can see that it would have done.

A Town Called Solace by Mary Lawson

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Somehow five months have passed since I read A Town Called Solace (2021) by Mary Lawson and I haven’t written about it yet – but that’s not because I disliked it. On the contrary, Lawson is up there with the small number of living authors I love – and my love of her came on in bounds when I read The Other Side of the Bridge and declared it my best read of 2021.

In A Town Called Solace, Lawson is back in Ontario, Canada, in the fictional small town of Solace in 1972. It’s the sort of place where everyone knows each other, there’s only one place to eat, and that one place has a minuscule menu. In this community we first meet Clara, looking out of the window at the house next door – Mrs Orchard’s house. She sees a new, unknown man arrive there.

There were four boxes. Big ones. They must have lots of things in them because they were heavy, you could tell by the way the man walked when he carried them in, stooped over, knees bent. He brought them right into Mrs Orchard’s house, next door to Clara’s, that first evening and just left them there. That meant the boxes didn’t have necessary things in them, things he needed straight away like pyjamas, or he’d have unpacked them.

Clara is an eight-year-old, and so her perspective on things that happen around her is not an adult perspective. She knows that her older sister Rose is missing, after a row with her parents, and has vowed to stay looking out of the window until she comes back. She knows that Mrs Orchard – Elizabeth – is also away, because she has been asked to feed the cat. But she doesn’t know who this man is, what his connection is with Mrs Orchard, or why she is taking so long to return.

Lawson takes us into another two perspectives, in different chapters. One is this new man, Liam, who has just separated from his wife and left city life for this provincial backwater. I loved seeing him discover a small-town community (and interested to discover that Lawson left Ontario herself for England in the 1960s – so this is all drawn from memory). This community is not particularly warm to his arrival, and certainly doesn’t find some pure, simple folk to Remind Him About The Meaning Of Life. Rather, Lawson shows the contrast between urban and rural life, with the advantages and disadvantages of both. I particularly enjoyed reading the stilted, amiable relationships he finds with locals – in the sole eating place, and especially with Jim, a local handyman who starts to employ Liam. What a lovely, insightful portrayal of Jim this is:

He straightened up and raked through a jar of screws. “All you do for your kids, three square meals a day, nice warm house, teach them a good trade, what do they do? Take off and learn to be a vet. I told him, you like animals so much, get yourself a dog, for Pete’s sake! Get a horse! Get an elephant! Cheaper than a vet degree. I’m staring poverty in the face.”

He was a big, tough-looking, weather-beaten guy but he was so proud of his son he couldn’t even look at you for fear it would show, Liam could hear it in his voice.

The third perspective we get is Elizabeth Orchard’s – though this is the only that isn’t from the 1970s. We see her thirty years earlier, and gradually learn about her connection with Liam. I shan’t say anymore about that, but it’s done beautifully. Lawson is better known for slower, more meditative narratives. A Town Called Solace is still more interested in character than plot, and she transports the reader into a different world for a while with an expert authorial gentleness – but this is definitely plottier than the other books I’ve read by her. There are twists and turns in the connection between Elizabeth and Liam, and in the modern day story too. It even gets a bit dark, which I felt perhaps distorted the tone a little at times towards the end. That’s my only quibble with this book.

Overall, I thought this was another triumph by Lawson. It has certainly stayed with me over the months since I read it, while most novels fade from my memory very quickly. Lawson is so good at drawing complex, interesting, believable people – and even better at putting them in communities and seeing how the dynamics shape and evolve. All three of the main characters here are fully realised people who draw the reader’s empathy and even love. It’s hard not to love characters this vividly created.

The City of Belgium by Brecht Evens

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The City of Belgium: Amazon.co.uk: Brecht Evens: 9781770463424: Books

You might know that I’m a fan of the graphic novelist Brecht Evens. The City of Belgium (2021) is his fourth or fifth book and I’ve read and enjoyed all the others to differing extents – from deeply loving to being deeply disturbed, but still recognising his brilliance. The City of Belgium was translated by Evens himself – it was originally published as Les Rigoles, which Google translate tells me means ‘the channels’, but is a venue in Paris. I thought it was originally written in Flemish, so this all gets a bit confusing. Suffice to say, I was delighted to get a review copy of this from the publisher, and I think The City of Belgium is a brilliant title.

