The Good Doctor

Adam Haslett 2002

Introduction

"The Good Doctor" by Adam Haslett is the second story in the collection You Are Not a Stranger Here, which appeared in 2002. The nine stories in this collection depict small moments in the lives of fully developed characters, some of whom are estranged or disturbed. Several deal with mental illness and several with male homosexuality. Haslett is as adept at locating his stories in England as he is with situating them in the United States, and regardless of the subject, his stories are written in a poised, elegant style. In "The Good Doctor," a young psychiatrist drives to a remote house on the Nebraska prairie to evaluate a patient whose prescriptions need renewing. Within the framework of the psychological interview, Haslett examines various topics connected with drug addiction, trauma, grief, chronic rural poverty, and disillusionment. One point the story in its entirety seems to make is that federally funded medical programs in remote areas are ineffectual in delivering the necessary sustained support to people with chronic psychiatric and medical problems, problems which are themselves often caused by the very remoteness that obstructs the delivery of the needed services.

Author Biography

Adam Haslett was born on December 24, 1970, in Portchester, New York. He received his B.A. in 1993 from Swarthmore College. The following year he spent in Provincetown, Massachusetts, on a fellowship at the Fine Arts Center. While there he learned he had been accepted into the Iowa Writers' Workshop at the University of Iowa. He put his acceptance into the Yale University Law School on hold and moved to Iowa. He received his M.F.A. from Iowa in 1999.

Next, he returned to his original goal and pursued a degree in law at Yale University. At the same time that he was studying at Yale, Haslett was publishing short stories. On the strength of reading one of them, an editor at Doubleday offered to publish a collection of stories: thus, the nine stories that came to make up You Are Not a Stranger Here, which includes "The Good Doctor," were welcomed into print as a collection in 2002. This first book was well received: It was the August 2003 selection for NBC's Today Show Book Club. Also in 2003, Haslett received the L. L. Winship/PEN New England Award. That same year he graduated from Yale with a degree in law.

As of 2006, Adam Haslett was making his living as a writer and as an attorney. He divided his time between living in New York and London, England.

Plot Summary

Set in the barren prairie of northeast Nebraska, "The Good Doctor" tells the story of an at-home interview between psychiatrist Frank Briggs and Mrs. Buckholdt, a patient who has been using sedatives and antidepressants for four years and who has recently missed several of her clinic appointments with her regular doctor. Young and somewhat idealistic about how much he can help, Dr. Briggs drives two hours to visit Mrs. Buckholdt because he wants to evaluate her case directly. He does not believe it is healthy to continue to prescribe medication for her over the phone. Though he is trained in "biological psychiatry," a physiological method of treating psychological problems with drugs, Dr. Briggs subscribes more to the value of talk therapy. He believes that a patient needs to experience empathy from the therapist, a sense of connection and caring. He takes the trouble to drive out to the Buckholdt house because he wants to understand Mrs. Buckholdt better, to hear her story firsthand. However, when he arrives at the sagging "fifties prefab" in the middle of nowhere, he confronts a family of alienated, hardened individuals and a client more in charge of the situation than he anticipated.

The night before this interview, Dr. Briggs learned that Congress was reducing funds for the National Health Service Corps, the organization for which he works as a volunteer in exchange for his medical school debt being repaid. One year into his three-year contract, Dr. Briggs is suddenly aware that his career may be on hold and that he may come away from his current work in rural Nebraska with debt he hoped to have eliminated. At the age of thirty-two, Frank Briggs has recently ended his six-month relationship with his girlfriend, and he offers himself the dubious consolation that his patients have "romantic lives more desperate than his own." He has a headache from having drunk too much alcohol the previous night, is worried about his future, and exhausted by the one-hundred-degree heat as he pulls into the Buckholdt property.

In turn, Frank meets each of the four family members. They are separated spatially from each other and not inclined to talk. The daughter appears in the driveway, but she turns and walks away in response to his greeting. After a few knocks at the door, Jack Buckholdt opens up. Jack says the daughter "ain't a bigger talker," an understatement that clearly applies to the whole family. Dr. Briggs notes that Jack evinces some physical signs of "Hepatitis C … or the end of a serious drinking habit." Jack's second comment begins a pattern that characterizes the interview between Frank and Mrs. Buckholdt; Jack minimizes Frank's authority by commenting on his age. He is "young to be a doctor" and appears to be running an errand for the clinic, "the one they sent up." Jack says his wife is inside and then edges past the doctor and disappears into the yard. Dr. Briggs adjusts to the dark interior and notes the back of the son's head in the kitchen. The boy is watching an animal chase on "a muted television."

While he waits for Mrs. Buckholdt, Frank looks over her record. He thinks about his ex-girlfriend Anne and how they disagreed in their residency program about the emphasis on drug therapy for psychological problems. While other residents "joked about the numbing" that insulated them from patients' problems, Frank knew he was not adapting similarly. In fact, "he still felt like a sponge, absorbing the pain of the people he listened to." Now he reviews Mrs. Buckholdt's chart, which contains an assessment by an internist. He finds her case mismanaged. What he learns is that she first appeared at the clinic four years earlier, complaining of depression following the death of her son, Jason. She had been given antidepressants followed by benzodiazepines, "written as needed." There was no therapy, and the previous psychiatrist would not have considered making a five-hour round-trip just to check on his patient, "so he'd just kept calling in her refills." In the margin of the chart, Frank sees a little note, "Injury may be a factor."

Mrs. Buckholdt's first sentence is remarkably refined: "My apologies for not greeting you at the door." She is attractive, in apparently good health, nicely dressed. Frank had expected "a disorganized person," but Mrs. Buckholdt seems "out of place here, in this house out in the middle of nowhere." She locks the door to the kitchen and sits down, facing Dr. Briggs. He begins conventionally; the director wanted him to check in on her in person. She denies eye contact, looking over his shoulder. Her response is a non sequitur: "I take it you're childless." Clearly, Dr. Briggs wants to conduct a typical assessment interview: he asks the relevant questions, and the patient answers them. But Mrs. Buckholdt asserts control, asks personal questions, chooses the subjects she discusses. She is not a weakling, a victim; rather, she is "self-possessed" with "powerful" eyes and "a strong, almost male jawline." Then she moves a certain way, and Frank sees that her four fingers have been cut off her right hand. He focuses on her face, and then he decides he will accept a glass of water.

In the kitchen, Frank greets the boy, but the boy only looks vacantly at him and then back to the television, where an animal feeds on the stomach of a deer. As he leaves the kitchen, he turns the key in the lock as Mrs. Buckholdt had and rejoins his patient. He begins again, asking her if she is still troubled by the depression she had four years before when she first came to the clinic. Again, she responds with a non sequitur: "Where is it that you grew up?" When he brings her back to the subject, gently reminding her that it would be good to use their time together to understand her situation, she still pursues personal questions about him. She explains that she likes to have "a sense of who [she's] talking with." Thus, she draws the conversation off her and onto him. Frank tells her he grew up outside Boston. Again, he tries to pull the discussion back to her depression, inquiring if it is a current problem. She directs his attention to a print of a Brueghel painting on the wall.

Then Mrs. Buckholdt begins to talk about her past, and Dr. Briggs decides to acquiesce to her choice of subjects. Mrs. Buckholdt went to college out East, where she studied art history. She loved paintings and hoped to have a better life than small-town Nebraska offered her. But her father died as she began her senior year, and she had to return home. She married Jack Buckholdt, a handsome young man who read books and had a promising job at the bank. She believed him when he talked about saving up for a couple years and then moving to California. But years went by, and they did not move. They had three children instead; the area suffered an economic depression during which the bank closed, and Mr. Buckholdt took up drinking and then lost his job.

