Anne Buist and Graeme Simsion – The Glass House

Hachette, Australia, 2024
Cover design and illustrations by Alex Ross
Cover image Shutterstock

While The Glass House is a work of contemporary fiction, amply meeting our needs for a fast-paced plot and well-developed characters, it is also a study of the state and status of psychiatric medicine in Australia.

Prof Anne Buist and Graeme Simsion spoke to Barbie about The Glass House

It carries a strong sense of realism – in fact, it presents at times like a reality TV show with its stream of dramatic events, conflicts, under-currents and power struggles.

The story is set in the fictional Menzies Centre’s acute psychiatric care ward and told in the voice of principal character Dr Hannah Wright, a psychiatric registrar.

The main case studies that underpin the plot introduce us to three patients with mental health conditions – an eating disorder, post-partum psychosis and severe depression resulting in an apparent suicide attempt. However, each situation has run-off cases, some of which fall under the psych. team’s purview.

Essentially the book mulls over the debate between (chemical) medication-based approaches to treatment and the therapy route, the places where ‘traditional medicine’ and diagnosis intersect with psychology and its clinical applications.

To the outsider, the debate seems almost irrelevant. Surely both have a place? But here is where the medical hierarchies come into play. Status is jealously guarded and neither professors nor heads of departments will brook challenge from administators, junior doctors or other health professionals.

All of this, of course, adds to the drama of the story-telling. Not only do we experience the mind-numbingly hectic pace and long hours of emergency medicine and acute psychiatric care, but also the internal struggles of our heroes and heroines as they grapple with work-life balance, their aspirations and their own demons.

The intensity of this book comes not merely from the descriptions of Sian’s psychotic episodes, Chloe’s heart-breaking anorexia and family situation, the MP Xavier’s erratic behaviour and an emerging troubling backstory, but from the struggles of the doctors, nurses and other health professionals with an impossible daily workload and their sense of failure when things go wrong.

They carry with them the losses and traumas of their own lives and those of every patient with whom they come into contact. These experiences are emotionally cumulative for the fictional characters but also for us as readers.

While Hannah finds herself wooed by a patient’s glib jibe that she should go off and become a ‘real doctor’ because she is good at it, she nevertheless yearns to be accepted into the specialty psych program and to overcome the Prof’s prejudice against her.

It’s the same message again – psychiatry deserves a place at the table; it may be imperfect but it’s what we have and we keep learning about the complexity of the human mind at the same time as we advance in traditional medical disciplines like surgery or cardiology.

Most people may not have had personal experience with psychiatric wards, but many will have felt the stress and drama of an emergency department in a major hospital. We can draw on that experience in reading this book.

Increasingly, we are hearing about a ‘mental health epidemic’ especially in young people. Books like this one are part of a new willingness to speak about these things without fear or shame. This is just one of its strengths.

The Glass House enables us to hear stories of mental illness, to meet fictional though credible health professionals in the field and to understand something of what they are up against on all fronts.

It casts a non-judgemental but candid, informed and astute eye on the system, those who work in it and those who need its services. It arouses our sympathy and empathy, develops our understanding and increases our knowledge in areas long kept hidden or decreed taboo. And it’s a darn good read.

Thank you to Hachette for my review copy and to Anne and Graeme for speaking with me about their hopes for this book and about the state and status of psychiatric medicine in Australia.