The book follows three people on a night – three separate nights out for Jona, Rodolphe, and Victoria, and the various people they meet, interact with, love and loathe. We interweave between them all, with a colour-coding indicating which world we’re in.

Being Evens, these are not quiet, happy nights. His work often includes menace, unhappiness, warped eroticism, and the surreal. But it also includes moments of joy, unexpected connections, and hope. The balance of these elements is what makes an Evens’ book a favourite or not, in my eyes. The Panther went a bit too far into warped territory for me; The Making Of hit the sweet spot.

I think The City of Belgium is perhaps a little to the right of the sweet spot – perhaps not quite enough hope to balance out the despair. We see violence, loneliness, arguments. But then there are pages like this one, showing the humour that Evens threads through any situation.

 

The story is one thing, but what always draws me back to Evens again and again is his stunning use of colour and form, and his astonishing imagination. Some pages are spare, like the one above – or even more so, even disappearing in a mist. Others are a riot of colour and action, beautifully balanced and judged perfectly. The cover is one example, but sometimes a whole world is going on. You can see more examples in this excellent article, which includes interviews with Evens. The stereotype of graphic novels is still that they look like superhero cartoons – and, while there is a world beyond that, I’ve browsed through a graphic novel shop for hours without finding anyone who uses colour so gently and sensuously as Evens’ watercolours. The meeting of subject matter and technique is particularly striking.

You’ll leave an Evens graphic novel feeling both unsettled and satisfied. Perhaps that isn’t always the combination you’re looking for from a book – but it is a profound mix, and sometimes feels exactly right.

Fifty Sounds by Polly Barton

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I bought two copies of Fifty Sounds (2021) by Polly Barton in the year it was published – one for a friend and, because I couldn’t resist it, one for me. Not only was it that beguiling Fitzcarraldo white, adding to my growing pile of matching covers with diverse insides – but it was about languages. As a monoglot, I find the experience of becoming fluent in another language a total mystery, and absolutely fascinating. That is all the more true when an author writes about immersion in a language and culture, and even better if translation is involved. Polly Barton’s memoir (of sorts) was thus unmissable for me.

Fifty Sounds is about a lot of things, but the most obvious of them is Barton’s experiences moving to Japan to teach. The chapters are each headed with a ‘mimetic’ – close to what we’d call onomatopoeia in English, though Japanese has far more of them and the link between sound and meaning isn’t always immediately clear. And often the word has several different meanings, each of which can be traced back to some slippery integral sound-meaning, or may rely on subjectivity. Some examples of these chapter titles include ‘hiya-hiya: the sound of recalling your past misdemeanours’, ‘kyuki-kyuki: the sound of writing your obsession on a steamy tile, or the miracle becoming transparent’, and ‘shi’kuri: the sound of fitting where you don’t fit’.

Before Barton moved to Japan aged 21, she knew very little of the language or culture. It seems a very impulsive move – she cannot answer the questions she gets about why she chooses Japan. The surface answer is that a boyfriend convinced her they should both apply – though, as it happened, only Barton got a place. As you get to know her more in these pages, it’s a decision that embodies so much about the way Barton approaches situations: bravely, adventurously, perhaps unwisely. She doesn’t even go to Tokyo or somewhere that might be on a bucket list – she goes to a small island, and dives head-first into a period that seems absolutely overwhelming.

I loved Fifty Sounds for many reasons. As I’d hoped, Barton is so interesting on the topic of language-learning. The moment when she understands something she reads casually is described like an awakening. There are fits and starts as she gets closer to fluency – though ‘fluency’ is a concept she will examine in the book, as well as exploring what the stages between ignorance and fluency could be. And she is so good on the different personalities one might have in different languages, and what that phenomenon does for one’s sense of a stable identity.

