The Patient X of the title is noted Japanese author Ryunosuke Akutagawa, who lived in tumultuous times before committing suicide in 1927 at the age of 35. Perhaps the best known of Akutagawa’s stories in the west is Rashomon, which used multiple viewpoints to tell the story of a crime. He was influenced by Western authors like Edgar Allan Poe as well as traditional Japanese and Chinese stories, and a combination of Eastern and Western thought and religion.

The concept behind this book is that Patient X is a mental patient spinning tales to whoever will listen. The novel is divided into 12 chapters, each one inspired by some aspect of Akutagawa’s writing and life. Some are told in the manner of fables; others contain embedded narratives in the style of Edgar Allan Poe. There are recurring themes of madness, doppelgangers, the role of the author, the conflict between Christianity and traditional Japanese beliefs.

By turns fascinating and frustrating, Patient X feels more like a portrait of madness than a portrait of an artist. Its fragmentation works against it, as the narrative voice constantly shifts, and at times it is difficult to tell who is doing the narration – Akutagawa, his alter ego, his doppelganger, his madness, or someone else entirely.

Another frustrating aspect is the recurring theme of the kappa, an amphibious demon that’s apparently an important character in Akutagawa’s writing, but the nature of the kappa is never once explained and I had to Google to find out what a kappa actually was. I think a familiarity with Akutagawa’s writing is assumed by Peace, and the reader who is not familiar is left at a distinct disadvantage trying to put the pieces together.

I wanted to love Patient X but it is at times too impenetrable, too clinical. In terms of scope and ambition it is impressive, but in the end it left me cold.

Reviewed by Tessa Chudy