The Best Australian Essays 2015 (20 page)

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The runaway bestsellers
The Brain That Changes Itself
and
The Brain's Way of Healing
by Norman Doidge have been widely criticised – particularly by doctors – for ‘blaming the patient for their disease'. The Canadian psychiatrist's two books rage against the institution of medicine that is structured to reinforce what he calls a patient's ‘passive resignation' in the face of disease. He argues that we have been trapped by the myth that treatment comes only in the form of a pill. He believes that medicine must change.

His interest is in brain plasticity. He shows the multiple ways there are to ameliorate or slow the progression of many neurodegenerative diseases through doctors ‘prescribing', medical systems supporting, and patients engaging in active therapies. These therapies are mostly arduous and involve a great deal of mental and physical effort. One of his case studies tells of John Pepper, a man with Parkinson's disease who had almost lost the ability to walk. Pepper teaches himself to make the brain stem (unconsciously performed) movements of walking cortical (consciously controlled). Each movement is directed by a conscious thought – bend hip, lift knee, kick foot out, straighten knee – so that to take a step requires all of Pepper's concentration. You'd have to train like an athlete to attain this ability to make the unconscious conscious: it would be exhausting, you'd have to want to walk more than anything else. You'd need to be taught how to do it. Other forms of physical therapy improve the symptoms of Parkinson's or slow the decline, but they too can seem much like boot camp. Doctors see patients with Parkinson's, diagnose them and usually only prescribe medication, as if the patient is a generic, inert body. Conventional treatment has become something one receives from an encounter with a doctor and his or her script pad. It is this passivity of the patient – reinforced by medicine – that Doidge challenges. He asserts that the brain and the body are ‘use it or lose it' structures. He writes, ‘Exercise decreases the risk of dementia by 60%. If a medication did that it would be the most popular, talked about treatment in medicine.' Unfortunately, you can't just buy it. You have to do it.

I sat next to Doidge at a literary festival. As we signed books, I looked at the lines of waiting people – his line snaking far across the room – and I wondered if anything would come of his words, or if we were all buying these books in the millions the way we buy diet books in the millions and never lose weight. We buy them in hope, hold them in our hands, flick through the pages, read stories of transformation, but when we don't discover a miracle or quick fix we slip them onto our bookshelves. We buy them as talismans. We buy them as if they are pills.

Blame the patients? Blame the doctors? According to an article in the
British Medical Journal
in June this year, multiple studies have found that, when asked, patients overwhelmingly wanted more studies of non-drug interventions for common ailments – treatments such as physiotherapy, psychotherapy, education and coping strategies. Despite this, according to the World Health Organization International Clinical Trials Registry Platform, 86 per cent of treatments studied in commercial trials between 2007 and 2014 were drugs. Better to blame the socio-political structures the patients and doctors move within, and the industries supporting these structures.

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Rudolf Virchow said that medicine is a social science and politics is medicine, but he went further. ‘Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution.'

We feel sick even if we are physically well. We are organically diseased by lack or excess. Most of our healers – mainstream and alternative – now act and are treated like shopkeepers, and have become entrepreneurs (or the pawns of entrepreneurs). If they don't give us the goods – the diagnosis and pill – we'll shop elsewhere. We seek passive means of attaining health and longevity, which is what medicine (both conventional and alternative) promotes. We want diagnoses. We want solutions we can browse, buy and swallow, be they pharmaceuticals, tinctures or vitamins. It's convenient for politicians, suits industry very nicely. Pills are our tiny white black holes: absorbing all our hope, agency and energy. They divert attention from prevention, population health and inequity; they promote consumption.

The individual body and its individual cells exist, of course, and can be altered and treated by drugs. Mainstream medicine is magnificent in many situations: in treating frank organ dysfunction, trauma and infection; in ablating clots and tumours and abscesses. It is sometimes adequate in others: regular bursts of personal support for the desperate or lonely, prescribing drugs to protect organ function, prescribing drugs that must be taken for a long time by many people to extend the life of some. But prevention and amelioration of most of our grumbling Western ills demand something more than medicine. An alternative, a complement; yes, an ‘integration'. Real ‘integrated medicine', however, is not Pfizer plus herbs plus acupuncture; it is not recognising a bunch of new diseases and their treatments; it is not energy lines plus cells. It is recognising that a large portion of our ill health is a combined mental, physical, environmental, interpersonal, social and political phenomenon.

