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Book Review   |    
Alan Brown
Psychiatric Services 2008; doi:
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by Andrea Barrett; New York, W. W. Norton and Company, 2007, 297 pages, $24.95

Dr. Brown is clinical professor of psychiatry, University of Massachusetts Medical Center, Worcester.

Andrea Barrett's new novel, The Air We Breathe, sat for awhile on my "to be reviewed shelf" sandwiched between the most recent psychiatric textbooks and therapy manuals. As an admirer of Barrett's wonderful previous works, Ship Fever and Servants of the Map, I welcomed the opportunity to obtain the hardback copy, but how would I write a review of this novel that would be relevant to mental health professionals?

In this latest work, the story is set in an Adirondack tuberculosis sanitarium serving indigent immigrants just before America's entrance into the World War I. At the time, a strict regimen of rest and nutrition offered the best hope to contain the consumptive pulmonary phase of the illness. Imploring adherence to the program, the hospital director explains the "scar tissue around each pocket of germs is fragile, like a spider web." The routine of institutional life is broken when a wealthy patient from town introduces a weekly educational discussion group. The tenuous calm of the institution devoted to the containment of disease is disrupted by the passions of its patients and staff and a fire that nearly destroys the sanitarium. In its aftermath, a war mentality of fear and distrust intrudes, as suspicion unfairly focuses on Leo Marburg, a patient nearly killed in the blaze. Individuals and the group of patients as a whole must come to terms with their shameful participation in accusing and ostracizing one of their own.

There is much to enjoy in Barrett's novel. As in her previous works, the author writes with an appreciation for a 19th century type of natural science that engages the world with a pleasant curiosity and a delight in the understanding that empiricism affords. Her heroes are the observant cataloguers Mendeleev and Linnaeus. Without postindustrial technological complexity, this world of study and wonder is accessible to the amateur scientists of the discussion group and the boon-docked staff of the institution. Barrett communicates the enjoyment in being alive and scientifically minded at an earlier time. Her prose reflects this naturalist's predisposition, evocative and clearly descriptive, without being overly elaborate.

In The Air We Breathe, Barrett continues her pattern of gentle twists on narrative forms that add to the pleasure of the reading. In her previous works, she ostensibly offers collections of short stories, each of which may stand by itself, but each also informs and enriches the other stories in the book. The effect—as in psychotherapy—is that we learn of extended families, their origins, their relations, and their secrets, not linearly, but in interlocking accounts or sessions that inform each other. She continues in this novel to expand on characters mentioned in her other books, and her fans will find themselves digging out her past works. In an additional turn, the narrator of The Air We Breathe is slowly revealed to be the collective voice of the sanitarium's patients who struggle to create a coherent account of the events leading up to the fire and their own misunderstanding and betrayal of Leo.

As to relevance to mental health professionals, insofar as we want to develop an active empathy, Barrett's fiction may be particularly helpful. Although fiction offers a path to the interior lives of others, a chance to walk in someone else's shoes, with this book the sensibility we enjoin is that of the collective narrator and the author. It is an appreciative voice not frequently heard these days, cognizant of human foibles and sympathetic to our mortal condition, but hopeful, admiring, and affirmative of our individual and collective capacities to acknowledge our weaknesses and aspire to decency—a stance that may do well for certain therapists. Like the scar tissue enveloping pockets of bacilli, the decency and understanding encapsulating our prejudices and hatreds are also "fragile, like a spider web."

My quibbles with the book are minor and mostly in light of having adored this author's previous efforts. Her perspective, which describes a way of observing the world and others, effaces interior psychological tension and may be better suited to shorter novellas and stories. With that said, I would recommend a place for this and Barrett's other works on our bookshelves.




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