Come on in Doctor: the jig is up. Psychiatry has not supplanted Christianity, psychology is not the new Gnosticism, nor Freud the new god, nor anti-depressants the new Eucharist, nor therapy the new confession, nor mental illness the new original sin.

With malpractice lawsuits against psychiatrists and corporate psycho-pharmacology racketeers becoming as commonplace and high profile as paedophile priest scandals, not to mention recent reports of Irish children as young as eight being given mood-altering drugs such as Prozac and Ritalin in residential care, the public at large are undergoing a crisis of faith as regards the subject of the diagnosis and treatment of psychiatric conditions.
It’s a fine time for Will Self to publish his latest book Doctor Mukti and Other Tales Of Woe, a black-hearted satire that does for its subject what few Irish novelists have yet done with the clerical abuse scandals – render it equal parts Ralph Steadman cartoon and industrial school nightmare.
The title story of this, the fourteenth book by Self – a prolific novelist, talking head for hire and bad boy of English journalism turned sober but still acidly funny middle-aged man of letters – is based upon the fiendish conceit of a duel between two psychiatrists, the sexually frustrated Shiva Mukti and his older more established rival Zack Busner. The two begin exchanging patients in a sort of warped Russian roulette, precipitating a downward spiral that ends in a predictably bizarre Self-ian last act.
All of which begs the query: does this sorry tale have real-life roots in the fluorescent hothouses of London’s psychiatric wards?
Will Self taps pipe tobacco into an ashtray in the lounge of the Clarence Hotel and considers this question. He is nearing the end of his first publicity trip to Dublin in some six years, a trip which included in its itinerary a reading in Hanna’s bookshop, followed by a Q&A session that testified to the man’s gift as an articulate and erudite public speaker with a handy knack in deadpan one-liners.
“Yes, it was in fact derived in some fashion from real life,” he decides. “It was derived from – and I simply cannot name names, it’s too contentious – basically meeting a young psychiatrist who was enormously embittered at the success of an older psychiatrist who was also a media pundit and making accusations of clinical malpractice against him, saying, ‘You know this person as being somebody who offers advice on TV and in newspapers, but I in fact know that they have caused the death by malpractice of a schizophrenic patient.’
“And falling through that trapdoor, (I was) turning everything around in my mind and thinking, ‘Yeah, y’know, these guys are viewing these ill people as commodities, and it’s just a short step from there to actually employing them as weapons against each other.’ They don’t think they are, but effectively, psychically, that’s what they’re doing. Then there were a lot of anecdotes I’d picked up, many of them through a friend of mine who’s now quite a prominent consultant psychiatrist who I’d known since we were at school together, he just tells me these fantastic stories.”
Such as the one about an emaciated woman who kept showing up in London hospitals with dangerously low haemoglobin levels, and who, on investigation, was found to have a catheter wound in her groin. That story would have been the one element that readers could have dismissed as an urban myth or the product of Self’s…
“…fevered imagination, I know. But it’s actually pretty much true. I mean obviously not the terrible denouement, but there really was this bloodletting cult and this young woman checking into various London hospitals with these incredibly low haemoglobin levels, who had in fact been bled for blood for rituals.”
Of course, urban myths don’t work unless they’re as plausible as they are horrible.
“There’s the famous urban myth of course about the people getting mugged and waking up without their kidneys, that turns out to have been very much true and been a fairly widespread practice.”
Perhaps unsurprisingly for the work of a Burroughs devotee (his introduction to Junky is worth the price of admission alone; ditto his essay on M. Ageyev’s cult classic Novel With Cocaine), Dr Mukti not only picks at the scabs of corruption that fester in any citadel of authority, but also our own complicity in maintaining the trust conferred upon such institutions. Through Shiva and Busner, Self has enormous sport with the idea of psychiatrists being every bit as craven, competitive and dastardly as anyone in the law or literary professions.
