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Book Review   |    
Risk Factor
Eric D. Lister, M.D.
Psychiatric Services 2000; doi: 10.1176/appi.ps.51.7.941-a
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by Charles Atkins, M.D.; New York City, St. Martin's Press, 1999, 244 pages, $23.95

This is psychiatrist Charles Atkins' second novel. His first, The Portrait, was reviewed here last year (1). As he did in The Portrait, Dr. Atkins brings us a novel of suspense set in the world of psychiatric practice, peopled with individuals familiar to all of us who work in the mental health professions.

As with any novel worth reading, Risk Factor delivers itself, simultaneously, on three different levels. The most superficial stratum is a murder mystery. We have multiple acts of seemingly senseless violence. Are they connected? If so, how? And, who done it? Dig deeper, and Atkins asks us to come to grips with the nature of man's propensity for violence and the nature of evil. As a good psychiatrist, he understands full well the obstacles we all erect against truly knowing what we wish not to have to face. Finally, we are asked to make sense of one particularly dark soul whose self-absorption and sadism in some ways define what it is to be evil.

For me, the novel succeeds reasonably well on the first level but disappoints in its attempts to mine deeper material. As a storyteller, Dr. Atkins has matured since The Portrait. My attention was held more steadily, and I had a keen interest in what was coming next. The obligatory romantic tension— between the book's protagonist, a female psychiatric resident, and a police lieutenant investigating crimes to which she has been exposed— is well done as a counterpoint to danger and darkness. The world of mental illness and mental health practitioners is represented in an accessible and fair way, although the idealized therapist whose assistance the protagonist seeks is, well, larger than life.

At deeper levels, however, Risk Factor disappoints. Indeed, it is anything but easy to maintain suspense while challenging the reader to explore issues that are daunting, complex, and easily avoided— issues such as the nature of evil and our propensity for violence. Finally, as much as I want to applaud Dr. Atkins' effort and follow his unfolding career as a novelist, I found his evil murderer to be disappointing, as he is too superficial a character to be believable. His hidden sadism is too easily explained by formulaic trauma in early life. Where I wanted to be troubled and moved, I found myself shaking my head "no." Unfortunately, this feeling distracted me from the book's final chapters, even as a novel of suspense.

Perhaps the ways in which I was disappointed by Risk Factor reflect my own hopes that Dr. Atkins would hit home runs on every level or the application of a standard for clinical believability that would be less troubling to nonpsychiatric readers. Nevertheless, I can recommend Risk Factor as an interesting and well-paced novel of suspense. However, I await Dr. Atkins' next offering to see whether we might have a more successful treatment of the deeper issues that so clearly intrigue him.

Dr. Lister is managing partner of Ki Associates, an organizational consultation firm based in Portsmouth, New Hampshire.

Lister ED: book review of Atkins C: The Portrait (1998). Psychiatric Services 50:120-121,  1999
 
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References

Lister ED: book review of Atkins C: The Portrait (1998). Psychiatric Services 50:120-121,  1999
 
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