Barton’s primary interest isn’t a clash of cultures – she finds the idea of exploring Japan only in relation to her own Englishness rather shallow and reductive – but she does write about how a language will interplay with a culture’s unspoken norms. And how much one may have to adopt a cultural viewpoint when one adopts a language. Here, for instance, is a conversation she has with Y – and older, married colleague, with whom she is having an affair:

That day, I had been reading something about kimi, which, the book said, is used by older men when speaking to subordinates at work or younger men, and also by men to women.

‘Is it true?’ I ask Y now of the above, and he nods. I actually end up asking him this question about a lot of things I’ve read in the textbook, like an idiot: is it really true?

‘But you don’t ever say kimi,’ I say. ‘I’ve never heard you say it.’

‘I could do,’ he says. ‘It’s kind of cute.’ And then he says, kimi, your hair is hanging in front of your face, and tucks it behind my ear.

And so, though I sense I am not allowed, I try it back. I call him kimi.

‘No,’ he shakes his head. ‘You can’t say it to me.’

‘Why?’ I say, in a way that is aiming to be cheeky and a little bit kittenish, but in fact makes me seem like a child. ‘Because you’re a man? Because you’d older than me?’

‘Yes,’ he says, serious. ‘It’s rude.’

‘But it’s not rude if you say it to me?’

‘No.’ He seems utterly unapologetic in a way that surprises me. I think I make a noise, some form of pff sound, and we get onto another conversation.

As that mention of her older, married boyfriend suggests, Barton doesn’t cloak anything. She is very open about her poor choices, indeed she often seems quite excoriating about herself in a way that makes Fifty Sounds as much confessional as linguistic exploration. It’s occasionally quite painful to read. As always with this sort of book, I can’t help feeling what the reactions were from friends and family (and exes) on publication day.

But I am not among that number, so I can simply admire the ambition and innovation of this book. It’s genre-bending, as so many of Fitzcarraldo’s output are, and Barton combines all the different influences with incredible success. I’ve previously loved Bleaker House by Nell Stevens and This Little Art by Kate Briggs, and Fifty Sounds feels rather like the meeting point of those two brilliant books. It is certainly an exceptional, and exceptionally interesting, achievement.

White Spines by Nicholas Royle

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About a minute after reading Susan’s review of White Spines by Nicholas Royle, I had ordered my copy – directly from the publisher Salt, which perhaps explains why it came with a surprise author signature on the title page.

It is exactly the sort of book I like: a book about reading, about buying books, and a love for literature that is more idiosyncratic than a slavish devotion to Lists of Great Works. The ‘white spines’ of the title are those that Picador used from the 1970s to the 1990s. If I’m honest, they’re exactly the sort of books my eye flashes past in a charity shop. It’s an era of literature that I know very little about and, except for a few stand-out names, I am pretty poorly read for those decades.

Royle does love some of the writers he buys from this period, but he buys books without necessarily ever anticipating reading them. He is a completist: he wants all of the titles. He wants the anomalies, from when some of the books had black or patterned spines. He wants a ‘shadow collection’, where he duplicates books already on his shelves of white spines. And his buying goes in tangents – an admiration for a cover artist will lead to him buying everything he can with the same artist on the cover, for instance. Almost anything can form the basis of a collection, and you get the sense of Royle’s – surely enormous? – house being a melting pot of different fascinations, grouped in overlapping collections.

Despite not sharing Royle’s particular tastes, and seldom buying books unless I have at least vague intentions of reading them, I loved reading about his bookish adventures. Next to going on a book buying spree, I enjoy experiencing them vicariously – and a lot of White Spines is about his book shopping. Sometimes far afield, sometimes in bookshops or charity shops that are regular haunts. He seldom comes away empty handed, and manages to convey both the excitement and the curiosity of the perennial haunted of bookshops. Here’s a trip to The Bookshop Experience in Southend… which I just kept writing out, because I enjoyed the journey we go on as he scans across the shelves.

As soon as I enter the Bookshop Experience, I know I’m in luck. I’m immediately taking the books off shelves. Paul Bowles – two Abacus collections, A Thousand Days for Mokhtar and Call at Corazon, in the same series, with excellent photographic covers, as two titles I already have. Calvino’s The Literature Machine, in the Brothers Quai (sic) series of covers from Picador (a separate series is credited to the Brothers Quay). And then – increasing heartbeat – I spot an early Sceptre paperback of Siri Hustvedt’s first novel, The Blindfold.

