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Book Review   |    
Lloyd I. Sederer
Psychiatric Services 2009; doi:
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by Ninni Holmqvist, with Marlaine Delargyare (translator); New York, Other Press, 2009, 272 pages, $14.95

Dr. Sederer is medical director, New York State Office of Mental Health, and adjunct professor, Columbia School of Public Health, New York City.

What is the purpose of a life? the author ponders. Does a life—yours or mine—exist to sustain the collective and its well-being, where value is in what a person produces, or does life have intrinsic value, where purpose derives from who a person is?

In the society that Holmqvist creates for her readers the former has hegemony. If you are a woman of 50 or a man of 60, living alone, without a child, and not a critical worker, you are designated as "dispensable" and go with trepidation but without resistance to a "Reserve Bank Unit." There you become a source of biological material (which means your organs are harvested, one by one—a kidney, a cornea, a slice of your liver) and a subject for experimentation until your utility is complete, at which time you make your "final donation," ending your stay in the Unit.

In Holmqvist's eerie, chilling, yet almost plausible social order, all citizens exist to further the gross national product (GNP): lives either advance or diminish the "capital" of the nation. Value (and meaning) issues from an individual's contributions to the national capital; for some, that means disappearing one day from the community and entering the Unit, where they further the social good as donors of body parts and subjects for advancing the scientific knowledge thought useful to the GNP.

And the GNP has been prospering, so the Unit can afford to be an ideal setting where comfort prevails, everything is free, and people have the time to attend to one another as the burdens of everyday existence vanish—as did its entrants from their antecedent but dispensable lives. For the residents of the Unit having trouble adjusting, and they appear numerous, there is an ample supply of capable psychologists to assist with coping (when they are not busy performing mind or drug experiments); physicians are occupied removing organs and aiding in physical recovery to prepare a Dispensable for her or his next contribution.

One has hopes for the protagonist, Dorrit Weger, who falls in love with another resident of the Unit and whose life changes in a profound way. She rails against the pain she witnesses among those around her and the grief of those still alive. At one point, Dorrit's anguish enables her to see, through the veneer of this well-ordered society, that her accommodations are a "luxury slaughterhouse." Holmqvist maintains the tension throughout and draws the reader into resisting what seems on the surface so reasonable yet curdles the blood.

This moral tale may be more credible to persons from European or Asian cultures, where the individual is more subordinate to a community ethos, as we witness since health care and education are universal in all but one advanced (Western) culture. An ethos of community before individual would hardly fly in Texas, Oklahoma, or Montana, to mention but a few places in the United States. Yet Holmqvist gives us a lesson in human nature and social engineering through a story that is spare, compelling, and all too human. I am reminded of what the great urbanist, Jane Jacobs, wrote, "Perhaps the greatest folly possible for a culture is to try to pass itself on using principles of efficiency." However adorned, the totalitarian state in waiting warrants vigilance since it seems to meet many a human need.

The reviewer reports no competing interests.

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