I am interested in reading about psychiatry, psychology, and mental health in general. I picked up this book thinking it was a series of case studies based on the author’s long-term neuropsychology practice. It turned out to be different than expected.

I enjoyed the first half, which provides examples of mental issues, such as declining memory, brain trauma, and epilepsy. As we get into the second half, it becomes more fragmented and less focused. There are paragraphs that are not coherent. I think, perhaps, the author is attempting to give the reader an idea of what it is like to live with mental disturbances. In my opinion, it may have worked better as fiction, where the reader may be more receptive to a creatively written, but disjointed, narrative.
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A.K. Benjamin’s Let Me Not Be Mad is a fascinating hybrid of a book. In part a collection of case studies of patients with neurological problems, it is also a rather slippery memoir, an exploration of the doctor-patient relationship, and a critique of Britain’s National Health System. Intense, ironic, sharply observed, allusive, erudite and (in places) possibly pseudo-scholarly*, the book demands a lot from the reader. This is particularly the case in its final third, where the narrator/memoirist, the pseudonymous A.K. Benjamin, is himself in psychological free fall. Up to this point, the reader knows “Dr. Benjamin” as a trustworthy medical professional. A neuropsychologist apparently employed in the general neurology department of a hospital in northern England, he has described his work gathering patients’ stories and testing those whose brains aren’t functioning properly for a variety of reasons—dementia, epilepsy, traumatic brain injury, motor neurone disease, and mental illness.

Dr. Benjamin comes across as a capable, deeply empathic diagnostician—though one whose approach to his work has seemingly been idiosyncratic and unconventional. (He meets patients for coffee and does non-pencil-and-paper diagnostics—in soccer stadiums, for example.) However, in the last part of the book the reader’s impression of Benjamin is largely undone by details of a mind and a life spinning out of control. In disorganized and at times incomprehensible prose, the memoirist presents himself as a person who is as troubled as any of his patients, running for years from a diagnosis he didn’t want to accept and for which he refused treatment. He reveals that some of the case studies he described are not based on patients but on himself and his own psychiatric history. The most notable of these cases concerns “B”, the young son of dysfunctional, psychologically “absent” parents, a boy known to leap from bedroom windows and shock himself using a model train set.

Given these later revelations, it’s not surprising, really, that one of the earliest cases Benjamin presents is that of a recently retired and widowed woman whose memory is failing. “Lucy” has recently been found in the wrong house, watering a neighbour’s houseplants. On another occasion, she forgot to turn off a tap before answering the phone and flooded her home. Her semantic memory (recall of facts) is receding, and her speech is odd: similar sounding words are spoken in place of the right ones. Based on her clinical presentation and her MRI scan, she’s diagnosed with early onset dementia, but a few months later when the scan is repeated, the abnormality (hypoperfusion of brain tissue) which led to her catastrophic medical labelling is no longer in evidence. The neurologist overseeing the case is forced to walk back the diagnosis. Lucy’s behaviour is now to be viewed as an extreme response to bereavement and significant life changes. Too late. She has accepted the initial verdict and begun the descent into actual dementia.

Benjamin explores a study of the ways in which input from medical professionals can drastically alter (read: limit) patients’ perceptions of themselves and their capacities. His awareness of such studies may explain in part his own resistance to a diagnosis when he was a younger person. Ultimately, however, his dysfunction catches up with him. His professional approach can no longer be written off as that of a maverick. It is clear that his behaviour is abnormal and his judgement dangerously compromised. He is mad.

For the most part, I found Benjamin’s book a fascinating one. The mind behind it, if disordered, is nimble and capacious. There are innumerable literary, neurological, psychological, and pop culture references, not all of which I comprehended. I suspect if I reviewed this book on a different day, I would highlight different sections and might even draw different conclusions about it. That’s how rich and stimulating it is. I do wish the last section, which deals with the author’s madness, had been more controlled. I suspect Benjamin wanted to communicate the degree to which his mind had unravelled. However, I’m not sure that forcing the reader to wade through so much muck and mess is necessary to get the point across.

I would like to thank Net Galley and Penguin Group/Dutton for providing me with a digital copy of this intense and challenging puzzle of a book

* I checked some parenthetically noted “scholars” and dates and couldn’t find the studies being cited. ( )