Dr. Briggs asks Mrs. Buckholdt to describe her symptoms. She says some mornings she is afraid to get out of bed. She takes medication to help her get up and serve her children their breakfast. She admits being afraid of her son. When he asks why, she answers that taking the pills helps her. Then she returns to talking about her past. Building some kind of rapport with Dr. Briggs, she asks if he is married or if he intends to marry. Then she goes on about her plans for her first son, Jason. If she could not escape this barren place, then she was committed to helping Jason do so. She read him her art books, bought him a violin, and gave him lessons. All went well until he hit fourteen, got criticized by children at school, and destroyed his instrument. She says, "this place … started doing its work on him somehow…. The little tough guy stance, afraid of anything that wouldn't make him popular." She was depressed, feeling that she was not "really there in the room" with her own children. Then Jason and his friend Jimmy Green got hooked on methamphetamine, "the drug of choice for kids out here."

Now Mrs. Buckholdt closes in on a certain Sunday when her husband and the other two children were away, and Jason was up in his room, having gone several days and nights without sleep. He began crying; she went upstairs to discover her son, now seventeen, naked and rubbed raw and bleeding. He looked at her like she had "severed a rope he'd been clinging to for dear life." She got gauze, ointment, and Band-Aids, and tried to take care of his skin. Downstairs, she was in the kitchen chopping vegetables for soup; he came in and chopped off her fingers with a meat cleaver. Then he went out of the house, naked, and never returned. Frank listens and waits, feeling "a familiar comfort being in the presence of another person's unknowable pain." A few days later, Jason and his friend Jimmy crashed someone's truck into the wall of an overpass on the interstate. Jimmy was burned; Jason was killed. Dr. Briggs listens, mentally writing his own note into her chart: "intrusive recall … hypervigilence, and generalized anxiety." He thinks she has post-traumatic stress disorder. Facing Mrs. Buckholdt, "this oddly compelling woman," Frank realizes why he became a doctor: "to organize his involuntary proximity to human pain." It served him as a way to control "this opening in him" to pain in others. He seems to benefit more from the interview than she does.

Earlier, Mrs. Buckholdt discussed a Brueghel painting in the room; now, having told her story, she returns to it. It was Jason's favorite work. She recalls learning that Brueghel "was a moralizer, his paintings full of parables." She takes charge of the conclusion of the interview. She does not want Dr. Briggs to return; she will not go to the clinic. It is better when she does not think of the past. She can use the pills, but she can get along without them. As she rises and alerts her son that they must soon leave for his violin lesson, Dr. Briggs feels panic at the thought that it is over between them: "he didn't want to lose her, he didn't want the telling to end." He tries to hold on by asserting that therapy is advisable, but she cuts him off: "didn't you hear what I said?" she asks him. She has the last word. She does not need him, but he knows how much he needs her.

Characters

Anne

Anne is a psychiatrist who went through residency with Frank Briggs and visited him once in Ewing Falls, Nebraska. They had dated for six months but are now no longer a couple. Like Frank, Anne was trained in "biological psychiatry"; unlike him, she does not question this drug-based method for treating mental illness.

Dr. Frank Briggs

Frank Briggs, age thirty-two, is a new psychiatrist, having completed his residency just one year before this story begins. Now he is about to enter his second of three years as a volunteer with the National Health Service Corps, an agreement which entails his working in an underserved area in exchange for his medical school loans being repaid by the organization. Frank's immediate predicament is that the Congress has cut funds to the service, and while he is committed to this work contract, he is disheartened to know his medical school debt will not be paid as he anticipated.

Frank does not believe in the current practice of relying mostly on medication to treat psychiatric conditions. He believes that patients seek "someone to acknowledge what they [are] experiencing." His ex-girlfriend Anne accuses him of "clinging to an old myth about the value of talk." Intuitive and sensitive, Frank feels "like a sponge, absorbing the pain of the people he listen[s] to."

Jack Buckholdt

Jack Buckholdt grew up in northeast Nebraska, married, got a house, a job at the bank, and for years harbored dreams of moving to California and owning a house with a view of the ocean. He told his wife they would someday have an orange tree in their yard and museums nearby for her to enjoy. Instead, the couple lived in the barren northeast Nebraska prairie, they had three children, Jack had his work at the bank, and years passed. Financial hard times hit, property was foreclosed, and Jack took up drinking. Now he is an unemployed alcoholic with liver disease, living in a broken-down house out in the middle of nowhere.

Jason Buckholdt

First son of Mr. and Mrs. Buckholdt, Jason was his mother's hope for escape from the culture-starved Nebraska landscape where they live. Before puberty, Jason was willing to be schooled by his mother in art and to study the violin, but in his teens, he resented the mockery of his classmates, and with Jimmy Green, he became addicted to methamphetamine. Strung out on lack of sleep, he sunk into a psychotic state, and attacked his mother with a knife. Days later, Jason and Jimmy borrowed a friend's truck and crashed it into a wall of an overpass on the interstate highway. Jason died in the accident; Jimmy Green survived with burns.

Michael Buckholdt

The middle child of the Buckholdts' three children, this boy sits in the kitchen watching television with the sound off while Dr. Briggs interviews Mrs. Buckholdt. The boy is unresponsive when Dr. Briggs goes into the kitchen and speaks to him and seemingly acquiescent to Mrs. Buckholdt's confining him in the kitchen behind a locked door. When the doctor is about to leave, the son asks his mother's permission to leave the kitchen, and then he goes upstairs to get ready to go to his music lesson. The son's impassive acquiescence suggests he is also traumatized by Jason's attack and perhaps alienated too by the emotional absence of his depressive mother.

Mrs. Buckholdt

Mrs. Buckholdt, age forty-four, is the mother of three children. She and her husband, Jack, live in a run-down place in northeast Nebraska near Ewing Falls. As a young woman, Mrs. Buckholdt attended college in the East, where she studied art history. After her junior year, she returned home to Nebraska. She married Jack Buckholdt, believing in his dream of their moving to California as soon as they had the money. Years accumulated, and the dream was lost. Mrs. Buckholdt suffers from depression as a result of the death of their first son, Jason. She also suffers from post-traumatic stress disorder from Jason's attack, in which he cut off the fingers on her right hand. Now she manages to provide minimally for her two younger children, but she needs a prescription for a sedative to get through some days. Though she is resigned to her meaningless life, Mrs. Buckholdt thinks about art and cultured places out East where she once went to college and saw for herself how other people are able to live.

Daughter

The Buckholdts' daughter appears in the driveway when the doctor knocks at the door, but she does not respond to his greeting. Frank describes her as looking "eight or nine, but her rigid mouth and narrowed eyes [suggest] someone older." Explaining why she does not respond to the doctor, Jack Buckholdt says, "She ain't a bigger talker." The daughter is disconnected from the family: she stands in the driveway doing nothing. There is no place to play in this dirty yard, and the sign on the barn prohibits her from going in there: "No Girls Allowed."

Jimmy Green

Jimmy Green is Jason Buckholdt's high school friend. The two get involved with methamphetamine, borrow a truck from a friend, and crash it into the wall of an overpass on the interstate highway. Jimmy survives the accident and lives in the area. Mrs. Buckholdt remarks that she sees him every once in awhile.

Themes

Chemical Drug Use and Abuse

"The Good Doctor" is much concerned with drug use and abuse. Life in this rural, economically depressed Nebraska prairie offers little opportunity or hope, and drugs become the means by which people dull disappointment and disillusionment. Jack Buckholdt promised his wife they would leave for a better life in California; Mrs. Buckholdt promised Jason he would escape poverty. When as a little boy he would cry over trouble at school, she would soothe him with a fantasy about taking him across the Atlantic so he could visit Italy and Greece. But by the time he was fourteen, Jason must have realized the only escape was through drugs. He became addicted to crystal methamphetamine. His erratic behavior, his sleeplessness, and his psychotic rubbing of his body, all indicate the effects the drug had on him. Moreover, his attacking his mother in a psychotic episode and running out of the house naked, never to return, suggests quite literally how drug addiction can maim those around the addict who love and want to care for him. The accident on the interstate is probably a direct outcome of Jason's drug abuse, and metaphorically, it hints at the sense Jason may have had of there being no escape from this place. Moreover, the story shows how drugs can be abused by medical professionals who rely on them as an easy fix to mask psychological symptoms in welfare patients. Mrs. Buckholdt is a poor woman; it is easier to sedate her than it is to face the trauma and grief of her home life. Mrs. Buckholdt uses prescription antidepressants and tranquilizers to increase her ability to function in her family, to care for her remaining two children, but the drugs do not neutralize her anxiety, lift her disillusionment, or mitigate her fear of her surviving son. The story portrays drug abuse, illegal and dangerous teenage abuse, legal and equally dangerous professional use, all against a backdrop of chronic poverty and powerlessness. The tonic of the moment insulates or dulls, but it cannot fix the landscape of problems which grind people into complete disillusionment and alienation.

