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Leo Cookman reviews Adam Steiner’s outsider on the inside novel of institutional derangement.

Adam Steiner, Politics of The Asylum, (Urbane Publications, 2018), 320pp.

The British National Health Service is in trouble. With site closures, special measures, pay freezes, missed Accident & Emergency targets, the Winter crisis and more, it seems like every day brings a new story of failure or difficulty into media focus for one of the UK’s most loved institutions.  Adam Steiner’s novel Politics of the Asylum intervenes in this emotive discourse, boldly exploring the ever-increasing tensions within the NHS.

Steiner’s protagonist is perfectly conceived as a nexus to dramatize these problems: Nathan Finewax is a cleaner in an unspecified hospital and the novel’s narrator. He acts as an ‘outsider on the inside’ for the reader, a character without the elite biases, myopia or agendas of an establishment figure or the insider perspective of a frontline healthcare professional. Yet Nathan sees and hears everything that goes on within his hospital’s walls. Finewax’s mental state is the main pulse of the story and watching it fracture and deteriorate seemingly in parallel with the state of the hospital around him is what maintains the reader’s almost ghoulish compulsion to keep reading. Steiner blends insights into Nathan’s personal life, his relationship with a character he dubs ‘Queen Bitch’ becomes more and more prominent for instance, with an exposure of the hospital’s own deterioration to create a narrative that reveals the slowly crushing weight on the souls of Finewax, the hospital and, in the end, the NHS as a whole.

The prose itself is key to the novel’s success. Its flow of imagery and definite rhythm, short chapters but dense paragraphs, broken sentences, words that tumble down the page, its literary allusions and references (numerous chapter titles make references to medical practices but also pop culture) biological sketches and illustrations, streams of consciousness and poetic language, that all hark back to early twentieth-century modernism, in the vein of James Joyce or Virginia Woolf. At its opening, the book appears conventional, but as the prose begins to twist and deconstruct, it seems to reflect Finewax and the Hospital’s degrading state. A standout moment for this type of altered presentation in the novel is the chapter ‘Omnie Die’ that is structured like a medical form with a column of ‘Patient Notes’ and a column of ‘Duty Nurse Observations’, a form of writing that should supposedly be objective and observational but instead becomes confessional and personal. These revealing juxtapositions are common throughout the book, and the duality they expose reveals the inherent contradiction between healthcare as an essential service to emotional and vulnerable people on the one hand and its operation through managerialism and infiltration by distant and disinterested business concerns.

The skilfully constructed prose does hide one of the weaker elements of the book, however, which is the story itself. From the outset there is a numbing inevitability to Finewax’s story: it is a tale played out in media stories on the NHS on a regular loop, and this modern context of the book presses down on the narrative, so that despite the never-a-dull-moment prose, there are few surprises throughout. Instead the story maintains a steady, bleak pace that submerges you in the oppressive, Orwellian labyrinth of the hospital and its office politics, real world politics and the increasing mundanity of life and death. The text itself begins to take on the impression of bureaucratic paperwork with its sub-titles, sub-sections, redacted elements and fragmented punctuation, that coldly describes the near constant pain and suffering that echoes around the four walls of the eponymous ‘Asylum’.

The pull quotes on the cover make the point that Politics of the Asylum is very much a state-of-the-nation novel. A book that zeroes in on one of the most complex and controversial places in British life, that acts as a microcosm for revealing the issues that permeate British society and every public institution in the age of austerity. The literary equivalent of a VR experience, Politics of the Asylum seeks to immerse you in a world of conflict that has permanent repercussions not just for the patients, nurses and doctors but from the management to the cleaners too. As well researched, formally inventive and linguistically accomplished as it is, and despite a slightly uninspired central plot, the book’s greatest strength is that its whole creation is structured to reveal the slow, grinding pressure that is turning Hospitals back into the Dickensian Asylums of the past. And in that regard it succeeds depressingly well.


Leo Cookman is a writer living in Brighton. His poetry has been published in Poetry of Sex (Penguin Books, 2014), The Best of Manchester PoetsBlack Sheep Journal, LadybeardMagazine and BlankPages Magazine, among others.

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