"We see nobody clearly," protagonist Charlie Weir concludes as Trauma nears its end. "We see only the ghosts of absent others, and mistake for reality the fictions we construct from blueprints drawn up in early childhood." That's a grim conclusion for anyone, much less a psychiatrist, but Weir's story gives him every reason to believe it. Therein lies the brilliance of the novel—and its most apparent flaw. The accumulated detail in Patrick McGrath's slow reveal of Weir's history make Weir's fatalistic outlook seem logical and inescapable. But as the novel nears its final twist, those details start to feel more contrived, and it becomes apparent that, for all Weir's grim philosophical conclusions, it's McGrath, not life, who put him in the trap.

So it always is with fiction, and so long as McGrath keeps his hand out of the frame, Trauma works as an unsettling psychological study of a man who makes his living diagnosing others, while leaving himself fatally untreated. A psychiatrist specializing in victims of combat-related post-traumatic stress disorder before it had a name—the novel is set largely in the 1970s—Charlie has never recovered from a childhood darkened by an absent father and a hard-drinking mother who made no attempts to hide her preference for Charlie's artist brother Walt. But Charlie's troubles don't end at childhood, and the novel's shattered chronology finds him reflecting on a failed marriage to the sister of an especially troubled Vietnam vet patient, a frustrated relationship with one of Walt's friends, and a last-ditch attempt to repair his family.

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He doesn't have a chance. In fact, the novel's deepest tension comes less from the outcome of Charlie's endeavors than from the moments when its ever-analytical protagonist casually mentions doing something horrifically self-defeating, without recognizing the implications of his actions. McGrath specializes in getting inside the heads of troubled characters, and, as in his books Asylum and Spider, he maps out Charlie's psyche with exceptional attention, using his troubled perspective to create a mood of unrelenting dread. The approach invites the compulsive page-turning of a more conventional thriller, but ultimately, the surrender to more conventional elements lets the novel down. When McGrath starts dealing in causes instead of effects, his blueprint seems less steady than the disturbing ornamentation that gives Trauma's structure its form.