Topics For Further Study

• Write a short story based on a medical or psychological examination you have experienced, characterizing the doctor by details that slip out regarding his personal life. See if you can introduce elements in the story that reverse the common expectations about how a doctor and patient conduct themselves during an examination.
• Research drug abuse among high school students in urban and rural areas over the past twenty years. Draw a chart indicating types of substances and rates of abuse in several different types of locations over two decades. You may include a large city, a small town, a farming community, and other types of remote areas. What pattern of increase or decrease in rates of abuse does your research indicate?
• Study the subject of domestic violence. Who in the family is most likely to become violent, and who is most likely to be injured? What are the long term effects on family relationships when domestic violence has led to permanent injury or death? Write an essay describing domestic violence, explaining patterns of family abuse and providing information on services available to people who suffer from this type of violence.
• Do some research on the National Health Service Corps, using its website as a starting place. Write a summary of the information you acquire about the service, the populations it serves, and financial arrangements offered to volunteers. See if you can pinpoint when "The Good Doctor" takes place by determining the time when the service lost funding through some action in Congress. What other clues does the story provide for determining the time in which it is set?

Post-Traumatic Stress Disorder

"The Good Doctor" presents a woman who four years earlier was maimed by her son, who cut off the fingers on her right hand and who shortly thereafter was killed in an accident on the interstate. Mrs. Buckholdt experienced a life-threatening, terrifying, and shocking event when Jason amputated her fingers; that event was closely followed by his death. When Dr. Briggs interviews her, he considers that Mrs. Buckholdt may suffer from post-traumatic stress disorder (PTSD). This interpretation makes sense because she was clearly traumatized by the dismemberment and by the shock of her son's death a few days later. Dr. Briggs theorizes that if this diagnosis is correct, Mrs. Buckholdt should be prescribed sertraline (Zoloft) to help neutralize her anxiety and irrational fear. Based on this one interview, however, Mrs. Buckholdt does not seem to follow the expected profile of someone who has PTSD. For one thing, she remembers the traumatic events but can discuss them as memory and not as though she is back there all over again experiencing the same pitch of emotion she went through in the moment. Her pain and loss have left her with irrational fear of her other son and with a fear that comes over her some days and prevents her from getting out of bed. Yet she does not evince drug dependency and, in fact, asserts that she can get along without the prescriptions if Dr. Briggs does not refill them. In the face of her pain, Dr. Briggs thinks about what he would recommend and how he would describe her condition in her chart, and yet Mrs. Buckholdt shows that she can manage without his help. She has developed toughness and resolve. She knows she must care for her surviving children, and she knows she can do it if she does not look back or dwell on the past. This may be denial, yet the reader will never know. She tells Dr. Briggs not to return and refuses the offer to come to the clinic once a month.

Alienation

This story depicts the members of the Buckholdt family as individuals who do not relate to each other. Each person is shown alone: the daughter on the drive, the father wandering into the yard, the son locked into the kitchen watching a television with the sound off, and Mrs. Buckholdt herself, sitting on the couch and looking past the psychiatrist's shoulder to the wall. Mrs. Buckholdt has hardened or shut down; in order to exist in the world of this household, she has repressed all emotion. The family lives out in the middle of nowhere, hours from the nearest small town, in a dilapidated house. The father drinks, the mother lies in bed some days afraid to get up, and the children are unresponsive and detached. It is as though each person is paralyzed emotionally, estranged, unable to express what is inside. The point seems to be that drug abuse and trauma can arrest people in their abilities to interact or be open to one another. The family is beyond the help of the psychological clinic, both geographically and psychologically.

Style

Setting

"The Good Doctor" is set in northeast Nebraska, near the small towns of Atkinson, Tilden, and Ewing. The Buckholdt family lives in a "white fifties prefab, sagged on one side" with "empty prairie stretching miles in every direction." The first thing Dr. Briggs notices on the property is "the skeleton of a Chevy Nova, grass to the windows." In this remote area, stuck in chronic poverty, this wreck of a car suggests a place from which there is no transportation or escape. Even the car's name literally means "no go." Then too the heat is over one hundred degrees, "the horizon molten in air heated thick as the fumes of gasoline." Art may provide "perfect" images of "lush landscapes," but these pictures are fanciful creations, unlike anything Mrs. Buckholdt has ever seen in her Nebraska-bound life. She reports to Dr. Briggs that she took her son, Jason, to Chicago to the museums, to St. Louis to buy a violin, and she told him stories about taking a ship across the ocean to visit Athens and Rome, but one may get the sense that Jason, by the time he was fourteen or fifteen, realized there was no hope for departure. His death in a borrowed truck that hits a wall of an overpass perfectly conveys his felt urgency to escape and the wall that prevented (or provided) it.

Allusion

An allusion is a reference to some work of art or historical event or person that lies beyond the present work; the effectiveness of an allusion depends on its being recognized by the reader. The allusion has significance of its own that is relevant to the present text; the connection between the present text and the allusion relies on the shared knowledge of the author and the reader. If something is mentioned in a work of literature, it is generally worthwhile to investigate the reference and ask oneself why this allusion was made and not another. One can assume the allusion is relevant to the text at hand.

During the interview with Dr. Briggs, Mrs. Buckholdt focuses on a print by Pieter Brueghel which hangs behind the doctor on the living room wall. She states that it is a copy of The Fight between Carnival and Lent, which Brueghel painted in 1559. Elsewhere during their talk, Mrs. Buckholdt mentions the artist Géricault and his paintings of Arcadia, "those huge, lush landscapes of his." Mrs. Buckholdt says the painting by Brueghel was Jason's favorite, so it provides in a sense an index to his character or to what held his attention. This painting depicts a village scene that is in every sense unlike the Buckholdt property. Whereas the Buckholdts are isolated on the prairie, the villagers in Brueghel's painting are all out in the town square interacting with one another. Great diversity is depicted: people reveling, others praying; some overindulging, others gaunt with fasting. Good and evil, abstinence of Lent and celebration of carnival, all mix together among these lively, engaged peasants. To step into Brueghel's scene would be to invite total sensation and stimulation. Addicted to methamphetamine, Jason existed in a hyper state of over-stimulation, unable to sleep or to focus. In a place practically devoid of stimulation, he rubbed himself raw. The Brueghel painting helps readers understand the imagined world Jason longed for. In a similar way, Mrs. Buckholdt's love of Géricault's landscapes conveys her longing for a world very unlike the one she inhabits, green, mountainous, moist. She loved studying art history in college because standing in front of those paintings allowed her imaginatively to escape the limitations of her life in Nebraska.