A cause for many of our Western ills, organic and non-organic alike, might be found in a catchphrase that has become a cliché: that our society has degenerated into an economy. Read the papers – our main purpose and duty is to acquire and consume. At the expense of others in need, of our planet. Inequity increases. Education standards decline. We suffer existential ills that manifest in our bodies. We drive, work and eat, become sedentary, fat, diabetic and depressed. Hospital wards fill with social catastrophes and the outcome of styles-of-life and social policy. Mainstream medicine alone cannot fix this. Real integrated treatment of our disease requires vast social action. It requires personal action: use it or lose it.

Instead, we seek cures that are acts of consumption, quietly swallowing the disease itself. Browsing the numerous alternatives, we buy instead of do. And neoliberal to the core, we regard our population's health as a problem that lies with discrete, always self-determining individuals. And at the very times when the modern, mainstream, despised and idealised discipline of medicine might actually help, or when it finally says ‘no, it's not your body that is sick, I cannot help you', it is only then we start to run. Seeking an alternative that will not fail us, that offers us hope, that promises a cure, but which turns out to be more of the same.

The Monthly

Fully Present, Utterly Connected

Tegan Bennett Daylight

When I remember being a child and reading, I think first of sunlight, which I was always manoeuvring to be partly, though not wholly, in. This sunlight is always linked to quiet, to stillness. The sense of movement around me, but happening at a distance – my mother talking on the telephone (her voice louder as she strayed to the very end of the cord), or my sister using her sewing machine – the sort of movement that envelops you but allows you to be alone. The psychotherapist and writer Adam Phillips, referring to D.W. Winnicott's essay ‘The Capacity to be Alone' (1958), says that ‘the goal for the child is to be alone in the presence of the mother. For a long time this has seemed to me to be the single best definition of reading.'

Perhaps the best definition of good writing is the kind that recreates this safe aloneness, this suspended awareness of the self, this being lost but at the same time attached. We adult readers can go a long time between books that have this effect, and still be entertained and even inspired by what we read. But if we are lucky, every few years a book or a writer will appear that brings this sense back – a book that makes us feel as though that stillness in the centre of movement has been both captured and, in the act of reading, reproduced.

Joan London's
The Golden Age
is this kind of book, and as I learned in reading my way through her work, she is this kind of writer. The best word that I can come up with to describe London's voice is
mature
, which has not much to do with the author's age, and everything to do with her skill. It is the sort of writing that does not immediately invite a mental reply, whether that reply is
how wonderful!
or
how awful!
It does not obscure its subject – no chorus line of verbs or orchestra of adjectives gets in the way of what she is writing about. Her writing, which calls attention to itself only by its precision, gives you an opportunity, the way silence sometimes does, to reflect productively. Best of all, it returns you to an early pleasure: the pleasure of story, of wanting to know what happens next.

The Golden Age
is set in a children's convalescent home for victims of polio – the novel sitting solidly on the foundations of the real place (same name, same function) in 1950s Perth – and tells the story of a twelve-year-old boy, Frank Gold. Frank is the child of Hungarian refugees Ida and Meyer, who have come unwillingly to Perth (they had hoped for America). Meyer has done more than resign himself to this; he has a capacity for happiness that carries him though the novel. He is always on the move, always buoyant, always alight. Ida, on the other hand, is still and dark and angry. The miseries and terrible losses of the Holocaust will never be in the past for her, and her son's disablement by polio, contracted after they settle in Perth, is one cruelty too many. Once she was a concert pianist, but since Frank's illness she has not touched a piano. Her not-playing – and the resolution of this – is one of the book's background melodies, if you will: a sad tune, quietly heard throughout.

The novel opens vividly as a dream:

Already we find Frank in search of the same space that the fortunate reader inhabits: a space where he is held and kept safe, in his case by the hospital, but nonetheless allowed to be alone. It is important to note that despite its setting,
The Golden Age
is not a misery novel. It does not tell a story of abuse, and although it gives us a candid and painful account of Frank's suffering, both as a small boy hidden from Nazis in 1940s Budapest and a few years later as a polio patient, it does not ask us to be either voyeur or fellow sufferer.
The Golden Age
is a story about Frank's dawning and intensely vivid realisation of self – probably accelerated or exaggerated by his experience as a patient, but in truth available to any child who is given enough psychic space in which to grow up.