“I think what I’m trying to say is that we put these people on a pedestal,” he considers, “we make them the authority figures, and (also) just looking at the mental pathologisation of the culture. Take a phenomenon like Attention Deficit Disorder. Now I’m not saying it doesn’t exist in one way, shape or form, but it’s a wave that spreads east across to us from the States, you have thousands if not tens or hundreds of thousands of kids taking Ritalin who may just be rather bouncy kids, and it’s a diagnosis that falls disproportionately on socio-economically disadvantaged families. You’re much less likely to be ADD if you’re in a good income bracket because your parents will get you out in the fresh air more.
“So what you have here is a kind of collusion between a society that wishes to see itself as mentally ill, or possessed of personality disorders, and the psychiatrists are like guys who’ve got a quick-fit exhaust centre, and suddenly everybody says, ‘I need a new exhaust.’ I mean, they’re not going to turn the business away. And the other thing is, at one point in Dr Mukti Busner writes to Mukti and says, ‘I’m sure you, like me, have long since discarded this ridiculous view of professional ethics.’ And what he seems to be saying is, ‘We love our patients much more, we’re not professionally distanced from them’, but of course the reader interprets it sinisterly, that he’s abandoned all humanity.
“But I think the point of it is that within professional groups, there is a kind of understanding that the external view of the ethics doesn’t pertain. When you’re in with lawyers, the way they talk about things makes your ears curl. Or with the police, the disregard they have for things, the fine line between the cutting corners on professional ethics that actually improves the lot of the general public, or else leads to serious miscarriages of justice or medical malpractice – it’s a very hard line to call.”
There’s also the idea that the mental institutions of Frances Farmer or RP McMurphy horror stories have been consigned to the mad attic of history, when in fact such places remain just as terrifying to anyone unfortunate enough to commit themselves while still being even halfway lucid. In which case, the sight of poor shaven-headed wretches rocking back and forth while nursing teddy bears can put that case of ‘nervous exhaustion’ in perspective.
“I’ve been onto a lot of psychiatric wards over the years,” Self says, “usually in connection with people I’ve known with drug problems, and they’re some of the most frightening environments in the known world. Again, another irony about our perception of mental health is that from the outside, people fondly imagine or like to kid themselves that psychiatric wards aren’t like Bedlam in the 18th century, but actually they’re just the same if not worse. I suppose what this story and a lot of my fiction is saying is we’ve become so entranced with notions of mental pathology that derive from psychiatry and psychotherapy that it’s infested the entire culture; we’ve become unable to avoid these catch-all terms. The minute you say, ‘Well, you’re bi-polar, you’re manic-depressive, you’re schizophrenic’, you pass them off to Doctor Mukti. With his hypo.”
Growing up in the south-east of Ireland, before the bandying about of psychotherapeutic jargon became fashionable, this writer recalls hearing a myriad of dysfunctions addressed under umbrella terms such as, “The nerves are bad with ’em”, a phrase which could have applied to anything from wartime mustard gas cases to the highly-strung, the stressed out and post-natal depressed.
“Yes, but – and you can correct me if I’m wrong – the fact that there was a much more generalised catch-all was in some ways a much more humane thing,” Self observes. “It wouldn’t mean that the response to that person’s problem was any less sensitive or adapted to their circumstances.”
Indeed, as Self indicates, such terms were inclusive rather than exclusive. In dealing with dodgy characters or dirty old men, as they were known before the word ‘paedophile’ entered the common lexicon, children were taught to not run away from or vilify such individuals, but merely to keep a healthy distance and be aware of their unsavoury nature.
“They were contained within the community,” Self says, nodding. “Again, another great phrase: when Thatcher broke up the British mental hospitals and sent the patients back in for ‘care in the community’ perhaps they fondly imagined that they’d all be going back to rural Ireland in the 1960s and ’70s! (Laughs.) ‘Oh, don’t you worry about him, his nerves are gone!’ Not a bit of it!”
Psychosis in all its various manifestations has long been one of Self’s preoccupations (the character of Zack Busner originally appeared in The Quantity Theory Of Insanity), but the writer’s introductory essay to the 1998 Pocket Canon edition of the Book Of Revelation compounded the link between religious and clinical mania. Rather than attempting any sort of biblical exegesis, Self instead penned a chilling memoir of a friend, Ben Trainin, who died at the age of 28 following a harrowing descent into madness, among whose side-effects was a fixation with John’s Apocalypse.