Irony

One form of irony is the discrepancy between what is expected and what actually happens. The difference between what one anticipates, between what ordinarily happens, and what in this case unfolds draws the reader's attention to a central topic or problem in the story. In some ways, the interview in "The Good Doctor" reverses what conventionally happens during a psychological evaluation. It is conventional for the doctor to ask the questions, and the patient to answer them. The doctor is in charge; as the professional helper, the doctor has choices and can suggest and administer treatment. By contrast, the patient is understood to be the one with the problem, the one who is vulnerable and needy. However, in this story, in some ways, the opposite is true. The doctor is in his patient's home, on her turf so to speak. Dr. Briggs is younger than his patient, and he seems less assertive or dominant than she appears. Instead of answering his questions, she asks her own, and when he objects politely, she is able to draw him into speaking about himself, something he knows is unprofessional and inappropriate. He comments that she has missed several appointments; she asks him if he is childless. He asks her if she was depressed after her son died; she asks him where he grew up. Dr. Briggs attempts to establish control, tries to bring her back to the subject, her psychological condition and need for medication, but she counters with another question about his past, his background, his intention to marry. It is surprising to see the repeated ways in which she takes control of the interview when one would expect the psychiatrist to have control of it. Indeed, when he asserts, "it's important for me to get a handle on your situation so we can try to help you," she apologizes yet again poses a question: "Of course. I apologize. I just like having a sense of who I'm talking with. You're from the East I take it." Mrs. Buckholdt, the patient, the one who has had a traumatic experience and may, as Dr. Briggs theorizes, suffer from post-traumatic stress syndrome, is the one who comes across as organized, "self-possessed," and in surprisingly good physical health, whereas Dr. Briggs has a headache from drinking too much alcohol the previous night, is unprepared for this interview, and, as readers learn elsewhere, he is unable to sustain a romantic relationship longer than six months. These reversals in what might be ordinarily expected direct the reader to consider both the doctor and the patient in different terms. The doctor's youth and inexperience are emphasized, and Mrs. Buckholdt's strength and ability to persevere suggest she needs less professional support than Dr. Briggs assumes. In all, she is able to describe what happened to her and to assert that she can manage, without talking to him again and without the prescriptions, if he does not refill them. That she refuses his offer of further treatment causes Dr. Briggs to panic. Thus, irony is used to show the ineptness in the professional to address the problems of his patient. It also reveals that the patient may in some ways be stronger than the doctor.

Historical Context

National Health Service Corps

According to its website, the National Health Service Corps (NHSC) was established in 1972, as a part of the U.S. Department of Health and Human Services, a federally funded agency to address the medical and psychological needs of under-served populations, wherever they are found in the United States, from rural and mountainous areas to certain inner city communities. As of 2006, an estimated fifty million Americans are without access to healthcare services, including medical and psychological support. Since its beginning in 1972, approximately 23,000 healthcare professionals have participated in the programs that seek to deliver support services to people who normally do not have them. In 1987, Congress authorized a NHSC student loan repayment plan for medical professionals who establish and maintain a practice in a geographic location which the NHSC has identified as underserved. According to a 2000 statement by the National Association of Community Health Centers, the primary problem with NHSC is limited federal funding. That association suggested that at least five times as many practitioners are needed to begin to meet the needs of underserved U.S. populations. According to the NHSC website, in 2006, some 2,700 professionals were involved in the various programs, serving the needs of several million U.S. citizens.

Rural Substance Abuse and Poverty

Rural areas in the 1990s witnessed an increase in instances of substance abuse. According to a 2003 report published by Hazelden, rural youngsters were more likely to use some drugs than their urban counterparts. For years, many believed that drug abuse mostly occurred in urban settings and rural areas were relatively free of the problem. In fact, according to a report funded by the Drug Enforcement Administration (DEA), illegal drug use was found to be higher among rural eighth graders than those children living in cities. These rural children were 83 percent more likely to use cocaine and 43 percent more likely to use marijuana. Among twelfth graders, rural teens used inhalants, amphetamines, and cocaine more frequently than those students in the same grade living in cities. According to the Hazelden report, as drug enforcement is more effective in urban settings, illegal drug activities have moved increasingly into less enforced rural areas. To illustrate the point, Hazelden cites that the DEA in 1994 seized 263 labs which were manufacturing methamphetamines, and in 1998, it uncovered 1,627 labs with most of those located in the rural Midwest and West. The problem, in part, is that in low population areas, law enforcement must cover large distances in order to locate illegal activities but does not have sufficient money or numbers of officers to do so.

Drug abuse in rural areas correlates with poverty. In a 2002 New York Times article, Timothy Egan mapped out "a generations-old downward spiral in the countryside," in which "the hollowed-out economy has led to a frightening rise in crime and drug abuse." The crime is directly connected to "a methamphetamine epidemic." In this article, Allen Curtis, executive director of the Nebraska Crime Commission, is quoted as saying, "Meth seems to be everywhere in Nebraska right now." Between 1994 and 2002, the use of this drug nationwide tripled. But its abuse in rural, thinly populated places is exceptionally high. For example, according to a survey conducted by the National Institute of Drug Abuse, in Wyoming, the state with the smallest population, estimates for 2002 suggested that 1 percent of the population required treatment for methamphetamine addiction. Abusers of methamphetamine "tend to be erratic, violent and in some cases, borderline psychotic—especially when on a sleepless binge." All of this information is relevant to Jason Buckholdt's addiction and fate.

Critical Overview

Adam Haslett's first book of short stories, You Are Not a Stranger Here, in which "The Good Doctor" appears, was viewed as a candidate for awards. The collection was a finalist for the 2002 National Book Award and a Pulitzer Prize for Fiction finalist in 2003. For this work, Haslett won the L. L. Winship/PEN New England Award in 2003. His collection was described in mixed terms but overall taken as a positive first publication by a new writer.

A reviewer for Kirkus Reviews in May 2002 writes that though the stories are "extremely uneven," the book as a whole is an "unquestionably promising debut." This review notes that some of the stories hold "some spectacular moments." About "The Good Doctor," the Kirkus reviewer summarizes: "a callow physician's efforts 'to organize his involuntary proximity to human pain' are unsettled by the story of a luckless family's destruction by economic failure and drug addiction." Emphasizing the collection's dark topics, a reviewer for the New York Times Book Review says the stories "exhale a desiccated bleakness, a despair mitigated by the characters' continuing desire to be good … despite hopelessness, loss, disease and frequent mental illness."

A reviewer for Publishers Weekly points out that "Often, Haslett convincingly interweaves the perspectives and lives of seemingly disparate individuals" and concludes that "this is a strikingly assured first effort." Tom LeClair, writing for Book, points out that all of Haslett's characters "are estranged," and "most of his characters have no hope." LeClair cautions that the book may not suit some readers. In all, LeClair finds the stories something of a downer, stating that "Not every reader will care or dare to enter Haslett's sometimes melodramatically painful world, but the book welcomes the courageous—and the estranged."

Criticism

Melodie Monahan

Monahan has a Ph.D. in English and operates an editing service, The Inkwell Works. In the following essay, Monahan explores setting as the inescapable trap of chronic rural poverty and drug addiction and the failure of the federal outreach program to address local needs as these are depicted in "The Good Doctor."

In Adam Haslett's short story, "The Good Doctor," setting is both an historical and a geographical context, the decades-long persistent local economic depression and a history of failure of the federally funded medical outreach program, sponsored by the National Health Service Corps, to respond effectively to local substance abuse needs. The chronic poverty and the inadequate federal program attempting to address its effects, taken together, create an insidious, deterministic context, an inertia as unnoticed as the height of the grass growing through the rusted "skeleton of a Chevy Nova," on the Buckholdt property. Here is a story of a story of a story: a problem within a problem within a problem. It might be schematized this way: first comes the story of the interview between Dr. Frank Briggs and his patient, Mrs. Buckholdt; next is her story of her son's addiction to methamphetamine, his attack on her, and his death; and last is the economic story of chronic poverty in a remote landscape that stretches back through the history of this family and the history of the parents of this family, all in a place beyond the effective reach of professional assistance. The first two stories are symptoms of the third problem, which in this case, the patient appears to understand better than the doctor.

Chronic poverty is presented first in "The Good Doctor" in the image of the half-buried Chevy Nova, rusting on the Buckholdt property. This car, whose name means "no go" in Spanish, signals no means of escape from this "empty prairie." The sagging "fifties prefab," the "dilapidated barn," the "air heated thick as the fumes of gasoline," all make up the immediate setting or backdrop, the barren, dusty landscape, in which Mrs. Buckholdt, her alcoholic husband, Jack, and their two children exist. What is wrong with this place and these people has been wrong a long time.

