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Book Review   |    
Baer Ackerman
Psychiatric Services 2008; doi:
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by Roxanne Robinson; New York, Farrar, Straus and Giroux, 2008, 420 pages, $25

Dr. Ackerman is child, adolescent, and adult psychiatrist for Alma Counseling Psychiatric Services, Plano, Texas.

The novel Cost is a very gripping and superbly written story about the destructive effects of heroin addiction on the brain, mind, and soul of Jack Lambert and on his family. In addition to accurately describing "an intervention," Roxanne Robinson also provides superb information about the neurochemistry and neuroanatomy of addiction. She describes the concomitant cognitive, psychosocial, interpersonal, and psychodynamic distortions that both predispose to and are caused by the addiction. Ms. Robinson also beautifully describes the common regressions that can and often emerge at family gatherings, in which adults act more childlike than is ordinarily the case.

The novel is in prose, but it is really a poem conveying the textures, tastes, sounds, colors, assumptions, lusts, banalities, hypocrisies, vanities, regrets, joys, iciness, warmth, smoothness, and stickiness of living, in a style ranging from luxuriant to spartan. When one first picks up this wonderful book, one is greeted on the book jacket by a beautiful pastoral painting of a cottage on a hill. The painting has been shredded into four vertical strips that visually foretell the torn, misaligned, and yet fundamentally and curiously coherent quality of the Lambert family.

The dedication page reads "In memory of Henry Ward Scoville 1909—1924." Alone on the page, the words and numbers looked as if they had been etched on a tombstone. I continued to puzzle over the dedication, and after reading the book I contacted the author, who told me that Henry Ward Scoville was her mother's favorite brother who was killed while riding his bicycle to school. The pain and shock of that grief never left the author's mother, and even decades later, profound sadness welled up in her mother at the thought of that terrible day. Ms. Robinson went on to tell me that "one of the things the novel is about" is the notion that the loss of a child leaves a wound that never heals and never vanishes within a family. The sadness haunts those close to the child forever.

In summary, I highly recommend Cost for anyone wanting to better understand the vicissitudes of our human condition and the tragedies of heroin addiction. Importantly, the novel is also about the centrality of memories and how each interaction either lovingly or cruelly creates a new memory and thus a new present and future.

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