“Like many people who are teetering on the edge of psychosis – one foot rammed hard in the door of perception lest it shut forever – Ben found in Revelation an awful, immanent level of identification,” Self wrote, “an apparently fixed point around which his own frail psyche could orbit and then fission.”
“It was a very painful piece to write,” the author says now, “because I’d made it so nakedly personal, a memoir of this guy. I felt very uneasy about promoting it, I felt odd about having done it as a piece of writing. But I think when you come to write about the Bible in general, you have to kind of find a way into it, because with any sacred book – although it seems particularly true of the bible, the way in which it has accreted its own equivalent of the Talmud, its own endless commentaries and glosses and interpretations – it becomes almost impossible to see those books for what they are again. It’s almost impossible to come at them cold, and that was my way into it. For the new book I’m writing, I’ve just become interested in reading a lot about the bible… it ain’t what it seems at all!”

At this juncture, we encounter an unlikely aggregation of martyrs: Jesus Christ, Oscar Wilde and… Sebastian Horsley. Since Self last spoke to this magazine, on the occasion of the publication of How The Dead Live, he adapted and updated Wilde’s The Picture Of Dorian Gray for the screen. When the movie project went down the toilet, he converted the screenplay (written using Bruce Robinson’s Withnail & I as its template) into prose form. Reading Dorian, one cannot help but think of Self’s friend Horsley, self-styled decadent, dandy and tormented artist, perhaps most infamous for participating in his own private Golgotha in the Philippines, preserved on film by Sarah Lucas.
“The film, if you ever get a chance to see it, is absolutely astonishing. Sebastian came out and showed Deborah (Orr, Self’s wife and award-winning columnist) and I, and it’s just a beautiful film.”
More recently, as reported by Olaf Tyaransen last December, Horsley is notorious for having sent out a ream of Christmas postcards featuring the image of himself having sex with an amputee.
“He didn’t send me that,” Self says. “He knows that I would not have approved. Not in front of the women and children, like frightening the horses!”
At the time, Horsley contended that the lack of response from friends such as Self and Nick Cave was ominous.
“He may have sent it to me and I may have literally opened it and glanced at it and binned it,” Self considers. “Knowing Sebastian, and I don’t think I’m speaking out of line, he’s a tortured and unhappy guy, but there’s a point, somewhat counting against what we said before, where the individual level of pathology becomes so plangent that it’s very difficult to see it as art; there has to be some sense of a sane shaping and ordering mind behind things before you can take them in that way. I don’t know what’s going to happen to Sebastian, I think he has to drop some of the dandiacal obsession to discover himself properly, creatively, and be a little bit happier in himself.”
Did he have any bearing on the characters in Dorian?
“No, I only met Sebastian about four years ago, although he could have stepped out of the pages of it; he sort of knows people tangentially in the milieu that I’m writing about, the beginnings of the 1980s. I went to Oxford and came from a not exactly bohemian but slightly odd middle-class background, and we lived in a suburb in North London in a semi-detached house and we weren’t incredibly well off or anything. But when I went to Oxford it was the first time I’d met people who were wealthy, aristocratic and cultured, and it was a real shock.
“My mother was an old communist, she brought me up to believe that people who were really rich and connected were all stupid and uncultured, and it impacted on me very badly, y’know, I suddenly thought, ‘Hang on a minute, this isn’t true, in fact, if you think it through logically, these people have everything’. It was kind of dazzling in that way. And they were into drugs. What could be cooler? And I slightly fell in thrall to that for the first few years of the ’80s.
“But Dorian is a sustained satire on the aristocracy, just as the fantastic thing about Wilde – and you pick this up as a kid seeing things like The Importance Of Being Earnest – the entire English upper class were duped. Wilde was a genius because… the Irish writer Robert Wilson said to me once, ‘The English have such a reliable appetite for being told what shit they are’, and Wilde purveyed that shit brilliantly, packaged it in a presentation box: ‘Here, look! You’re shit!’ all dressed up in these fantastic apparently light drawing room farces. So it was great fun to take that and do it to the English again!”
