The Book Nook

Unsettling blend of fact and fiction   Joyce Carol Oates is an American author who has been producing highly acclaimed works since the 1960s.  Her latest novel, “Butcher” was published in 2024.  Set in the mid- to late 1800s, it contains a complex and disturbing story that is masterfully told and contains elements that are still relevant today.  This is not a book for the faint-hearted, as the descriptions of medical procedures are told graphically and with unnerving immediacy. We meet Dr. Silas Aloysius Weir at the start of his career.  He’s denounced after botching his first medical procedure, making it almost impossible to start his medical practice.  He uses his family connections to secure a job at a women’s mental asylum run by his cousin.  There he was able to specialize in the treatment of female conditions no other doctors wanted to tackle. When his cousin dies, Weir assumes a role as the interim director, taking measures to secure that position permanently.  Once past the probation period, he’s free to run the asylum as he sees fit, much to the detriment of the residents.  Believing that mental illness in women stemmed from their reproductive organs, he sought to cure them by “correcting” certain body parts - treatments more tortuous than effective. The hapless patients endured experiments, mutilation and surgical removal of healthy tissue and organs, often without anesthetic or painkillers as Weir believed lower class women did not feel pain.  His greatest success came from repairing painful tears in the urinary tract that could arise from a difficult pregnancy.  But his victories didn’t offset the inhuman and excruciating “cures” that sometimes drove his patients to suicide. Weir successfully justifies or hides any problems that would invite public scrutiny, firing staff who question him or lodge complaints.  On his side are laws allowing women to be institutionalized if they don’t conform to their family’s wishes or society’s expectations of them.   Between a lack of public interest in marginalized people and Weir’s tight control over every aspect of the institution, the patients have little hope of help.  But there are some who fear and hate Weir enough to find a way to end the mistreatment in a dramatic event. This ostensible story is told in part by Weir’s son Jonathan, who uses the doctor’s medical journals to provide a fuller picture of his father.  The narrative’s second half derives from a young woman who is one of the asylum’s indentured servants.  Brigit is not only Weir’s biggest success story, but later his assistant and a major contributor to his downfall.  While a helpless patient in the beginning, she gains power, sometimes by speaking up and mostly through her deeds. This fiction is supposedly based on true historical documents and figures, although specifics were hard to find.  Oates may have used a Dr. Silas Weir Mitchell as the inspiration for her protagonist as he lived in the same time period and performed similar techniques on his female patients.  One of those patients was the famous writer Virginia Woolf, who ridiculed his treatments in her novel “Mrs. Dalloway”. We may never know the details of the story’s inspiration but we do know from existing medical records that the horrible procedures described actually occurred.  After seeing the sinister book jacket, I wasn’t surprised to find a long list of content warnings that include rape, forced institutionalization, pregnancy, suicide and medical content, among others.  The descriptions may be too real for some, yet Oates’ dexterous writing is able to grab and hold interest throughout the book.  Her tone and language, combined with careful research creates an atmosphere that feels authentic to the time.  We understand Brigit’s conflicting feelings as she expresses gratitude that Weir relieved a painful condition while recognizing the harm he did to her and others. Although we’re taken back over a hundred years in time, certain aspects have a contemporary feel.  One is the patronizing attitudes that persists in some medical professionals.  Weir sees himself in the best possible light, yet it’s the other narratives that pull reader’s judgements in another direction.  And as agency over women’s bodies is being challenged again, this book may have been intended as a cautionary tale.    Oates is a prolific author with over 50 novels, many non-fiction works and numerous short stories, collections and poetry to her credit.  A high percentage of her novels fall into the bibliomystery category, a subgenre of mystery featuring books as the plot’s central theme.  One commonality in her fiction are Americans with obsessive issues or who succumb to suicide or a violent death due to forces beyond their control. In spite of the dire subjects and brutal descriptions, the book is wonderfully written in a way that provides chills and food for thought.