BJGP Library: Trainspotting

There is nothing cosy or comforting about Trainspotting. Published in 1993 it follows the lives of a collection of characters based in Leith, Edinburgh. Four main characters shine through: Renton, Sick Boy, Spud, and Begbie. Mark Renton could be described as an antihero: a junkie vegetarian who hates the world and hates himself in equal measure. Welsh portrays the junkie lifestyle in full brazen technicolor complete with vomitus, urine, faeces, and other excreta. Trainspotting started life as a series of short stories and its origins remain obvious. It skips around characters, backstory is often missing, and there’s no narrative arc, just the see-saw of relapse and abstinence, abuse and misuse. There is misogyny, racism, casual and senseless violence. It’s also bleakly comic but it tests the limits of black humour.

Trainspotting breaks many so-called ‘rules’ of writing and there is much that will offend the casual reader. One chapter may be written in the first person, the next might be third person: sometimes in head-hopping omniscience, sometimes a single point of view. This is a book that doesn’t let you settle. The Scots dialect is presented phonetically and even if you think Welsh has a good ear the reading isn’t always easy. Long-listed for the 1993 Booker Prize, Trainspotting notoriously didn’t make the shortlist because it ‘offended the sensibilities of two female judges’. Trainspotting is not a book that will die wondering.

Many of the scenes in Trainspotting will live long in the memory, and, in truth, it is now difficult to disentangle the book from Danny Boyle’s film: Renton diving into the foul excrement of a bookie’s toilet to retrieve his suppositories; lovable Spud and his amphetamine-fuelled job interview; psycho Begbie lobbing a pint glass into a crowd; Spud and the fouled sheets bespattering his girlfriend’s family; the harrowing death of baby Dawn; and the overdose scene with Renton and Johnny ‘Mother Superior’ Swann. There are other stories in the book that didn’t make it into John Hodge’s whipsmart screenplay: ‘Bad Blood’ is a grim HIV revenge tale; ‘Na Na and Other Nazis’ recounts the beating of Spud’s mixed-race uncle; and the experiences of characters such as the alcoholic Rab ‘Second Prize’ McLaughlin — so called for his tendency to start fights and lose them.

There is no glamour here and violence is always bubbling under the surface, exemplified by the uneasy and dishonest relationships with Begbie. Men and women are brutalised but the women call to mind all those seen in clinics: too anxious to leave their homes, beaten blind by their men, pimped out by incestuous uncles; scarred physically and psychically, and too often in thrall to violent men. As for the swearing: it is an all-pervasive profanity, wrapped up in a foul nihilism where control has been given up. It’s life with all the protective filters stripped away. Nothing is sacred. There are many people who won’t like Trainspotting, will despise it even.

It wasn’t Trainspotting that took me into work in substance misuse services but, for all the appalling stories, one can be beguiled by the drug counter-culture. Sometimes all I can do in the clinic is sit, spectating, on another tale of car crash NHS care. Health care simply isn’t the same for them as it is for most of the population.

I regularly get asked by doctors why I work in substance misuse services. The question is freighted with prejudice and ignorance but it goes some way to explaining the stigma users endure daily. If doctors can’t imagine treating people with these problems then what hope is there? The characters of Trainspotting are still in every town in the country, still overdosing, still living with untreated hepatitis C, still stigmatised by society and healthcare services.

They remain the undeserving sick. Fiction it might be but don’t be fooled: Trainspotting is hard reading but reality can trump it.

• © British Journal of General Practice 2016