Frank has been moved from the adults' polio hospital to The Golden Age, where he will be the oldest patient. It feels to him like a demotion. In his previous incarnation as The Kid at IDB (the Infectious Diseases Branch of the Royal Perth Hospital), he was able to exploit his capacity for charm, to make friends, to feel freer, less seen. At IDB, he met Sullivan, an ‘adult' (just eighteen) in the iron lung ward, who would lie all day looking at the white ceiling, thinking and composing poetry:

The two spend hours together. Frank transcribes Sullivan's poetry, and comes to understand that to be a poet is his vocation too. He writes his rhymeless verse on a discarded prescription pad. Conversation about poetry achieves for the two patients what literature sometimes can – respite, and a feeling of clarity in the midst of chaos. London creates a sense of genuine companionship between these two. She does not overstate the pathos of Sullivan's death in the early pages of the novel, intuitively understanding – or perhaps remembering – how children deal with loss. In this understatement, she renders their relationship indelible.

After Sullivan's death, it is thought that Frank will do better at a hospital for children. This is where we see him first, climbing into his wheelchair at rest-time in The Golden Age, with one object: to glimpse the only other child his age, Elsa. She is the single creature who saves him from disgust at his new surroundings, from the indignity of his demotion. The relationship with Elsa is the new poetry in his life; he has someone to write to again. Elsa already has the sense of self that Frank is moving towards. Her status as the oldest child in her family has something to do with this, but it is polio that has given her the strength and calm that Frank is drawn to. London's description of Elsa's initial infection and her time in the Isolation Ward – clearly the worst and most painful part of each patient's illness – is frightening. But it is also balanced, like Elsa herself. Elsa survives, partly for her mother, but partly because of a self she has found at the height of her suffering: ‘another person inside her who had suddenly taken charge, a sort of captain who was going to hold on no matter what'.

Elsa's captain calls to Frank's poet. This calling could be said to constitute the plot of
The Golden Age
: Elsa and Frank ‘fall in love' (or, in fact, simply love each other), and their growing relationship results in a physical encounter that causes the main movement or upheaval of the narrative. But the plot is infinitely more complex and interesting than this suggests. To focus on their relationship and its potential difficulties would be to forget all the fascinating action that takes place around them. London has a deep awareness of her characters' sensual selves, and Elsa and Frank are not the only two people awakened to their bodies. Sister Olive Penny from The Golden Age, whose husband has died in the war and whose daughter has grown up, is visited by a few of the local policemen for encounters that are as satisfying and sustaining to her as they presumably are to the men, whose point of view we are not treated to. The description of Sister Penny putting ‘her soft breasts back in their cups, button[ing] her uniform, quickly stuff[ing] a hanky into her knickers' and reflecting that her sex life ‘fed into her work' is as stirring and sensual as any explicit scene. She is a sexually awake woman who is neither predator nor victim, and only one of
The Golden Age
's richly imagined secondary characters.

The Golden Age
is told in the third person and moves through points of view which are signalled by chapters with titles such as ‘Frank's Vocation', but which are sometimes to do with location: ‘The Sea', ‘The Verandah'. Each character who thinks or speaks is allowed London's careful attention, from Meyer and Olive through to Elsa's mother, whose grief for and worry about her daughter is as judiciously handled as all the other emotional content of this novel. Comparisons have been made before to the work of Alice Munro, and indeed London has that same respect for every character that Munro does. Her writing is free from the sort of contempt that so many novelists rain down on their minor characters. Often you can feel a writer dealing various blows to people they would like to punish, whether the man who cut them off in traffic or the girl who bullied them at school. Anyone who writes knows that this can be a temptation hard to resist, but London shares with Munro and her hero Chekhov a determination to realise her characters' inner selves, so that their faults and casual cruelties are universal and, most importantly, shared or borne by the author.

One can feel a sort of patience at work in London's choice of words, as though she is prepared to wait for the right expression – as when Frank reflects on his move to The Golden Age: ‘He felt like a pirate landing on an island of little maimed animals. A great wave had swept them up and dumped them here. All of them, like him, stranded, wanting to go home.'