I love The Blindfold. My edition is later and features a woman’s midriff in a crop top that has always felt wrong to me. I like this earlier, uncredited cover with its blindfold, its disembodied eyes, Chrysler Building and 109th Street sign. Next, a King Penguin edition of BS Johnson’s best-known novel, Christie Malry’s Own Double-Entry, that, as with The Blindfold, I hadn’t even known existed. Finally, I can’t quite believe it, but, yes, there, under K, a copy of the white-spined Picador edition of Kafka’s The Trial, which I have only seen once before, in the home of writers David Gaffney and Sarah-Clare Conlon.

When I saw it at the Gaffney-Conlon residence, I was tempted to become a book thief. The Trial exists in many editions, from different publishers, with different covers. This Picador cover, by Steven Singer, has the distinction of having previously been, to me at least, invisible. Normally, if there’s a Picador I know I want, I don’t order it, as previously discussed. In the case of The Trial, however, I weakened. Having seen it in the wild, having even handled it, I couldn’t resist and did go online and did order, off eBay, what appeared to be the same edition. When it arrived it was a Picador Classics edition. The same translation, by Douglas Scott and Chris Waller, but in the black spine of Picador Classics, with a cover illustration by Peter Till. The search for the white-spined edition would continue, but my lesson learnt, only in the real world.

If this sort of thing is your jam, then this is the book for you.

There is a lot else of interest here, including Royle’s own writing career and his experience of sending stories to small magazines, his interviews with people connected to Picador and other publishing ventures, and an entertaining tangent into authors with the same names. He has reason to find this interesting: there is another Nicholas Royle, and they even both appeared in a collection I read about writing. The other Royle wrote a novel called Quilt that I found impenetrable and a book called The Uncanny that was rather too self-indulgent to be useful as the critical text I was hoping it would be for my DPhil. Safe to say, I prefer this Nicholas Royle.

Personally, I seldom care what edition a book is, and the only books I’ll get simply for the series they’re in are Persephone Books and Slightly Foxed Editions. But Royle still conveys much of what most of us will recognise in ourselves: someone who is not simply an occasional reader, but someone for whom books mean an enormous amount. We love reading them, but we also love being around them, choosing them, collecting them, and hunting them down. Royle is a witty, friendly writer, and it was a delight to go on this voyage with him.

The Painful Truth by Monty Lyman

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As I probably said when I wrote about The Remarkable Life of the Skin, I would probably never read popular science if it weren’t written by Oliver Sacks – or by one of my friends. And it would be my loss, because if I didn’t read my friend Monty’s books then I’d have missed out on a lot – and I found The Painful Truth even more fascinating and engaging than his previous book.

As the subtitle says, this is about ‘the new science of why we hurt and how we can heal’ – but it’s also how everything we think we know about pain is wrong. Or, rather, everything I thought I knew; I shan’t tar all of you with the same brush of my colossal ignorance when it comes to science. I’d also blithely assumed pain was largely connected with nerve and tissue damage. Of course, I knew other factors could be at play – pain always hurts more when you don’t know what’s wrong and you’re really anxious – but I hadn’t realised quite how big a role expectation and comprehension play in how much pain we feel. (While being ‘all in your mind’ doesn’t, of course, make pain any less real.)

Vision is not a measure of light and colour: it is designed to make meaningful sense of objects in the outside world. Pain is very similar: it is not a measure of damage or danger but is instead the brain’s unconscious opinion on whether our body is damaged or at risk.

