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The Patient
by Jasper DeWitt
HMH, $23.00, 224pp
Published: July 2020

For a debut, this is accomplished stuff indeed. 'The Patient' is a novella, so it makes for a small and slim hardback, something that might easily fit into a pocket, appropriately given that it's a medical case history of sorts.

Of course, it would fit well as an e-book too, given that it's phrased as a set of anonymous posts to a now-defunct web forum for medical professionals. It was archived "out of curiosity" and shared with the "author" who has an interest in "ostensibly true horror stories" and who, in turn, is now sharing it with us.

If that seems like a modern equivalent of epistolary novels like Dracula or shorter versions like The Call of Cthulhu, you'd be absolutely right and it's incredibly telling when the patient's last name is "revealed" as M——. I'd called the need for em dashes a few pages in. The clinical but friendly tone works too, both for the material at hand and to play into that old style.

The narrator is a psychiatrist, a young and eager one, who's taken a job in an underfunded state asylum. He calls it the Connecticut State Asylum but he also makes it very clear that he's changed names and places so that no reader will figure out the real people and locations involved, so I'll avoid a lot of unreliable detail.

We soon focus in on the patient of the title, Joseph E. M-----, usually simply called Joe, though we're kept waiting for seventy pages for him to appear. He does so just over a third of the way in. That's a calculated risk made by the author, but it pays off wonderfully, because it's Joe's case history that hooks us, rather than Joe himself. It doesn't need dialogue and, if there's a moment that does, it's there in transcripts.

And it's a bizarre case history indeed, one that will no doubt have all of us trying to figure out. Of course, the doctors within the book have to adhere to some semblance of reality, We, given that we're reading horror, can go far beyond their limits with our educated guesswork, but we still might not nail this one. Re-reading a little way, there are certainly clues left in plain sight, but Jasper DeWitt plays with us and hints that we should take other paths that we shouldn't.

Joe is a forty-year-old man when we meet him, along with our narrator, but he was first brought to the asylum at the age of six. Diagnosis wasn't easy, even back then, because his symptoms changed over time.

Initially he was admitted with night terrors, a little boy who believed that a monster was climbing out of the wall of his bedroom to scare him. After a little treatment, however, that seems to have been cured entirely and the little boy went home. Yet, back he came, this time non-communicative and violent. Over time, his symptoms continued to evolve until they no longer made any sense at all.

The key problem now is that anyone who treats him, or perhaps even talks to him, is driven mad, often to the point of suicide. Sometimes that's quick, as when patients have to share rooms. Sometimes it takes time, as with an array of doctors and nurses. But it inevitably happens, because Joe seems to have the ability to see into other people and prey on their fears, even if those fears tie to specific incidents in their past of which Joe can't possibly be aware.

There's not a lot of room here for this to get fancy. Chapters tend to begin in a personal fashion, our friendly narrator often surprised at the reaction that his previous post received on the web forum, so he meets the need by supplying another chapter. That new chapter quickly falls back into a prose style that's much more formal and professional, as befits a psychiatrist.

It begins with our narrator joining the staff at the state asylum with a firm intention of making a difference, quickly hearing about Joe and deciding in no uncertain terms that he'll be the one to cure him. A little research later, he's not quite as sure as he was, but things progress forward in the way we expect. Well, until they progress forward in a way we don't expect, because DeWitt is a cunning writer, especially given that this is his first book.

I liked everything about this. I liked the framework, which is at once highly traditional and also very contemporary. I liked the prose, which is lean and to the point. It wouldn't be difficult to double the length of this novel with subplots and romance and action setpieces, but it wouldn't maintain quite the impact it has as a slim volume that's delivered to us personally, almost like an urban legend. Hey, have you heard about that patient who...?

I won't spoil where it goes, of course, but I will praise the logic that comes into play when it gets there. I think this will become a very different read the second time through, knowing what we know now. It would seem to me that much of the book's power is in its mystery, which simply isn't going to carry over to return visits. The question is whether it'll become something else instead or just fizzle away, like any book or film that relies on its twist. I think it might become something else, with the narrator becoming more of a focus and Joe less.

Either way, it played magnificently on a first read and I look forward to the next book Jasper DeWitt will sic on us. I don't expect it to turn this into the series it doesn't need to be, but it ought to be something utterly different, not just with new characters and ideas, but with a new approach and a new framework. This one's been done now. And done well. ~~ Hal C F Astell

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