Book review / Losing your heart in the madhouse

Asylum by Patrick McGrath Viking, pounds 16

The asylum of the title is Broadmoor - this much seems clear from a jacket note to the effect that the author's father once worked there as medical superintendent - and the opening chapter of Patrick McGrath's agreeably taut fourth novel finds each of its chief characters lodged in that establishment. They include a desiccated psychiatrist named Max Raphael, his brooding wife Stella, an older physician, Peter Cleave, who doubles as the book's narrator, and a seriously disturbed intern called Edgar Stark, who has been incarcerated after murdering his wife and mutilating her decapitated head.

Ah, the subjects novelists choose these days, to be sure! Stark is a sculptor by profession, and Stella, watching his muscular form going about its tasks in the garden - Max is having the old conservatory refurbished, bless him - can console herself with the thought that the object of her affections is an "artist". There is even more comfort in the realisation that his offence (motive: sexual jealousy) can be romanticised as a crime passionelle. Boredom, frustration and summer languor do the rest. It comes as no surprise - at any rate to the reader - when after a particularly intense coupling in the Raphaels' marital bed, Stark steals a suit of Max's clothes and goes over the wall.

At this point canny onlookers are suspicious of Stella but unable to prove her involvement. All this changes when Stella deserts Max and their only son Charlie to join her paramour in his derelict London hideaway. Before long the old behavioural patterns - rage, insane jealousies, morbid fixations and so on - reassert themselves: Stella, returning nervously to the loft after a violent confrontation, finds that Stark has vanished and is herself arrested by the policemen sent to find him.

Happily, Stella avoids prosecution; her husband, on the other hand, loses his job. Removed to a barbarous corner of North Wales, where Max is forced to accept a much humbler position, she goes completely to seed, takes up with the weaselly farmer next door and occupies her leisure in gin-sodden reveries. Such is the level of her detachment that, accompanying Charlie on a school trip, she can only watch abstractedly as the boy drowns in a hillside pool. Initially arraigned on a manslaughter charge, Stella is eventually returned to the asylum and the all-too tender ministrations of Dr Cleave, since promoted to superintendent.

While all this is written up with huge attack and intensity, full of shrewdly observed dilemmas and incidental drama, McGrath can't avoid - in fact, rather seems to welcome - a kind of staginess which in consequence seems mildly tongue-in-cheek. When Max's boss remarks of his charges that "We try and treat them, but not, I'm afraid, with any great success. We can manage them...but we don't really know how to treat them. Because we don't really understand what they are." Stella wonders, "Is he talking about his patients... or women?"

The same kind of parboiled irony infects the moment when Stella, mindful of what Stark did to his wife, listens to him grunting over a drawing of her head as if he were "performing a particularly delicate surgical operation."

Many of the same problems attend the omniscient, if not always reliable, narration of Dr Cleave. The account is retrospective, so we know that Cleave knows - or thinks he knows - everything. This gives a satisfying gravity to his narrative, while making the reader raise an eye over some of the incid- ental wayside nature notes (did Stella tell him about the fat bumble- bee that crawled up a thistle head, then lifted into the drowsy air and sailed away? Or did he guess?) and see immediately through the endless hints and prefigurations to the messy climax that lies ahead. Prone to describe emotional disturbance as "a depressive episode," Cleave has the professional habit of explaining motivation ("Max behaved now like a man who no longer believed in doing his moral duty...") rather than demonstrating it.

The result is a novel so tightly controlled by its voice that the characters end up stifled. Charlie, for instance, is marked down as a sacrificial victim at an early stage, and I never could believe in Cleave's (frustrated) wish to marry Stella.

Neatly plotted and sharply written - the scenes in Stark's hideout are particularly well done - Asylum would have benefited from some less obtrusive schematics.