Reading the Detectives discussion

Our second Adam Dalgliesh challenge book is A Mind to Murder by P.D. James, first published in 1963.

When the administrative head of the Steen Psychiatric Clinic is found dead with a chisel in her heart, Superintendent Adam Dalgliesh of Scotland Yard is called in to investigate. Dalgliesh must analyze the deep-seated anxieties and thwarted desires of patients and staff alike to determine which of their unresolved conflicts resulted in murder.

Please do not post spoilers in this thread - thank you.

Welcome to our second Adam Dalgliesh challenge read. For anyone who hasn't read this yet, the first six Dalgliesh books are currently 99p each on kindle in the UK.

Thanks for opening this, Susan. I am a little over halfway, will probably finish tomorrow. I think this is much better than Cover Her Face, if that is possible.

Yes, I also enjoyed this one more.

Thank you for opening up the threads, Susan. I'm about 1/4 of the way through and enjoying it so far.

I've finished and really liked the characters and the setting.

good heavens, people are already finished? I was planning to start tomorrow.

I read it a month ago so I don’t get behind. I’m on Unnatural Causes now.

Jackie wrote: "good heavens, people are already finished? I was planning to start tomorrow."

Don't worry Jackie. I'm planning on starting tomorrow. I like to read the challenge/group read books during the month they are set for.

I think we all tend to read at different times - for anyone who gets to a book later, no worries, as the threads will still be open.

I'm about halfway through now - finding it a quicker read than Cover Her Face. The setting is very different and it feels much more contemporary to the 1950s/60s to me, with the clinic offering treatments such as EDT and LSD.

I think there is a description of a similar London clinic offering LSD treatment in The Golden Notebook by Doris Lessing, published in 1962 - I vaguely remember it describing how disoriented and distressed the patients were after the treatment.

I thought of one flew over the cuckoos nest some of the time while reading it because of the talk about electro shock, although what I got from this book was that it was more of a transition period for psychiatry.

I was more than just mildly surprised that they were doing LSD treatments. It was well reported in the 60s that young people were taking the hallucogenic drug and then thought they could fly, jumped out of windows to their death. Others had what were called "bad trips" and were forever damaged. This just didn't seem to me to be good medicine.

According to this article, it is still considered useful for anxiety and depression:
https://adf.org.au/insights/lsd-thera...

I think it was early days and, as you say, Elizabeth, LSD really became widely used in the 60's. The novel did say that patients had to be watched, so, presumably, that was for their safety - as you say, possibly harming themselves while hallucinating.

I vaguely remembered that Cary Grant took LSD at a clinic for medicinal reasons, and have just found an article about it - this says that around 40,000 people were prescribed it between 1950 and 1965.

https://qz.com/1002997/cary-grant-was...

An episode of Grantchester this week also featured a clinic offering LSD treatment - I didn't watch it in full as I seem to have given up on the series following the departure of James Norton (don't have time to watch everything!), but I just saw a little bit.

I've just started and agree it feels far more modern than the first book, partly because the suspects are all workers rather than leisured/inherited wealth types. It's a nice reworking that still gives us the closed circle of suspects and tangled secrets - after all, a team of workers, especially in a small organisation, is like a family, potentially a dysfunctional one!

I meant to add, Doris Lessing already thought it was irresponsible and dreadful to prescribe LSD by 1962, as far as I remember from The Golden Notebook. So clearly attitudes did vary and I think awareness of the risks grew gradually.

Judy wrote: "I meant to add, Doris Lessing already thought it was irresponsible and dreadful to prescribe LSD by 1962, as far as I remember from The Golden Notebook."

And this was first published in 1963, so all the research had not come in yet. I am surprised that it is still in use, but as I don't have the requisite medical degree ...

I think it fell out of favour and is being re-discovered as potentially useful?

ECT of course is also extremely controversial - I'm not sure when that fell out of favour too?

LSD was used by the psychiatric profession around the 1940s, 1950s, 1960s. It was first used to treat shell-shock and similar afflictions I think. It wasn’t banned for use in the US until the late 60s, so it probably was still being widely used when this book was written. Of course, as is the case with many drugs used for medical purposes, it’s use became popular as a recreational drug from the early 1960s, just as meth is now.

I hope to read this soon, and I´m glad it´s better than the first Dalgliesh! ;)

This is definitely more engaging than the first! I’m really enjoying it so far, just about a third of the way through.

I preferred the first one, but I seem to be in a minority! I do tend to like country house mysteries though.

Susan wrote: "I think it fell out of favour and is being re-discovered as potentially useful?"

yes, finally it's being looked at seriously for all the good it can do, just like cannabis.

Judy wrote: "I preferred the first one, but I seem to be in a minority! I do tend to like country house mysteries though."

so far, I like them both about equally. this one is more modern and I actually prefer the feel of the first - and I also like a country house setting.

I realized fairly early that I have read this before, albeit only once and years ago.

the clinic does feel like a dysfunctional family as Roman Clodia says, and I love how efficiently James describes the characters and how they feel about each other.

