Jul/Aug 2018  •   Reviews & Interviews

Patient X: The Case-Book of Ryunosuke Akutagawa

Review by Ann Skea

Patient X: The Case-Book of Ryunosuke Akutagawa.
David Peace.
Faber. 2018. 299 pp.
ISBN 978 0 571 33346 2.

This is a curious and difficult book. David Peace has lived in Japan for many years, and his passion for the work of Ryunosuke Akutagawa, one of Japan's greatest writers, underlies this patchwork biography of Patient X. Using Akutagawa's own stories, essays, and letters, Peace has stitched together Akutagawa's own accounts of his life, his struggles with writing, his obsessions and his fear of madness, but Peace has done this, often, in his own words and often with his own interpretation, paraphrasing and retelling of some of Akutagawa's stories.

Just how much of this book is in Akutagawa's own words is hard to tell. Passages in italics suggest they are quotations, but that is uncertain. What is meant by the sub-title, "A Case-Book of Ryunosuke Akutagawa," is the first puzzle. Then, the "Author's Preface" suggests Peace actually interviewed Akutagawa, listening "with the physician in charge" as Akutagawa "told his stories at some length and in close detail." But this preface ends in a mad tirade of words—"You voyeur! Quack! Quack! Get out! Just save the children!"—and the reader is left wondering if any of it is true.

Peace begins the book with a parable in which Jesus and Guatama in Paradise look down of Ryunosuke (Ryunosuke and Akutagawa are used interchangeably throughout the book) who is "floating and sinking in the River of Sins." Can he be saved?

Then, in a chapter called "Hell Screens" there comes a description of Ryunosuke's birth. His father has his mouth to his mother's vagina and is calling "Can you hear me in there? Do you want to be born?" But in spite of his refusal, Ryunosuke is swept into the world: "In the year of the dragon, in the month of the dragon, on the day of the dragon, in the hour of the dragon, at the sinking of the moon, at the rising of the sun, you first see the light of the world, and you weep and you scream, alone, alone, you scream and you scream."

In the same chapter, we learn of the madness of Ryunosuke's mother, of her death, of how his father gives him away to his aunt and uncle, and about Ryunosuke's compulsion to read and collect books.

In the 12 chapters of this book, Peace charts Ryunosuke's biography, but sometimes it is characters in Ryunosuke's stories, or people he corresponded with or worked, or newspaper cuttings about something that interested Ryunosuke, which are used in this method of collage. If you do not know the stories or anything about Ryunosuke's life (Wikipedia has a useful page on this), you are lost.

As he got older, Ryunosuke was apparently medicated for his growing mental disturbance, and this was reflected in his work and in his other writings. At times Peace's book seems equally mad, but maybe that is deliberate. I cannot tell.

The final chapter of Patient X deals with Ryunosuke's suicide at the age of thirty-five. Typically, for this book, this chapter follows the meanderings and thoughts of a character called Yasukichi (who in earlier chapters has been Ryunosuke's ghostly double) until he tries to buy some matches from a woman in a shop and she appears not to see him. She goes to the back of the shop, returns with a box of sweets, unwraps one, puts the sweet in her mouth, and starts to read a newspaper—on which Yasukichi reads the headline: "Ryunosuke Akutagawa, renowned author, commits suicide at Tabata home." The chapter, and the book, end with Yasukichi trying to cry out "Not yet..." and with the woman picking up a box of matches from the floor, returning to her seat, and continuing to read the paper.


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