Waiting for Mrs. Buckholdt in the living room, Dr. Briggs examines her chart only to see "how shoddily her case had been managed." The problem of this family, summarized in the facts about Mrs. Buckholdt, go back four years, when she first came into the clinic complaining of depression after her son died. The chart provides only brief notes; she received antidepressants then sedatives and no therapy. In this rotating-door, federally funded agency, presumably one psychiatrist after another dealt with Mrs. Buckholdt over the past four years. The last one phoned in her refills rather than investing the time in driving out to her place to see her; Dr. Briggs, the new person handling her case, takes the trouble to visit her house in the hopes that talking with her will help. The chart does not clue him in on the background. In the margin, Dr. Briggs sees "a cryptic line," that "Injury may be a factor," a line that may be a warning but certainly is not all that informative and leads him to suspect incorrectly some kind of farm accident.

Immediately, however, readers are given reason to wonder if this clinic and Dr. Briggs's good intention are capable in any way of addressing Mrs. Buckholdt's case. In fact, "The Good Doctor" begins the morning after Dr. Frank Briggs gets some bad news. A volunteer with the National Health Service Corps, Dr. Briggs has agreed to work for three years for "a paltry salary" in the northeast Nebraska boondocks in exchange for repayment of his medical school debt. The news is that agreement is about to change: Congress is cutting funding to the agency, and Dr. Briggs is being left with "the full burden of his debt." As Mrs. Buckholdt's chart shows, the program has been ineffective for some years already, and now as Dr. Briggs begins his second year of working in it, the program faces budget cuts which may make it infeasible for Dr. Briggs to continue practicing in this location. Connected to money issues is a question about methodology.

Dr. Briggs was trained in a residency program dominated by "biological psychiatry"; drugs were the preferred method for treating psychological and behavioral problems. However, though he is a medical physician and trained in physiological diagnosis, Dr. Briggs clings "to an old myth about the value of talk." Young and idealistic, he believes patients need "someone to acknowledge what they were experiencing." Frank Briggs has not developed the "numbing" his fellow doctors acquired during their training. He knows himself to be "a sponge, absorbing the pain," and he puts his faith in the healing effect of empathy. That position is fine, but how can it be applied effectively within a program which faces budget cuts in an area so remote some of the clients are hours away? In other words, reduced funding for the program constricts its reach and effectiveness and undermines the workers who face unexpected financial worries themselves. In addition, treatment method is called into question given the mission of this program to serve populations in remote areas where frequent consultation is impractical and drug addiction widespread. Mrs. Buckholdt's case has gone unmanaged for years, and given internal difficulties in the agency and Dr. Briggs's own financial burden, how likely is it that Mrs. Buckholdt's best interests can be served in this place and at this time?

Unlike the previous psychiatrist, Dr. Briggs wants to extend himself to his patient. He is willing to drive the five-hour round-trip to her house to see for himself how she is doing and to evaluate her medications. But in their interview, Dr. Briggs encounters some surprises. The contrast between the chart and Mrs. Buckholdt herself is immediately apparent. Her first response to Dr. Briggs is refined, gracious, so unlike this most ungracious "fifties prefab" out in the middle of nowhere. She appears in good health, is nicely dressed, and has "a self-possessed demeanor." Older and in some ways in better shape on this afternoon than the doctor, who is himself suffering from a hangover, Mrs. Buckholdt takes charge of the interview.

Dr. Briggs wants to focus on her present condition, inviting her to describe her symptoms. It registers on him as off the subject when she chooses instead to question him about where he grew up and went to school, eliciting the fact that he comes from an affluent Boston suburb. The subject is germane, however, from her point of view, for she went to college back East, and she knows the difference between affluence and poverty, between being cultivated and not having a clue about how to survive in a place that offers no hope of a better life. Mrs. Buckholdt, in asking about the doctor, excuses herself for seeking personal information: "I just like having a sense of who I'm talking with. You are from the East I take it." It is not professional for the conversation to focus on the doctor rather than the patient, yet given the story Mrs. Buckholdt has to narrate, a sense of place is relevant. She knows where Dr. Briggs is coming from, both literally and professionally, and she wants him to know she can imagine the town where he grew up: "a rich town, isn't it? Tidy lawns. A country club. Kids going to college. Am I right?" These details of setting signify the context for Dr. Briggs's own development and suggest the factors that supported his becoming the psychiatrist he is. When he asks about her depression, she looks over his shoulder to a Brueghel print on the wall.

The case at hand, from this patient's point of view, is a matter of setting. It matters that she was sent back East to college, that she studied art history, that she was cultivated and saw how rich kids live in eastern cities. It also signifies much that the death of her father called her back to Nebraska without allowing her to complete her bachelor's degree, back to a mother who thought the cost of education for a daughter was a waste of money. In this way, Mrs. Buckholdt learned what she could not find in northeast Nebraska. She married and bought into her husband's dream of escape. Investing more than she knew in the hope of a change in real estate, she and her husband bought a house in Nebraska, theoretically to save up for the move, and then they had children, the first one born quickly. Thus, the factors were in place for their remaining where they were longer than they envisioned. Perhaps imperceptibly at first, economic depression made the inertia of this place more adhesive. Mr. Buckholdt's job became one of managing foreclosures; then the bank folded, and he lost his job and began to drink. Some years later, what chance of leaving existed? Disillusioned for herself, Mrs. Buckholdt nonetheless perpetuated the narrative of escape for her son, Jason.

What Do I Read Nest?

• The Collected Stories of Richard Yates (2001) contains selections from Yates's two earlier collections Eleven Kinds of Loneliness (1962) and Liars in Love (1981), along with nine other uncollected stories. Readers who like Haslett's style may enjoy Yates's way of exploring why individuals fail to achieve meaningful relationships. The book contains an excellent introduction by Richard Russo.
• Over thirty years after her death in 1967, the stories of Mary Ladd Gavell, managing editor of Psychiatry magazine, were published in I Cannot Tell a Lie, Exactly and Other Stories (2001). Set in a time before television, these stories explore with a surface simplicity the subtle nature of mily relationships.
• The elegant style of Donald Hall is at work in his collection Willow Temple: New and Selected Stories (2003), twelve stories in all, including one about children of alcoholic parents, another about a child who witnesses a mother's infidelity, and still others about early adulthood. In some of these, Hall traces the emptiness of life after a person is traumatized.
• Elizabeth McKensie wrote a novel in nine interlocking stories, entitled Stop that Girl: A Novel in Stories (2005). The stories cover the life of Ann Ransom, through her childhood, marriage, and divorce.
• In The Center of Everything (2003), Laura Moriarty tells the story of ten-year-old Evelyn Buchnow, who takes care of herself because her unemployed, emotionally imbalanced mother cannot care for her. Elizabeth experiences loneliness and confinement in her small Midwestern town.

In her story about Jason, Mrs. Buckholdt asks Dr. Briggs: "You're a doctor in these parts … You must know all about methamphetamine." Dr. Briggs agrees; cases of this addiction appear in his clinic; "It had become the drug of choice for kids out here, cheaper than coke." Existing in poverty-stricken rural Nebraska, seventeen-year-old Jason Buckholdt had perhaps as high as a one in four chance of exposure to this drug. On the day of his psychotic episode, Mrs. Buckholdt had gone to his room when she heard him crying in the same tone of voice he had had as a little child; now describing that scene to Dr. Briggs, she recalls years earlier when Jason was a little boy, how she would comfort him. Significantly, she consoled him with an escape narrative: "I'd tell him how one day we'd take at trip on a boat all the way across the Atlantic and he'd see Athens and Rome and all the places where the stories I'd read him took place." Mrs. Buckholdt used the myth of eastbound travel, a fantasy of entering the setting created in fiction, to appease her little boy. She might have taught him how to deal with school or kids who made fun of his studying the violin, but instead, she gave him the myth of escape.