Lyman (it’s easier for me to write objectively about this book if I imagine the author as Lyman rather than Monty!) doesn’t stop at this rather profound re-education on what pain is, of course. The Painful Truth often returns to this fact, and to the idea that pain is there to help not hinder us, and spreads outwards from this starting point. It is so chockful of extremely interesting experiments and facts (for instance – an experiment where strong opioid pain relief was given, but only had significant effect when the patients were aware it was being given; when they were told it hadn’t yet started or had stopped, the pain relief didn’t work). Lyman must have done an astonishing amount of research, and this is the anecdote I keep telling people, about hypnosis:

Highly hypnotisable people are able to respond to questions by ‘automatic writing’, where one hand writes answers to questions without the subject’s awareness. In 1973, the renowned Stanford psychologist Ernest Hilgard tested this out on a young woman – le5t’s call her Lisa – by first asking her to rest her hand in ice-cold water. Unsurprisingly, she found this intensely painful. Lisa was then induced into a hypnotic state, and again her hand was placed into the ice water. This time she reported feeling no pain whatsoever, but while she was verbally describing how relaxed she felt, her own hand continued to automatically write, reporting that she was feeling agonising pain – the same pain she felt when she was not hypnotised.

Yes, I find this rather creepy. But also completely enthralling, and helping shift everything I thought I knew about pain. Elsewhere, Lyman is really interesting on the placebo effect. I think, colloquially, this perhaps dismisses things that are ‘only the placebo effect’ – whereas when it comes to pain, this could be a very powerful solution. And how does it work? I shan’t summarise a whole chapter into a paragraph, but I did find this quote really interesting:

This isn’t the placebo – an inert substance – doing the work; let’s give our brains the credit. It is our belief in the treatment that opens up the brain’s drug cabinet. The active ingredient is expectation. This is neatly seen in the hierarchy of fakery; not all placebos are created equal. Saline injections tend to have a greater pain-relieving effect than sugar pills, and it wouldn’t be surprising if fake surgery is significantly better than both of these. An expensive placebo is more effective than a cheap none. The more dramatic the intervention, the more meaning the patient attributes to the treatment.

It reminded me of a book I read about why people believe conspiracy theories – and it is partly because we can’t cope with the disparity between enormous effect and trivial cause. Nobody has conspiracy theories about assassinations that just missed, but people find it hard to think that an invent that changed the world could be caused by one person with a gun. In sort of the same way, if I’m understanding it properly, our brain expects big results from big actions. And since the brain is the one determining our level of pain, it can answer its own expectations.

This is only a taste of the wide variety of topics covered, each covering a range of Lyman’s own experiences, notable experiments, and a little bit of technical info (which I didn’t always fully understand, but it is far from overwhelming in the book). Among other things, Lyman writes about people who don’t experience pain at all, pain and PTSD, pain after amputation, and the ordeal faced by patients with chronic pain – particularly chronic pain where there doesn’t seem to be any diagnosable cause. What makes Lyman’s writing appeal to me so much is the same thing I love about Oliver Sacks’ books: the compassion. It does help that I know him and know what a lovely guy he is, but I think it would come across anyway. The people he writes about aren’t simply scientific curios, or even patients. They are people with complex lives who are often suffering deeply, or bewildered by the tests they have undergo, or frustrated by no solution being in sight. The only times Lyman is clearly frustrated himself is when writing about medical professionals who don’t have compassion, won’t try to find solutions, or underestimate the consequences of pain.

I was initially wary of telling friends with chronic pain that I was reading a book about pain. I am sure people who suffer in this way are sick of being recommended remedies, usually from people with far less expertise than them. But I think this book would be helpful. While Lyman is very keen to emphasise that The Painful Truth is not a self-help book, it does include some really useful things people who experience persistent pain can do – recognising that, though the responses he lists have a weight of research behind them, the medical profession is often very behind in treatment recommendations. I’ve experienced difficult-to-treat pain over two periods – intense and constant tension headaches one year, and severe RSI over several extended iterations – and I know how exhausting it is to keep going back for diagnosis or treatment when neither seem forthcoming – and that was only over short-term periods. I really hope a book like The Painful Truth can offer some help, even if it isn’t a self-help book. At the very least, Lyman recognises the severity of persistent pain and the impact it has on millions of people.

But whatever your experience with pain is or isn’t, The Painful Truth is an engrossing, well-written, and wide-ranging book. Even if you’d never normally pick up popular science, I think almost anybody would get a lot out of this. It’s always a relief when a friend’s book is genuinely excellent, but even better when they’re as brilliant as this book is. And Monty has my rapturous Instagram messages to prove that I’m saying the same thing in public and private!

