Marc Nash's Reviews > Politics of the Asylum

A lacerating vision of decay - both of the human body and the British National Health System charged with the task of free treatment of all our ailments to preserve and return us back into life, but as the population grows older, the money to pay for it is cut and hospital administrators come up with whizz bang new schemes to justify their unjustifiable jobs, the picture is of hospitals returning to their original function, that of keeping the sick and dying away from the healthy ones.

I say this is a lacerating vision, but it comes from the language and the imagery rather than scenarios and stories within the very short chapters. Steiner is a poet and the book is a non-stop barrage of wonderful, jolting word combinations and imagery. Our guide is a hospital cleaner - "Keep busy- don't think - to the floor, losing face in this germ diaspora, sickness makes no distinctions".

Nathan Finewax is the man with a mop, who labours every day to keep an antiseptic shine on every tap, floor, door handle, but knows both that there are unseen and unloved tiny corners for the germs to hide and pullulate, but also comes to realise that all the doctors do is the equivalent of mopping up patients, returning them to life still far from pristine and vulnerable to germ attacks and corrupted bodies. Even the staff, the nurses and porters are fighting to stay healthy enough to remain out of hospital out of their contracted hours, but the stress and unreasonable demands made of their bodies ensure they will all wind up there eventually. There is the brilliant notion of bins for medical waste disposal serving as toxic compost heaps breeding newer and deadlier germs and bacteria as they come into contact with one another and cross-fertilise and pollinate.

There are some wonderful set pieces, such as when the cleaner is given a white coat and asked to impersonate a doctor to talk to a troublesome patient to fob him off and give the nurses an easier life for an hour or so. There's an incident log report form, which the author has sardonically filled in in a call and response with Nathan.

Sometimes the density of the prose-poetry can obscure the scenario being evoked, but towards the end the book's message becomes chillingly clear: an administrator gives Nathan the vision of the future, how like the modern art market, hospitals themselves will be merely something to make a killing from on the stock market - "I have a vision to do away with all of this awkward clunking back and forth... more controlled conditions, they will have to keep coming to us until we overflow with new stakeholders, we'll stack the aisles with our newly dead... Imagine new ways to cure and eradicate illnesses we haven't even invented yet, you can trade on a TB comeback, invest in the rage of sickness as health". This reminded me of those rumours that Al Qaeda made a killing on the US stock market by trading in airline stocks & shares shortly before they flew into the Twin Towers. Such is the insanity of money when twinned with the double edged coin of creativity and destruction as expressed by this hospital administrator. Hospitals are money pits, demanding ever more funding as the populace lives longer and consequently infirmity is greater, dementia more widespread, so that the thinking is that hospitals have to generate money to contribute to their funding; but the money making motive exceeds the healthcare one - (a nurse)"Trained to administer care, now she becomes another sick dose with knowing consequence... Going overboard for the still imperfect murder, but leaving the rest to be finished off by neglect of 'best practice' efficiencies. Our great medical minds had been so creative as to mould and shape all our futures, to fashion and promote new generations that live on for longer. These systems now so decayed, with too many ideals crammed-in before breakfast, soon to be stripped for easy millions".

The book put me in mind of two others, Toby Litt's "Hospital" which has a similar descriptiveness about the strange internal architecture of a hospital, but wraps it up in a thriller plot with comedy; the other book is the punishing lyricism of the human body of Ed Atkins' "A Primer For Cadavers", though that lacks the political and moral clear-sightedness of this.

An important book, but not an easy read, both in terms of its density but also the terrifying punch it packs about Britain's most cherished social institution. It just so happened that I completed this a day after the publishing of the report into the Gosport War Memorial Hospital's unearthly high death rates, which found that some 450 patients were pain medicated to death, just to shut them up from complaining about their suffering and bothering the hospital staff. This novel could not be more timely.