Unfortunately, the effectiveness of this anodyne wore off by the time Jason was fourteen. Mrs. Buckholdt states, "this place, it started doing its work on him somehow." Just as Jason entered puberty, "His father had started drinking … Everything was going to hell around here, prices dropping through the floor … And as for symptoms, yes, to tell you the truth, I was depressed…. Things hadn't gone like we'd planned." Given her own shrinking circumstances, she thought about the contrast between her life and the young women who attended college with her, "visiting Europe, standing in front of those pictures."

The reality is that increasingly in the late 1980s and throughout the 1990s, methamphetamine was cheap and easily available in the rural Midwest. Jason and his friend Jimmy Green were caught buying some in a parking lot in Ewing Falls, Nebraska. Jason was sent for three months to a juvenile detention center in nearby Atkinson; when he came home he was "angrier, more confused." Mrs. Buckholdt theorizes that he procured meth even while incarcerated; she asks, "how they can run a jail where children can get drugs?" Some time later, when she was home alone with Jason, who had been awake for several days and nights, a terrifying psychotic episode occurred. He was naked, sobbing, and had rubbed his flesh raw. She says, "he looked at me like I'd severed a rope he'd been clinging to for dear life, just like that, like I'd sent him down somewhere to die." She adds, "I was his mother … What was I supposed to do?" She wrapped him in a towel and applied ointment to his wounds. Later, in the kitchen, he grabbed a meat cleaver and "chopped [her] fingers off, the fingers [she'd] touched him with." Dr. Briggs is silent as he listens to the story, and after she finishes speaking, he remains quiet. With the truth out in the room, Mrs. Buckholdt seems "smaller and more frail, her earlier, imposing demeanor exhausted." Significantly, when he died, Jason was heading west on the interstate; the borrowed truck hit a cement wall.

Hearing her story, Dr. Briggs feels "a familiar comfort being in the presence of another person's unknowable pain." He acknowledges to himself that "More than any landscape, this place felt like home." Able to attend, to pay attention to her story, Dr. Briggs still responds clinically, mentally composing a statement for her chart as he watches her: "intrusive recall … hypervigilance, and generalized anxiety. Diagnosis: posttraumatic stress disorder. Treatment: a course of sertraline, one hundred milligrams daily, recommendation for psychotherapy, eventual titration off clonazepam." Sitting quietly, he has to wonder if "the power to describe the people they listened to save [doctors] from what they heard." He thinks about the psychological vacancy of some patients, the denial of others, "the unsaid visible in their gestures, filling the air around them." Musing about his patients, thinking now about Mrs. Buckholdt's story, Dr. Briggs realizes why "he'd become a doctor: to organize his involuntary proximity to human pain."

But the illusion of being able to organize pain is immediately shattered by Mrs. Buckholdt's resolute dismissal of him. They look again at the Brueghel print, The Fight between Carnival and Lent, Jason's favorite work of art. The painting depicts a village square with lots of peasants engaged in various activities and at its center the "contending forces" of self-indulgence and abstinence. It is not the "lush landscapes" Mrs. Buckholdt loved; it is a painting, though, full of life. Mrs. Buckholdt is ready for Dr. Briggs to leave; she is taking her surviving son for his violin lesson. In response to the idea of leaving the house, Frank Briggs feels a visceral tightening: "the panic beginning before his mind could form the thought: he didn't want to lose her, he didn't want the telling to end." But the stories have all come to an end: he can recommend drugs and therapy, but she already knows there is no escape from the setting that controls this plot. When he demurs, she holds the door for him, asking him, "didn't you hear what I said?"

Dr. Briggs has, in fact, not heard her, if he continues to think that his remedy of drugs and talk can extricate her from the place and time that controls her life. Evidence provided at the outset also suggests that neither Dr. Briggs nor the more distant National Health Service Corps which he represents can in any way transform the remote regions in which cases such as that of Mrs. Buckholdt occur. They cannot undo the past, shift the decades' long downward spiral of economic depression, or make the barrenness in her life as lush as a painting or the California fantasy she once loved. The story proves the lie of its title; here is a case of chronic poverty and drug addiction, of trauma, grief, and loss, which the "good" doctor cannot even begin to fix.

Source: Melodie Monahan, Critical Essay on "The Good Doctor," in Short Stories for Students, Thomson Gale, 2007.

Adam Haslett and Sherry Ellis

Ellis is the editor of NOW WRITE! a collection of fiction writing exercises published by Tarcher/Penguin in September, 2006. Illuminating Fiction, her anthology of author interviews, is forthcoming from Red Hen Press in September, 2007. She is at work on a novel and a collection of non-fiction writing exercises. Her author interviews have also appeared in The Kenyon Review, The Writer's Chronicle, Glimmer Train, and AGNI, as well as other literary and arts magazines. A personal writing coach, she teaches writing in Concord, Massachusetts. In the following interview, the author talks about his writing process, the theme of estrangement and psychological disturbances, language and dialogue, and rhythm in his stories.

Adam Haslett is the author of You Are Not A Stranger Here, a short story collection that portrays pivotal moments in the inner lives of characters who suffer from estrangement and psychological disturbance. Craig Seligman in his New York Times Book Review wrote, "There's not a clinker in the group, and this consistency, along with the maturity and the austerity and the exceptional tact of the writing, gives every indication that unless something goes radically haywire, You Are Not a Stranger Here is the herald of a phenomenal career."

In 2002 You Are Not A Stranger Here was a finalist for the National Book Award and in 2003 it was a finalist for the Pulitzer Prize. The story "Devotion" is included in the anthology: The Best American Short Stories 2003 and "Notes to My Biographer" was a finalist for the National Magazine Award. In August, 2002 You Are Not A Stranger Here was the selection of the NBC Today Show Book Club.

Haslett completed his undergraduate studies at Swarthmore College where he studied with Jonathan Franzen. He subsequently received fellowships from the Provincetown Fine Arts Center, the Michener/Copernicus Society of America and Breadloaf. In 1999 he received his MFA from the Iowa Writer's workshop. In 2003 he won the L.L. Winship/PEN New England Award. A man of many talents and interests, in 2003 Haslett earned his law degree from the Yale School of Law.

He divides his time between New York City and England. Recently Sherry Ellis spoke with him by phone at his home in New York City.

[Sherry Ellis:] You Are Not A Stranger Here is a collection of stories that contains the themes of estrangement, suffering and the desire to make connections. "You Are Not A Stranger Here" is also a line in one of your stories. How did you choose it as the title of this collection?

[Adam Haslett:] It did come out of a story. It was in the story first, certainly, and the story was actually titled "Wars End" when it was first published in Bomb Magazine. And then I ended up deciding to re-title it and I liked the title, so I used it for the book. "You Are Not a Stranger Here" was the only one that struck me as inclusive of all the others, in a sense, addressing the reader, inviting them into the book.

When did you know that the nine stories in this anthology were short stories and not novellas or novels?

I was always writing short stories. None of them were longer pieces that were cut down. They were written as short pieces, and I wrote at least two-thirds of the stories before I even conceived of them as a collection. Only the last third were written with the book in mind. At that point I had contracted to complete a manuscript.

As the story "The Beginnings of Grief" draws to a close you describe a visit between a violent teenager and a recently orphaned classmate who takes solace in physical pain. "He came on a Tuesday. Rain was falling through the naked branches of the trees onto a carpet of rotting foliage". Is the vocabulary and metaphor you use in this passage an example of what you describe as finding "the correct rhythm" in language, and can you describe the process of trial and error that you use?

To answer the process question first, the trial and error is really just a repeated reading of the sentences over and over again, to try to discern the rhythm of them, to find out if the second sentence is obeying the rhythm of the sentence before that. It is another way of describing the editing process. I think of each story as having a rhythm, an intensity, and I am always trying to find the rhythm that fits a particular story. In the first story in the book the rhythm is quite fast, and in others more deliberate. As for "The Beginnings of Grief there is a certain kind of emotional detachment in the narrator. The ambition was to allow that detachment to filter down into the semantics of the sentences.

