Trauma, by Patrick McGrath

The wounded healer of Manhattan
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This has been a vintage year for novels about shrinks who need to help themselves. Both Hanif Kureishi (Something To Tell You) and Siri Hustvedt (The Sorrows of an American) have embellished the trusty motif of the wounded healer. Patrick McGrath, son of a medical superintendent at Broadmoor, has in supremely sinister novels such as Spider and Asylum compiled a casebook too tragic and florid for most kinds of talking cure. Now, in this seventh novel, he chooses as his narrator a suspiciously articulate late 20th-century Manhattan psychiatrist. Charlie Weir has a snappy diagnosis to hand for every tipsy slip of the tongue. So you wonder if McGrath has forsaken his gruesome Gothic patch for the anxiously chatty world of Woody Allen.

By no means. Not only has Charlie, lonely, divorced and at risk of burn-out, made his name but marred his happiness by giving therapy to the traumatised veterans of the Vietnam War, their lingering pain and guilt "stamped on their faces like bootprints". Not only does he fret under the family burdens of a rejecting mother, a feckless boozer of a father, and a golden-boy artist brother, Walt, who hogs limelight and love. The suicide of his wife's brother, a patient whose Vietnam ordeal drove him berserk, has managed ­ seven years before the action - to ruin his marriage and stall his career.

Fixated on Danny's death and the break-up with Agnes, Charlie feels increasingly like one of his veterans: a trapped man whose grief runs on a loop. With trauma, "the event is always happening now". McGrath teases out the kinship between fiction and psychotherapy: joint enterprises in the shaping of chaos. Regular flashbacks and the drip-feed of memories punctuate Charlie's efforts to win Agnes back and his affair with desirable, damaged Nora.

In the sweaty and feral background, the New York streets before Giuliani's clean-up heave with menace and panic: "human wreckage everywhere you looked". Charlie, both controlling and out-of-control, is headed for a smash-up. It arrives, with a flourish that whisks us back onto classic McGrath terrain, not in mean Manhattan but in a snowy backwater of the Catskills. Here, the pure Gothic of forlorn asylum and creepy hotel trigger a crisis.

For the psycho-novel with its face turned to the past, outcome matters less than origin. Before Danny's suicide, what injury made Charlie's wound? The faint anticlimax of the last revelation muffles the denouement. Sometimes, the storytelling demands that Charlie sound both barking and benign at once: a tough call. But his journey home has all McGrath's mastery of looming dread: not of what's to come, but of what has been.

Gazing at the snowfall through the window of their heartbreak hotel, Charlie and Walt seek "some means of escape, some portal through which we could flee the past". Some ask; some hope.