BJGP Library: Human Traces

Sebastian Faulks is a well-known author, but this was the first time I have read any of his work and I came across it purely by accident as it was one of my mother’s books. However, I found this book to be a fascinating and insightful read, giving me much to reflect on in terms of modern-day psychiatry. The book is set in the late 1800s–early 1900s and follows the path of two psychiatrists, Thomas and Jacques, from their training through to the development of their career, and ultimately their decline.

Jacques has a schizophrenic brother and at the beginning of the book you see him caring for this brother, who is forced to stay out of the main house and is ultimately admitted to an asylum. This leads Jacques to become a psychiatrist as he wants to be able to give his brother a better life. At the same time, he meets Thomas, who is more fascinated by the mind, and they agree that once they have finished their studies they would join together and develop a clinic.

Thomas works initially in an asylum in England as a medical officer, describing well the conditions of the time. The two of them then set up a clinic where they are able to explore mental illness in the context of the time as well as the psychiatric theories of the day.

Apart from the interesting historical context, the author describes an interesting viewpoint on mental illness through the eyes of the two psychiatrists and the leading lights of the time. Jacques believes it stems from traumatic experience, but loses this belief after a person he treats turns out to be physically ill. He had been treating a patient for the traumas they had experienced, believing this was the cause of their symptoms, but they had had rheumatic fever. However, I personally feel this highlights more the link between mental and physical states, and was disappointed that this was brushed aside in the book, and highlighted simply as a failure.

Thomas, by contrast, is fascinated by Darwin’s theory of evolution and believes the mind has evolved just as the body has. Prior to developing the ability to read and write, and to communicate over a distance, we would all have heard voices in our heads, thoughts that would have enabled us to plan and develop, and to store memories. However, this became unnecessary once we could record things in a physical way. He believes that schizophrenics have not lost this ability, only that it has gone somewhat awry. The fact that the percentage of people with schizophrenia is relatively stable across populations confirms this in his mind. I find this an interesting take on what we perceive to be mental illness, suggesting as it does that it is intrinsic to the nature of humanity.

Thomas himself develops dementia at the end of the book, although this is covered only briefly. There is also a slight side topic surrounding the death of Jacques’ son in the First World War, which I feel could perhaps have been explored further, particularly in regard to its emotional impact.

There are also quite a lot of side chapters and discussions away from the direct theme of psychiatry, at times seeming a bit disjointed. However, in themselves they added interesting historical context, for instance, the building of a funicular railway where Faulks describes Jacques travelling to America to see one that had already been built. There is also a lot of discussion around family, affording a slight love interest and personal thread to the book, making it feel warmer at times.

In terms of psychiatry at the time, themes were often developed through listening to or giving lectures, especially those based in Paris, which gave a good insight into what was happening at that time — a history I was previously unaware of. There was also a section where the main characters view someone operating directly on a brain while the person was awake, which was very graphic, not really necessary to the reading of the book, and almost aimed to shock.

At times it was difficult to know whether this is a book about Thomas and Jacques, or about medicine and the time itself. Overall, though, I found it to be both well written and thought provoking, and would definitely recommend it as a historical perspective on mental illness and its treatment.

• © British Journal of General Practice 2017