Do you plan the direction your stories will take before you begin writing, even if they happen to veer off somewhat differently in the process? In "The Beginnings of Grief" for example, was that specific ending planned from the beginning?

I generally have a sense of where the story is headed emotionally, i.e. I know where I want to reader to end up, the feeling I want them to end up with and the process is writing the story toward that end, hoping to get at that ideal balance you have in your head at the outset. Obviously, one's ideas develop as you go along, but the emotional key rarely changes.

Last year TBR ran both a Spanish and a Catalan translation of "The Beginnings of Grief"; the Spanish translation of You Are Not a Stranger Here had just come out (Salamandra, 2003), and the Catalan version of the collection is due out April 2004 (Angl TBR's editor said: "The earlier Catalan version had been done by a class of translation under the tutelage of Matthew Tree, writer and translator. They had a hard time with 'sloppy joe,' and Matthew, who's British, had never heard the term either. Salamandra's Spanish translator, Eduardo Hojman, went with 'bocadillo,' but the Catalans tried for the more literal 'la carn picada amb tom?? et' (hamburger with tomato). 'Helicopter "wings'" gave them pause, too. But generally speaking, Matthew said what the students found tricky was maintaining the fine balance between the literary register in the story and the free use of colloquial American English, which works fine in the original but in Catalan is difficult to slip in and out of from one register to another." Might you have any general comments about the art of translation? Have you ever read any of your stories in translation?

Let me first say I have enormous respect and gratitude to my translators. It is a greatly unappreciated art and I feel very fortunate to have had such good translators thus far. Pocia, my German translator was particularly careful and thoughtful. Sometimes I get questions from them about particular idiomatic phrases that they are having difficulty translating into their native tongue and I try to offer more background or alternatives. In the end, it seems to me what one wants in a good translator is the same as what you want in a good writer—an ability to emphasize, a good ear, and a talent with language.

I've read some translations of my work, but am only really competent in French so can't judge most of them. The Greeks could have put a cookbook between the covers and I would have been none the wiser

Allan Gurganus once said that, "Dialogue isn't what characters say to each other, but what they do to each other." Do you want dialogue to have the effect on your characters of doing something to one another? And what other function(s) do you hope your dialogue serves?

I think I agree with Gurganus about that. You want it not to be simply giving information but to be characterizing and active. I don't know that I've thought about dialogue as a separate issue and when I work it's all part of the rhythm question, deciding when dialogue or description makes more sense.

In "Reunion" a young man with AIDS uses writing to have imaginary communication with his deceased father. In "My Father's Business" letters between psychologists are the means through which the primary character is revealed. In "Devotion" letters demonstrate sabotage in a complex, oftentimes symbiotic relationship between middle-aged siblings. What led you to use written communications in these different situations and what do you think they help you to achieve?

That's interesting. You're pointing out a connection I'd never even noticed. So I'm somewhat disarmed by the question. But now that I think about it I think particularly in "My Father's Business" and "Reunion" and less-so in "Devotion" letters give me the ability to use another written form within the story, to get at information and the world in a different way than standard realist narrative. So in a sense it's an outlet. I'm able to get things into a story that wouldn't otherwise find a way in.

In the story "The Volunteer" you explore psychopharmacological treatment and its impact on perspective and creativity. When a woman with schizophrenia decides to stop taking her medication she "wakes to colors more vivid: the Oriental carpet's swirls of burgundy and gold; dawn kindling the sky an immaculate blue." It seems from this story that you might be supportive of people who stop taking their medicine. How did you become interested in exploring this theme?

Well, I certainly don't advocate people not taking their medication; I don't really have an editorial position on that. My goal is always to take the reader as far into the minds of my characters as I can get them, and in a few of the stories in the book that means taking the reader into the lives of people facing the dilemma of whether to take medication, what it does to one and so forth. So in that story, "The Volunteer", I think it had consequences both good and bad for her. And in terms of how I came into all this I've said in other places that my father was a manic depressive and there is some family background as to the question of taking medication or not.

Many of your characters are complex, multi-faceted individuals who are diagnosed with psychiatric problems. For example, in "Notes To My Biographer," Franklin Caldwell, the protagonist, is a seventy-three year old inventor who has had mental health problems since his youth. He comments on the many Robert Wagner look-a-likes he sees. How do you balance humor and pathos in your characters?

It's not easy and I'm lucky if I can. That's a very tough question to answer. I don't think there's anything deliberate or intentional about it. I get lucky with a certain voice that allows me into a certain mind like his and a certain sense of humor can come out. But combining humor and pathos is a pretty tall order and it's a very difficult thing to accomplish. I don't feel I have much control over doing it.

In an article in "The Yale Bulletin & Calendar" you are quoted as saying, "The law deals with people's exterior lives, with the uniform rights that people have, whereas in my stories I am concerned with people's interior lives, with their souls." When you are writing how do you investigate the "interiority" of your characters?

Well, it's kind of the whole shooting match for me. That's really the point—I think it's the act of imagining myself further and further inside, the act of projecting myself into the position and situation I've made up for my character, and then trying to imagine in as much detail as possible what a human reaction would be in that circumstance. So, it's the same kind of trial and error and concentration. Some days you can maintain it, and some days you can't.

You've previously discussed the differences between creative writing and law, but do you also believe there are connections between them?

There are so many different levels on which they may be related, but I don't think that the main preoccupations of each are related. I mean the exterior/interior is divided pretty clearly. But I think lawyers are fictionally very interesting characters, as people who find themselves advocating for things they may not believe themselves. Also, law is the language that power speaks through in this country, so if you want to get at the social fabric it can be an important discourse. I suppose the big, obvious thing is the story telling aspect, that when you go into in the courtroom you are really trying to tell a story; but the stories that writers and lawyers are each telling are so radically different, and hopefully a good lawyer is restrained by the facts.

"The portrayal of the dark side of human experience is not a pessimistic act," is a comment you once made. Can you further explain what you mean?

Well I guess some people's reaction is that the stories are depressing. It seems to me that response comes out of a sense that something is depressing or not because of how it ends, which to me seems too literal. Something could have a dark ending but that doesn't mean it's a pessimistic experience to read it, because the optimism may arise in the identification the reader has with the predicament of a particular character. That usually involves some kind of emotion. I think of any emotion, even sadness, as different from depression, which is really a numbness, a lack of feeling.

In "The Good Doctor" a psychiatrist visits a female patient at her home with the goal of enticing her into treatment. He finds her in a very bleak and disheartening circumstance and experiences "a familiar comfort being in the presence of another person's unknowable pain … more than any landscape, this place felt like home". How did you choose the title "The Good Doctor"?

The title just captured something about his intentions and what would become of them.

William Trevor has said of writing short stories, "I think it is the art of the glimpse". Can you discuss this comment in regard to your own experience of writing?

William Trevor is one of my favorites. I think he is an incredible writer. I guess I take him to mean that it's a slice of life found in a particular moment, a clarifying moment captured. Short stories have a poetic density to them that novels simply can't achieve. You can think of them as one long exhalation. It's one of the things I like about writing them; their emotional intensity is quite satisfying.

Who are the other writers that have inspired you?

As to the short story I'd say William Trevor, Joy Williams and Alice Munro. My taste in novels is all over the place, but I'm a bit of a modernist fan: Faulkner, Joyce, James, Woolf, Mann, all those folks.

You've lived, and continue to live, in England for extended periods, and several of your stories are set there. Can you give us a quick personal take on the US versus England—the people, culture, etc.