In an excellent interview with Charlotte Wood (part of Wood's digital treasure trove,
The Writer's Room
), London talks of the work editors have done for her: ‘they apply themselves with unstinting concentration to the sense and logic of your sentences, the unconscious contradictions or repetitions you have made, and commit themselves to the voice and point of view of the writer.'

If this is so, then London is very lucky, because her editors are so good that their presence in the text cannot be detected.
The Golden Age
reads as though only London herself has had control of the words, and that control has come about through this deep and patient waiting, a kind of resistance to the hurriedness of publishing schedules and contemporary life.

London's previous novels,
Gilgamesh
(2000) and
The Good Parents
(2008), have this same centredness, and the same kind of architecture. London incorporates stories from past and present, characters major and minor, in their youth and maturity. In doing so, she risks building novels that look as though they have been frequently renovated. But I am noticing her structures with a reviewer's eye, trying to understand the way she works; to the reader I gratefully and restfully became in my first pass through
The Golden Age
, the architecture is almost invisible. So many contemporary novels fail to do what Annie Dillard calls ‘erasing your tracks'. They can make you feel unpleasantly active, always aware of the writer and their elaborate scaffolding. By contrast, London's novels seem to float, unsupported.

There are themes running through all of London's novels – a rather high number of difficult sisters (perhaps because London has sisters herself), and an abiding interest in the past. In the
Writer's Room
interview she says:

She goes on to say:

And perhaps this is what I mean by the maturity in London's writing: the slow shifting of focus from the self to the universal; the understanding that who we are is not simply about us. In
Gilgamesh
, the main character Edith is interrogated by her Anglo-Russian cousin Leopold about Group Settlement in Western Australia: ‘Was it a social experiment? And, if not, had it fulfilled its capitalist aims?' Edith and her sister cannot answer: ‘They had never thought of these questions, in fact they did not really understand their terms.' In this brief scene, London captures the childlike self-centredness of white Australia in the first half of the twentieth century, and brings us to consider the gift that was post-war settlement, the alteration in Australian culture that occurred with the influx of European refugees, a kind of awakening. The universal in the personal, all in the space of a page.

London still draws on her own experience, but it is atmosphere she seeks, not narrative. Of 1954, the year in which
The Golden Age
is largely set, London says, ‘I was six then, and for some reason that time has a sort of light around it.' This instinct, to try and capture this ‘light', gives a certain radiance to all of London's work.

London has said that most of her ideas now become novels, although she has been writing short stories since the late 1980s. I like the short stories less than her longer work, though they are invariably Londonesque in being closely observed and beautifully written. But by comparison with the novels, they seem to lack articulation, or declaration; they never quite tell you what they are
about
. Though they have that same tendency to intricate architecture, the architecture is not invisible – it disguises intent, muffles voice. There is also a variation of tone, which I know many would praise in a collection of short stories, but which I find to be simply distracting. This is not true, however, of the two most recent inclusions in London's collection
The New Dark Age
(2010): ‘The Photographer' and the title story. The latter is only twenty pages long but has that astounding Munrovian effect: it is a jack-in-the-box story, full of compressed information, which when released springs into something much bigger.

In some of Munro's best stories, and in London's novels, we often meet characters in their earliest youth and then move over large tracts of their life into their old age. It's an odd feeling, being asked to be suddenly familiar with a character who has aged forty or fifty years – and often, in both Munro's and London's work, a character who has shed the violent quirks of youth and become someone more thoughtful, more measured. This was my only difficulty with
The Golden Age
. The story ends fifty years beyond its beginnings, in New York. The ending has the feeling of a coda, but also of an attempted resolution. Frank is now imagined as ‘an old man with a cane', but a successful poet, too, with his laptop and his ergonomic chair. Perhaps it is resolution itself that I have difficulty with, when
The Golden Age
feels all about irresolution, about movement and growth and continuous change, with time feeling endlessly springy and resilient. In other words, perhaps it is my problem. I certainly hated seeing Frank surrounded by the trappings of the twenty-first century. It felt like a misstep, a change in tone too abrupt, a surrender to the reader's curiosity, when perhaps the reader ought to be left in that lovely suspended state in which Frank and Elsa find themselves in the penultimate chapter.