Click here to read the story in its entirety on The New Yorker webpage. Antonya Nelson's “Primum Non Nocere” was originally published in the November 10, 2014 issue of The New Yorker.
November 10, 2014

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“Primum Non Nocere” is about mothers and daughters, mental breaks and mental strengths, fake horror and real horror, and I think it is terrific.

Read the story before you go any further, in order that my efforts at accolade not spoil Nelson’s effects and revelations.

It’s the story of an hour, an hour after school when a teenaged girl is home alone and an unbalanced patient of her mother’s has snuck into the kitchen. Jewel’s mother and step-father are at work. Her older brother is away at college. It’s a twist on the horror movie: Jewel manages to manage the situation.

Claudia, Jewel’s mother, is a star at work, a therapist who takes only the hardest cases. Claudia, as portrayed by her daughter, believes in blunt tough love. “Claudia could leave a person speechless, defused,” thinks Jewel.

But while Jewel means that her mother can “defuse” difficult troubled patients, we wonder if Jewel herself hasn’t also been defused, but inappropriately so.

What is interesting is that while Jewel accepts her mother, we see that Jewel does not have the kind of access to her mother that the patients do. Jewel is the good daughter, the one who has given her parents no trouble, a role made fairly predictable by the bad behavior of her older brother. Good daughters should accept their mothers, and Jewel does. But we see her rethinking the whole situation as the afternoon with the crazy person plays out.

Oh, wait a minute: the crazy person isn’t really “crazy”; she is “borderline,” just someone with a diagnosis that is very hard to treat. Borderlines, for instance, do a lot of self-cutting. And they can be very, very needy, hence the fact that Jewel’s mother “stood up for them, visited [her patient’s] homes and talked to their problematic relatives, went to the store with them, walked them along the river, allowed them to bring their pets to their therapy sessions.”

Jewel does not think about her mother not doing these things with her; instead, she thinks about her mother’s obsession with decorating, an obsession successful enough that New Mexico Magazine runs an article about it.

The patient, who has suddenly appeared in Jewel’s kitchen, says that Claudia is “a tease.”

The reader wonders whether Claudia has crossed some kind of line. Claudia protests she has never had a patient to dinner, but she has had other very personal interactions with them — long w6alks, for instance, and shopping trips. A patient might come to depend on these excursions; a patient might think this attention could be life-long. After all, these are the kinds of things you do with a friend, and the ideal of friendship is that it might be life-long. Finding out that these are not life-long might precipitate a crisis.

We hear from Jewel that her mother goes to a lot of funerals. She has a lot of suicides in her practice. One wonders if these numbers are in line with the profession at large or if Claudia’s brand of therapy is not as successful as she thinks.

The story’s title — “Primum Non Nocere” — has a very official sound, and in brief, this motto suggests that the medical profession should first do no harm. What this story first questions is not so much whether Claudia is doing her patients harm, but whether Claudia’s absences and omissions at home are doing her family harm.

Claudia has a son, the story implies, who has in the past gotten drunk, passed out in the driveway, run away, and gotten arrested. Now he is away at college, and perhaps, not so much on their hands. But in addition to this, no nonsense Claudia has also married her therapist, who was much older, and somehow, after the kids were born and they were divorced, arranged to live far enough away that the man was no longer in their lives. He was too old to be interested in his second family, according to Claudia. He was depressed, she said, dangerous, and suicidal, which all turned out to be true. Claudia’s second husband is much younger, a “trophy husband.” But Jewel knows that her step-father has affairs, knows that her mother says he has a sex addiction.

When Jewel thinks, in passing, that her mother is “insatiable.” She says this flatly, yet the reader is thinking, yes, she sounds insatiable, and it isn’t pretty.

I worked through half of my children’s childhood; I too wanted to be at star at work, it being so much easier to be a star at work than at home. So I read this entire story with a kind of dread. Claudia is an extreme version of most of us, though. There is that comfort. Nonetheless, Jewel is home alone watching a horror movie when the patient breaks into the kitchen. The American version of mothering right now involves fracture. Work does not mesh with the kids’ school, and it does not mesh with life either. Kids spend a lot of time home alone, especially when they’re “old enough.” I find this scary, have always done, and the story’s casual acceptance of this situation underlines the questions that should surround this “home alone” problem. It’s an American issue, one we ought to solve. (My own solution has to do with streamlining the school schedule and the work schedule and the 60 hour week. But that’s another life-time.)

At any rate, the reader is watching Jewel the way she watched Crystal in Kirsten Valdez Quade’s recent story, “Ordinary Sins.” Both girls are slowly coming into a sense of who they really are, what their situation really is.

Nelson herself says, in her interview with Deborah Treisman (here):

Teen-agers, especially girl ones, seem like the perfect canary-in-the-coal-mine characters to me. They capture American culture and its perversion, its hypocrisy — how absorbed we are with youth and beauty and sexualized imagery, for instance, while preaching abstinence and modesty. Teen-agers’ contradictory power and vulnerability, their sophistication and innocence, in combination — what a nightmare it can be to be that person!

I enjoyed that exploration in Nelson’s story very much.

But I also thought the difficulties of the borderline patient were well done. The patient is clearly having a bad episode. She has committed a house invasion, her conversation is nuts, she is lacking ordinary personal boundaries, and she is carrying a knife.

Late into the confrontation she confesses her gratitude for the help that Claudia has given her. For one thing, Claudia has taken her off the meds. Joy, the patient, says:

The only thing every other a-holes could think to do was tranquilize, turn me into a zombie.

Now this could be a wonderful thing. We all know someone who is not well served by their meds. Meds are indeed sometimes a kind of chemical incarceration. The only problem is this: Joy is clearly having a crazy episode, and she is in need of something. Incarceration? Meds? What?

What I like about this story and its portrayal of mental illness is that it doesn’t pull any punches. Mental illness, real mental illness, can be at best a blundering presence in ordinary life, much the way Joy is a blundering mess in Jewel’s kitchen. We fool ourselves if we think otherwise. We want to think otherwise because as yet there is no accurate understanding of it, no dependable treatment for it, and no vaccine. It’s a scary situation for which our incredibly can-do health system has no fix. The more stories that explore the paradox of mental illness the better. The suffering is untold, and it needs to be faced and told.

One last thing about this story. In Nelson’s interview with Deborah Treisman, she indicated that she had altered the story, added a chunk at the end, at the editor’s request. Interesting.

When she adds that chunk, she adds the possibility that Jewel has realized, through crazy Joy and crazy Joy’s story, that “the only way to truly hurt her mother, Jewel saw now, was to hurt herself.”

But I don’t take Jewel seriously here. Yes, Joy is some kind of cutter. Yes, there are a lot of cutters out there. But the ones I have known do not have the kind of presence of mind that Jewel displays. Jewel could be a candidate — with a mother who is so able to suck the air out of a room — but somehow I think Jewel will have the presence of mind to rethink the whole thing. She does so much thinking that is unflinching anyway. I think she is a teenager, not a “borderline,” not a cutter. I think she will move on. Maybe get together with that bad boy she thinks about, which might not be so bad.

But maybe you disagree.

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