Is anyone else confused about whether the Steen is private or NHS? I understand it was established as a private clinic but it seemed to have been taken over by the government given the presence of Mr Lauder and talk of the Hospital Committee - but then Steiner says they only treat 'middle class and highly intelligent patients' - yikes! Does anyone know how this worked in the early 1960s?

I thought it said early that it had been private but then when NHS came into being, it became NHS. But not being familiar with a national health service, that's all confusing to me anyway.

Perhaps it was being incorporated into the NHS, but they still took private patients? Dr Steen was a bit of a snob, wasn't he?!

I also noticed that it was said that the clinic was originally private but now incorporated into the NHS.

Perhaps their patients are just middle class because that is the demographic of the referrals which come through to them in practice, due to the expensive area of London where they are based?

Haha, when he tries to talk literature with Dalgleish, and gets shut down fast!

It's hard to picture an NHS clinic with a Modigliani, even a minor one!, on its walls ;)

I wondered if being incorporated into the NHS meant the Steen Clinic still kept its private status and fee paying patients, but also received funding for taking a certain number of patients through the NHS.

Years ago that's what happened here with private hospitals and some private schools. It was an offer the government made to them in order to alleviate the patient/pupil numbers on government funded hospitals and schools that otherwise would have required the more expensive option to the government to build more hospitals and schools in certain areas.

To whom would Bolam have been submitting travel expense claims?

Lesley, thanks very much for posting your thoughts. Just editing to say that I'm moving your post over to the spoiler thread to be on the safe side - I did ask you to do it but then realised I could do it myself. :)

Judy wrote: "Lesley, thanks very much for posting your thoughts. Just editing to say that I'm moving your post over to the spoiler thread to be on the safe side - I did ask you to do it but then realised I coul..."

Not a problem Judy. I thought I was pretty much spoiler free, but hard to judge sometimes. :)

Thanks Lesley - I was possibly being a bit over-cautious but just in case.

Re travel expense claims, I assume they would go from the administrator to the clinic's accountant, at some point. She probably had the initial 'yes' or 'no' reply, as to what was acceptable.

That was weird, that patients were able to claim travel expenses! And there was talk of that grant that paid for one of the feuding marriage couples to go away for a holiday. It felt slightly odd anyway, the marriage counselling alongside ECT - quite a mixed bag of treatments at the Steen.

Susan wrote: "Re travel expense claims, I assume they would go from the administrator to the clinic's accountant, at some point. She probably had the initial 'yes' or 'no' reply, as to what was acceptable."

So that would indicate NHS? Who would reimburse the travel provider/patient?

I started this today. So far I like it better than the first book in this series. I think the clinic is NHS - there’s mention of the Hospital Management Committee which sounds like our current NHS Trusts (a group of hospitals, clinics etc in a particular area). But we still have a system where patients can be referred to private hospitals at NHS expense to reduce waiting time for routine treatments.
I haven’t yet seen any mention of patients receiving travel expenses, only a doctor. But when specialist equipment is needed but unavailable near their homes, patients may have to travel long distances & travel may be paid for them. In some serious cases accommodation is provided for a family member too so that the patient has support during their treatment.

Trisha wrote: "I started this today. So far I like it better than the first book in this series. I think the clinic is NHS - there’s mention of the Hospital Management Committee which sounds like our current NHS ..."

Which is very much as it is here today!

Elizabeth (Alaska) wrote: "Susan wrote: "Re travel expense claims, I assume they would go from the administrator to the clinic's accountant, at some point. She probably had the initial 'yes' or 'no' reply, as to what was acc..."

Not a question I can answer, Elizabeth. Someone had a budget for it - perhaps for patients who could prove hardship, or who had to travel for treatment which wasn't available locally.

I finished reading this today & liked it better than “Cover her face”. In general the story moved on quite well & I thought it was much more interesting. I’m already looking forward to reading the next book in the series.

Susan wrote: "Not a question I can answer, Elizabeth. Someone had a budget for it - perhaps for patients who could prove hardship, or who had to travel for treatment which wasn't available locally."

My question stemmed from Roman Clodia's question Is anyone else confused about whether the Steen is private or NHS? I thought the answer would come if we understood who was going to pay for the travel. If a private insurance company, then probably a private clinic. If NHS, then public. I don't know how either works in the UK and I didn't understand why the clinic would be submitting claims. Why someone would need travel paid for wasn't the question.

Some private insurance in the US will pay for travel, depending on circumstances, but it is usually extraordinary needs, including emergency travel locally. We have an extra policy to pay for medivac to the lower-48 in case of extreme and emergency medical needs. Medivac could cost $60k or more, so $125 a year is cheap.

Yes, I see your thoughts, Elizabeth. Often, we have doctors who work for the NHS and also see private patients, and that might have been the way the Steen worked. Mainly private and partly NHS or the other way around.

Susan wrote: "Yes, I see your thoughts, Elizabeth. Often, we have doctors who work for the NHS and also see private patients, and that might have been the way the Steen worked. Mainly private and partly NHS or the other way around."

Yeah, I don't think we have a clear answer to the original question, but your explanation is probably as close to the situation as we'll learn.

I think so. When P D James wrote it, then probably readers would have understood the way the clinic worked.