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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By |2015-02-03T01:06:32+00:00November 3rd, 2014|Categories: Antonya Nelson, New Yorker Fiction|Tags: |14 Comments


  1. lotusgreen November 7, 2014 at 2:06 pm

    In all my past reading I don’t ever recall a character as obsessed with overcoming and manipulating the past as Claudia, the unsentimental shrink whose primary customer slices up her own arms rather than face the fact that she’d prefer slicing the throat of her mother.

    Claudia herself, however, has several different coping schemes of her own: she’s obsessed with obtaining relics of the past (sometimes driving states away to find them) which she can arrange how she wants them to be; she marries a younger man (a boy toy?) and overlooks his repeated philandering; and she’s maneuvered everyone else in her life to take her as she is, even if that means giving precious little back in the way of comfort.

    Joy, her patient, has a gun firing at her unpantied crotch; how’s that for a symbol for ambivalence towards sexuality? This story reminded me of Shirley Jackson’s “The Man in the Woods,” the underside of generational warfare, the dark fearsome thing it really is, where coming of age literally suggests killing the mother; in this case, we might all want to murder a mother who, if we don’t, may just turn everything of us into wall displays that she can rearrange.

    Mirror mirror on the wall, who’s the fairest of them all? “What do you mean, teach her a lesson?” Claudia asked calmly, still staring at Jewel. “Tell me, Jewel,” Claudia went on. “I want to know.” The lady or the tiger, which will be Jewel’s choice?

  2. Trevor Berrett November 10, 2014 at 4:42 pm

    Betsy has sent me her comments on this story, and I’ll get them posted soon! I’m off to a meeting but hopefully will post when I return!

  3. Trevor Berrett November 10, 2014 at 6:35 pm

    Okay — Betsy’s post above!

  4. Betsy Pelz November 16, 2014 at 9:22 am

    Hey, Lotusgreen, – very nice comments that you rushed into print while I took my sweet time. (My dentist was trying out a new machine that “prints” a crown while you wait – except that the whole thing takes about four hours and my Monday threw me for a loop.) I purposely didn’t read your comments first. Now I’ve read them and thank you for your close reading.

    I like the way you get right to the point: Claudia makes you think of murder.

    And thanks for the chance to mention something that brought me to Mookse and Gripes in the first place. When we write about a New Yorker story, there’s nothing already out there. There’s no academy opinion, no established view. You cannot think something you read about this story a few years ago is your own original thought.

    Of course – there’s also the opportunity to be colossally wrong. I like that about the whole excursion. A modest kind of sky-diving.

  5. lotusgreen November 16, 2014 at 4:22 pm

    I was surprised to find no comments here when I arrived, fairly late as I recall, but posted it anyway then worried ever since if I’d broken protocol somehow (something I seem to do naturally) and swore I’d never do it again.

    With regards to your comment, “I like the way you get right to the point: Claudia makes you think of murder.” With the mother I had, that wasn’t difficult.


  6. Betsy Pelz November 16, 2014 at 4:52 pm

    When Trevor puts up the comment page, I think he means what he says! “Feel free to comment and we’ll have our thoughts up soon.”

    So speak up when the spirit moves. That’s the protocol! He wouldn’t have the comment section up if he didn’t want people to dive in.

    As for me, after several years, I find that some weeks the stories take me a while, and some weeks daily life sometimes intrudes.

  7. lotusgreen November 16, 2014 at 5:36 pm


  8. Trevor Berrett November 17, 2014 at 1:36 pm

    Yes, Betsy is absolutely correct. If a page is up with comments open, you can comment away! I’d hate people to think that they have to wait for me to get my act together :-) .

  9. lotusgreen November 17, 2014 at 1:57 pm

    Whew! :^D

  10. Greg November 25, 2014 at 6:18 pm

    Thanks Lily for being honest about your feelings on your Mom and for clearly revealing Jewel’s mindset with her mother. I didn’t viscerally grasp that on my own………and Betsy, your admission on wanting to be a star at work was a mirror for me, and your motivation for choosing that objective was even more instructive. “It being so much easier”…… true!

  11. Ken November 25, 2014 at 6:20 pm

    I am so glad the last paragraph was added because it was powerful yet not overdone. I agree with Betsy that Jewel is not going to become a self-mutilator, that she is simply turning over ideas and thinking, but the fact that she has acknowledged such rage is sort of the way we as readers also become increasingly turned off by Claudia. I love the take-down of those who feel brutal honesty, lack of sentimentality are always the best things and who fail to see how these too can become oppressive. My only quarrel (and this comes from my previously noted feeling that stories have too much back-story) is that the absent first husband’s situation takes up too much space here. A brief note that Zach is a second husband and the first one is gone would have sufficed for me.

  12. Greg November 26, 2014 at 4:04 pm

    I see Ken that you like the Hemingway approach to cutting out the backstory!

    And you have made my day when I read this part of your post:

    “I love the take-down of those who feel brutal honesty, lack of sentimentality are always the best things and who fail to see how these too can become oppressive.”

    Thanks Ken for implying that kindness and compassion are sometimes more appropriate than the literal truth.

  13. Ken November 27, 2014 at 3:52 pm

    Greg, I’d say it depends on the story but yes in general I do prefer that approach. Thanks for the kind words.

  14. Madwomaninthe attic January 7, 2015 at 1:55 am

    Agreeing with everyone (for once) about what the story is about and the dreadfulness of Claudia, I would add some commentary about the amazing cheese knife, which is so perfect an object that it almost brings black humor into the story. It is an external threat and at the same time a collectible that is right at home.” “Borderline” Joy manages to bring a weapon that so closely resembles one of the family’s possessions that both Zachary and Claudia think it is one of theirs. Nelson lingers over the knife’s description, and explains how it was a gift/not-a-gift, another piece of Jewel’s clear understanding of how things work in that family. Many of the threads of the story, Joy’s dangerous intrusion into Jewel’s afternoon of ‘fake’ danger, Claudia’s sharp-tongued heartlessness towards her own family, Zachary’s adolescent narcissism, their huge obsession with objects, and finally the sweet hope of Jewel’s redemptive vision coalesce in, of all things, a knife.

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