O’Keane never patronises – the vibe is like being in a lively lecture theatre. Her warm personality shines through her writing. Her mind is rich, burgeoning, tangential. I loved her sympathetic asides on cold water’s benefits (she swims throughout the year in the Irish Sea), and her account of the effect the scent of lovage had on her when expecting a child and her overriding wish to reassure readers. She explains that sleep and exercise improve memory. And while memory can be impaired by depression, she assures us it can improve once depression ends. For the forgetful, there is this comfort: “Knowing you have forgotten something is a form of memory.” She is generally uplifting on the subject of older people, suggesting we will arrive eventually at a serenity where we want nothing from the world “except to be in it”. When she writes about her childhood in rural Ireland, there is a lyrical memoirist in there clamouring to get out. But at no point is the memoirist allowed to wrongfoot the science.
She punctuates her narrative with brief but unforgettable case histories of some of the patients she has treated in her work as a clinician. These passages are vivid and immediate, and all the more affecting for the measured and unemphatic manner in which they are set down. If O’Keane is as fine a doctor as she is a prose stylist, her patients are fortunate indeed. The first “story” she tells is that of Edith, whom she encountered when she worked at the Bethlem Royal hospital in London in the early 2000s. Edith had no history of mental illness until she gave birth, but thereafter, the onset of her illness was rapid and devastating.
This complex book is challenging to read, and merits a second reading to fully understand. But, to borrow a phrase, il vaut le voyage. At the end of the book, O’Keane expresses her hope that the reader will have enjoyed even a fraction of the pleasure she had in the writing of it. Well, I did.
None of this is in waffly LA consciousness-speak; it’s all evidence-based neuroscience. But O’Keane also brings in writers who were aware of memory and longing — Proust and his madeleines; those who felt alienation, such as Sartre and Camus (was Sartre’s nausea in the eponymous book due to heightened sensations in the insula?); and those who explored consciousness — Henry James and his psychologist brother William; John Berger; Beckett; Dostoevsky; Huxley; Yeats; Joyce; Baudelaire; Munro; Eliot, Carrol; Dylan Thomas; even Nick Cave.
This cogent, meticulously researched book deserves to win the Baillie Gifford or Wellcome Prize.
You wouldn’t read this book for practical tips, though. It is more of a meditative investigation — at once scientific, philosophical, medical and literary. (And distinctively Irish: O’Keane quotes writers from WB Yeats to Samuel Beckett and the Dublin poet Paula Meehan.) It does not have the ease and narrative drive of a Sacks book, and the clinical case studies are not as astoundingly memorable — no one is mistaking anyone else for a hat here. Still, it is rich, revelatory and, in the best way, unsettling.