Ghosted by Jenn Ashworth

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Novels about missing people seem to be a genre in themselves. So many crime novels that I read about (and never read) are about missing children or missing women – massive turn-offs for me, partly because I’ve heard that they tend towards the gruesome, but also because I am fully Team Staunch Book Prize. Which is one of the reasons why I was keen to read Ghosted by Jenn Ashworth (2021 – a new novel!!) – because here it is the man who goes missing. Also it’s a novel by Jenn Ashworth, and I always want to read those.

The narrator is Laurie, a cleaner at a university who has been married to Mark for some time – they initially met at a wedding, where a psychic called Joyce thought they were already a couple. The novel opens with an ordinary scene of the two waking up together – talking about a broken curtain, about staying up too late. Unspokenly considering morning sex, and unspokenly deciding against. Getting up to make a cup of tea.

It’s hard to know how other couples live their lives, but all of this had become utterly ordinary for us. I told the police as much, later. I left for work while he was still in the shower. I don’t know what he was wearing that day. No, he hadn;t seemed unusual in any way that morning. 

The officers – they sent two, a man and a woman who both refused a hot drink and made notes on a tablet instead of in a notebook – seemed frustrated by the fact that no matter how they phrased their questions I had nothing to add – no suspicious or out-of-the-ordinary behaviour on his part – to my account. I didn’t tell them I was pissed off with him, but I am telling you now.

One of the unsettling things about the novel is that we don’t know who’s the ‘you’ that Laurie is speaking to, or even when the ‘now’ is. Mark might not have displayed any out-of-the-ordinary behaviour, but Laurie certainly does. Her emotional reaction to Mark disappearing is subdued. She is speaking directly to us, but holding back from any outburst or breakdown. She doesn’t tell people that Mark has gone missing – whenever his mother Mavis phones, she says he’s in the shower or otherwise unavailable. It’s several weeks before Laurie even contacts the police.

This is nothing as conventional as the unreliable narrator – except inasmuch as every narrator is unreliable. Laurie isn’t really connected with her own thoughts on and responses to this seismic event. Ghosted reminded me often of My Phantom Husband by Marie Darrieussecq. Laurie doesn’t unravel in the same way as that wife-of-a-missing-husband, but there is the same eerie inability to conform to anticipated reactions. Laurie certainly isn’t ignoring Mark’s disappearance, but her thoughts about it always skirt around the conventional. Everything in this novel skirts around the conventional, in fact. There is no desperate hunt to find him – but rather a sort of dispassionate paranoia and anxiety.

I know now the reason I was so reluctant to tell her that Mark had left me was because I feared she would blame me for driving her adored son away. Whatever made idea was currently gripping him and sending him across the country, it would be me that had planted it in his mind. My responsibility, at least, to pluck it out before it could take root. My task, as his lover and wife, to make home a sanctuary and a paradise that he could not bear to leave. If he’d found another woman – someone better groomed, more sympathetic, more likely to store colanders in the correct cupboard – well, he couldn’t be blamed for that. And underneath all that, the fear: once Mavis had decided this was all her fault, she would leave me too.

Mark’s isn’t the only disappearance in the novel. A second plot is Laurie’s relationship with her father, whose mind is gradually disappearing – and also his cleaner-turned-helper Olena, who is closer with him than Laurie is. Ashworth shows the shifting and sad relationship between father and daughter with the same subtle complexity that she does everything, pieced together with memories of the past and anxieties about the future. Other threads are Laurie’s obsession with a young girl who was murdered years earlier, tracking down psychic Joyce, and some money that Olena might have stolen. All are wound together naturally and cleverly, never quite going in the way you expect.

And that’s the brilliance of Ashworth’s writing, I think. Her novels are often unsettling and odd, but every moment is plausible. As soon as it happens, it feels exactly right, even as she resists the natural next steps and anticipated reactions. Overall, Ghosted leans towards the ambiguous and uncertain, but in a way that makes any alternative pathway from her initial premise feel unnatural and stilted. It’s another excellent and consistently interesting success from one of the few still-publishing authors whose books I will always look out for.