Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting them on Wednesdays to coincide with the schedule of his old BMJ column. We hope you enjoy them.

The writer Anna Kavan (1901 – 1969) was a heroin addict for most of her adult life. She was born Helen Woods and published six novels under her married name of Helen Ferguson before changing her name by deed poll to Anna Kavan. The choice of surname was odd, since she had used it in one of her novels to depict her husband as a drunken, sadistic, violent brute.

For many years she was dependent on Dr Karl Theodore Bluth, a psychiatrist who had been an exile from Nazi Germany and came to live in England. She found in him a soul-mate, and it was he who supplied her, legally, with her heroin, sometimes injecting her with it. Dr Bluth was himself a writer, having published essays in the highly-literary magazine, Horizon, edited by Cyril Connolly, and a book on the philosophy of Leibnitz. Of their relationship Kavan wrote (in fictional form):

Their relationship had not been clearly defined. It had seemed to achieve itself spontaneously, without effort on either side, and with no preliminary doubts or misunderstandings. To her it was both inevitable and invested with dreamlike wonder that, among all the earth’s teeming millions, she should have met the one being complementary to herself.

Clearly not the usual doctor-patient relationship, then; and when he died, in 1964 (there was an obituary in The Times), her behaviour became increasingly erratic and she described herself as waiting to die.

Her best book, probably, was the first written under her new name, Asylum Piece, which was published in 1940. It is a series of thematically connected short stories, very sparely written, and some have compared it with Kafka, whom she had almost certainly by this stage read.

The stories are told in the first person by someone who is either paranoid or very nearly so. The characters appear mostly under an initial, R or H or D. This in itself lends the atmosphere something mysterious and sinister; in the story Machines in the Head she is woken early in the morning by the sound of distant machinery of the reality of whose existence we are never quite certain, but which seem directed at her.

In The Enemy, she describes the atmosphere of hostility by which she believes she is surrounded. The story opens in a way reminiscent of Kafka:

Somewhere in the world I have an implacable enemy although I do not know his name. I do not know what he looks like, either. In fact. If he were to walk into the room at this moment, while I am writing, I wouldn’t be any the wiser.

All she knows is that he exists and in the end will come for her in a white coat, take her away and inject her with tranquillisers.

In fact, she had been in and out of private sanatoria, and in the story Asylum Piece she describes what she witnessed. The asylum is “a charming eighteenth-century house” by a Swiss lake on the French border. It was in the days of authority rather than of evidence-based medicine; the “chief doctor” arbitrarily forbids the mother of a patient from visiting her, and when the patient discovers that her mother has come to the asylum without seeing her, an omission that she ascribes to her mother’s wishes, she runs far out into the grounds:

Her heart breaks, she clutches handfuls of the sharp pine needles which pierce her flesh, while from between her thick lips, smeared with saliva and rouge, issues a desolate keening that soon leads her pursuers in the right direction.