Actually, I've lived most of my life in the US. I spent three years as a kid in Britain and I visit there and Scotland a fair amount, but my social and professional life are definitely based in America. As for cultural differences I'd have to say the most pronounced is the continuing thickness of class differentiation in Britain, tied to accent mostly, that is far less on the surface in America. The United States is very divided by class, but there is almost no acknowledgement of this fact and whenever politicians even mention taxing the wealthy they are accused of "class warfare." The myth of egalitarianism runs very deep in the US, less so in Britain.

How challenging has it been for you to cope with all the praise and attention, and the resulting changes in your life?

Well, I think I had the good fortune of being in law school when a lot of it was happening, so there was a balance because of all the other things I needed to deal with and attend to. I guess I feel incredibly fortunate that the book has had the life it has and the recognition it has got, and most centrally in terms of it effecting my life I'm glad that I'm able to be able do what I plant to do, which is begin work on a new book.

Do you have any suggestions for writers who are trying to develop themselves and become part of the literary marketplace?

I was actually rejected from a lot of MFA programs and I have a fat folder from literary magazines filled with rejections, so I went through that whole process. Sometimes I think it is just endurance, spending enough time at it, arranging your life so that you can work; MFA programs are one way of doing that for awhile, though they don't suit everyone.

I guess my real break came when the woman who eventually became my editor read a story of mine in a magazine and asked to see more. That was the beginning of the book being bought and eventually published.

And once you started to get your stories published did your writing career fall into place easily? Did you still receive many rejection letters?

Oh yes, there are always rejection letters coming. I don't think you pull a switch, and I think any other author would confirm that.

So, do you have any suggestions or words of encouragement for beginning writers who want to be published?

I guess I would say don't worry. Keep the idea of the market out of your mind for as long as possible, because it really doesn't matter when you publish something. There are people who will eventually know the difference between something that is really good, something that is carefully attended to and thought out. I have taught and my advice to my students is to keep the whole idea of marketing out you mind, until you feel you have something very strong, and then worry about it.

[Sherry Ellis:] "Devotion" is included in The Best American Short Stories 2003. If you had been asked to choose one of your stories for this anthology which one would you have selected and why?

I can't really say. I don't think I have an opinion on that one.

Can you talk a little more about what you're working on now?

Other than saying it is a novel, not really. I'm a little superstitious when it comes to talking about new work.

Source: Adam Haslett and Sherry Ellis, "Interview with Adam Haslett," in Barcelona Review, No. 41, March-April 2004, pp. 1-6.

Contemporary Authors Online

In the following essay, the critic gives an overview of Haslett's work.

Adam Haslett simultaneously applied for admission to Yale Law School as well as to a number of writing fellowships, and he was successful in both areas. Yale gave him a one-year deferral so that he could study in Provincetown, Massachusetts, and when he was accepted into the Iowa Writers' Workshop the deferral was extended by two additional years. During the second semester of Haslett's law studies, a Doubleday editor, who had read one of his short stories, offered to publish a collection. Thus, Haslett's law degree was postponed yet another year so that he could write an adequate number of new stories to take Doubleday up on their offer.

"Notes to My Biographer," the first of the nine stories in You Are Not a Stranger Here, was originally published in Zoetrope. It focuses on Frank Singer, an aged inventor and veteran suffering from mental illness who doesn't trust the medical establishment; by refusing to take his medication he makes life hell for all around him. Frank drives to California to see his gay son, Graham, who is suffering from the same inherited illness; the son does take his meds, though, for fear that not doing so will result in behaviors that would drive away his lover.

Reviewing the story for Salon.com, Laura Miller said, "it's not a story about the ravages of mental illness after all, but one about the price paid for mental health. More often than not, Haslett's characters find themselves contemplating a choice between subduing their demons or facing them head on; these stories are full of people deciding not to swallow their pills…. The twist in an Adam Haslett story is often a revelation about who is actually the stronger in a pair of characters."

Craig Seligman wrote in the New York Times Book Review that Haslett "may have talent to burn … but his prose exudes a desolation so choking that it can come only from somewhere deep inside…. Haslett has despair. And I don't mean the histrionic despair of discouraged youth…. Haslett writes like a man inured to disappointment." Seligman called "Notes to My Biographer" and the collection's last story, "The Volunteer," the "showpieces of the collection." The latter is about an ageing, institutionalized female schizophrenic and the high school volunteer who visits her. Regarding "Notes to My Biographer" Seligman wrote, "It's funny, it's awful, and it's the only one of the stories in this collection that gave me some hope that their creator might be able to draw some pleasure out of the spectacular career that … he's surely heading into."

Several of Haslett's stories are set in Great Britain, including "Reunion," in which a young man is dying of AIDS. Two stories that are gay-themed are "The Beginnings of Grief" and "Devotion," about a brother and sister who love the same man. Other stories that deal with mental illness include "Divination," in which a boy has the gift of prophecy but considers it a mental illness. Seligman said that this theme "supplies the ruling metaphor for the collection: a debilitating, humiliating, alienating condition … that can be escaped only through death; a condition, in other words, that's very much like life."

A Kirkus Reviews contributor called "War's End" "a hypnotically strange amalgam of Chekhov and Beckett" and "one of the finest, and most unusual, stories of recent years." A Publishers Weekly reviewer, however, thought this same story veers too much "toward the sentimental," though the reviewer concluded that You Are Not a Stranger Here is "a strikingly assured first effort." Finally, Book reviewer Tom LeClair said that the collection "welcomes the courageous—and the estranged."

Source: Contemporary Authors Online, "Adam Haslett," in Contemporary Authors Online, Gale, 2003.

Sources

Egan, Timothy, "Pastoral Poverty: The Seeds of Decline," in New York Times, December 8, 2002, Sec. 4, p. 1.

Haslett, Adam, "The Good Doctor," in You Are Not a Stranger Here, Doubleday, 2002, pp. 24-47.

LeClair, Tom, Review of You Are Not a Stranger Here, in Book, July-August 2002, p. 78.

Review of You Are Not a Stranger Here, in Kirkus Reviews, Vol. 70, No. 10, May 15, 2002, p. 685.

Review of You Are Not a Stranger Here, in New York Times Book Review, Vol. 107, No. 30, July 28, 2002, p. 14.

Review of You Are Not a Stranger Here, in Publishers Weekly, Vol. 249, No. 27, July 8, 2002, p. 32.

Further Reading

Lee, Steven, Overcoming Crystal Meth Addiction: An Essential Guide to Getting Clean from CM Addiction, Avalon Publishing Group, 2006.

A psychiatrist who specializes in treating methamphetamine addiction explains the physical and psychological effects of this condition and answers many common questions people may have about the problem, its effect on family members, methods for treatment, and rates of relapse and recovery.

Pickering, Kathleen, et al., Welfare Reform in Persistent Rural Poverty: Dreams, Disenchantments, and Diversity, Pennsylvania State University Press, 2006.

Readers who would like to understand better the disillusionment of the Buckholdt family may find this book of interest. It analyzes the circumstances and factors which cause chronic poverty in rural areas where there are few jobs, poor education, and low-income families that make do with little hope for improvement or escape.

Richie, Beth E., ed. Domestic Violence at the Margins: Readings on Race, Class, Gender, and Culture, Rutgers University Press, 2005.

This anthology of essays covers the field of domestic violence as it occurs among various marginalized populations, in part, in an effort to challenge stereotypes people have regarding perpetrators and victims and also to explain social and legal services which address the problem.

Rural Drug Abuse: Prevalence, Relation to Crime, and Programs, DIANE Publishing, 1994.

This study evaluates the extent of substance abuse in rural areas and its connection to crime. It also describes and evaluates programs designed to treat or prevent drug abuse specifically in rural, underserved areas of the United States.

Stamm, B. Hudnall, ed., Rural Behavioral Health Care: An Interdisciplinary Guide, American Psychological Association, 2003.

Readers who would like to know more about public and federal programs designed to deliver psychological services to remote and rural populations may find this book useful. Three topic areas are covered here: behavioral needs in rural areas; problems facing federal and public service agencies in delivering services, and special problems associated with certain populations in these areas.