Speaking of drawing room farces, Self has been embroiled in a few in his role as TV commentator, cultural and political analyst and professional shit shooter. Case in point: his appearance on the Beeb’s pet-hate baiting Room 101. When I remark that Self’s exchanges with the show’s host Paul Merton seemed a little on the snippy side, he says this:
“Well I think that, y’know, I probably didn’t handle it very well. I think that from the outset Paul Merton tried to kind of angle it as a class thing: ‘I’m kind of a working class boy from the sticks and you’re privileged upper middle class,’ and was trying to, not exactly trick me, but sort of put me in a position where my preferences were exposed as being snobbish, and I think I was a little bit snippy to try and get out of that. I’m the last person to propose myself as a man of the people – I know well the privileges I’ve had in life and the considerably greater privileges that I earned for myself as well, so I’m not trying to pull that bullshit – but on the other hand I don’t like to be typified as somebody who is in some sense completely divorced from the ordinary view of life, or coming from a position of privileged removal in terms of my cultural criticism.”
Which reminds me of a point raised in the Channel 4 documentary The Peculiar Memories Of Bruce Robinson in which the writer and director – and a friend of Self’s – waxed forth about how having money and privilege did not mean one had to abandon their leftist politics, not least because it plays into the Tories’ hands.
“It’s an age old problem for champagne socialists and people who wish to stick with leftist ideas but have a fairly lavish lifestyle,” Self acknowledges, “and the fact of the matter is everyone makes their own accommodation with it. I’ll tell you an anecdote, ’cos it’s probably the best anecdote I’ve had all year. I know Lucien Freud’s son-in-law and I met him at a kids’ party and I offered him my seat – I mean, he’s Lucien Freud for fuck’s sake. I’d never met him before, and of course he was this bird-like little man, terribly good looking and instantly charming. I said, ‘Do you want a seat?’ And he said, ‘No, no, I prefer to stand.’ And I said, ‘Are you sure?’ and he said, ‘No, no, I was on the bus the other day…’ – and you sort of instantly think: ‘Lucien Freud takes the bus. This is a truly great man. This is probably why he’s the greatest representational painter of the late 20th and now early 21st century: it’s because he takes the fucking bus.’
“Anyway, he says, ‘I was on the bus the other day and a man offered me a seat and I said, ‘No thank you, I really prefer to stand, I’m getting out at the next stop.’ But he made a big thing about it and people on the bus were starting to look, so eventually I had to sit down.’ And so I said, adopting a sort of cod-interviewer style: ‘How did that make you feel?’ And he said: ‘Somewhere between an old-aged pensioner and a prize cunt!’ (Laughs.) But that’s the point: take the bus. You’ve gotta do some things that keep you in contact, whatever they are.”
So, finally, from distinguished elderly gents to Grumpy Old Men. The Channel 4 series of that of the same name afforded Self the ideal organ through which to vent his not inconsiderable spleen at the flotsam, jetsam and assorted rubbish of modern life.
“I think it caught a current,” he says. “Y’know, there’s a particular reason why men between the ages of 42 and 55 are the most dissatisfied people, and the reason is because we bought the 60s. We bought it in two contrary ways that we couldn’t see because we were kids. On the one hand we bought socialistic free love paradise with no conventions and a kind of human-directed anarchy, and on the other hand we thought, ‘And jet packs! And meals in a pill!’ We thought it was all coming, we thought the innately and ever-conservative trappings of culture were going to be totally revolutionised and changed.”
And everything would be shiny and tungsten and curvy…
“Yeah, and where it wasn’t shiny and tungsten and curvy it would be hairy and moist! And there’d be nothing else! So what I think that programme did pick up on was that peculiarly irrational grumpiness that arises from two contradictorily utopian views both falling to nothing: technology’s shit, the planet’s choking on its own effluence and… the conservatives are still in power!”

Dr Mukti And Other Tales Of Woe is published by Bloomsbury