Patient X: The Case-Book of Ryunosuke Akutagawa

Patient X: The Case-Book of Ryunosuke Akutagawa

by David Neil Peace


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In these twelve interconnected tales, David Peace—acclaimed author of the Red Riding Quartet, Occupied City, and Tokyo Year Zero—weaves fact and fiction as he takes up the brief but fiercely lived life of the early-twentieth-century Japanese writer Ryūnosuke Akutagawa. Unique and offbeat, Patient X delves into Akutagawa’s rich and complicated private life: his fears and battles with mental illness; his complex reaction to the Westernization of Japan; his exacting creative process; and his suicide, weaving these facets into a hauntingly evocative portrait. But Patient X is more than a paean to one remarkable writer: it is also an incandescent exploration of the act and obsession of writing itself, and of the role of the artist in times that darkly mirror our own.

Product Details

ISBN-13: 9780525564119
Publisher: Knopf Doubleday Publishing Group
Publication date: 08/20/2019
Edition description: Reprint
Pages: 336
Sales rank: 382,373
Product dimensions: 5.10(w) x 7.90(h) x 0.90(d)

About the Author

David Peace—named in 2003 one of Granta’s Best of Young British Novelists—was born and brought up in Yorkshire. He is the author of the Red Riding Quartet (Nineteen Seventy-Four, Nineteen Seventy-Seven, Nineteen Eighty and Nineteen Eighty-Three); GB84, which was awarded the James Tait Black Memorial Prize; The Damned Utd and Red or Dead, which was shortlisted for the Goldsmiths Prize. The final part of his Tokyo Trilogy—to follow Tokyo Year Zero and Occupied City—will appear after Patient X, his tenth novel. He lives in Tokyo.

Read an Excerpt


And now, children, let me tell you a story about Gautama and Jesus.

It begins one day as Gautama is strolling in Paradise by the banks of the Lotus Pond. The blossoms on the pond are perfect white pearls, and from their golden centres wafts a never-ending fragrance. I think it must have been dawn in Paradise.

But as Gautama was strolling he heard the sound of weeping, a most unusual sound in Paradise. Gautama stepped down towards the edge of the pond and there, before the blossoms, amidst the fragrance, he saw Jesus kneeling beside the pond, by the water, staring down through the spreading lotus leaves to the spectacle below. For directly beneath the Lotus Pond of Paradise lie the lower depths of Hell, and as Jesus peered through the crystalline pool, he could see the River of Sins and the Mountain of Guilt as clearly as if he were viewing pictures in a peep-box.

And he was weeping at what he saw:

Down there was a man named Ryūnosuke, who was writhing in Hell with all the other sinners. This man had once been an acclaimed author but he had led a most selfish life, hurting even the people who loved him.

But now Gautama recalled how Ryūnosuke had performed at least one single act of kindness. Idling beside the Shinobazu Pond one day, Ryūnosuke had noticed a small spider creeping along the wayside. His first thought had been to stamp it to death, but as he raised his foot, he told himself, “No, no. Even this tiny creature is a living thing. To take its life for no reason would be too cruel.”

And so Ryūnosuke let the spider pass him by unharmed.

Hearing Jesus weeping, seeing his tear-stained face, Gautama decided to reward Ryūnosuke by delivering him from Hell, if possible. And, by happy chance, Gautama turned to see a heavenly spider spinning a beautiful thread atop a lotus leaf the colour of shimmering jade. Gently lifting the spider thread, Gautama handed it to Jesus. And now Jesus lowered the thread straight down between the white blossoms, through the crystal waters to the depths far, far below.

Here, with the other sinners at the lowest point of the lowest Hell, Ryūnosuke was endlessly floating up and sinking down in the River of Sins. Wherever he looked there was only pitch darkness, and when a faint shape did pierce the shadows, it was the glint of a needle on the horrible Mountain of Guilt, which only heightened his sense of doom. All was silent, and when a faint sound did break the silence, it was only the feeble sigh of a fellow sinner. As you can imagine, those who had fallen this far had been so worn down by their tortures in the seven other hells that they no longer had the strength to cry out. Great writer though he once had been, now Ryūnosuke could only thrash about like a dying frog as he choked on his sins.

And then, children, what do you think happened next? Yes, indeed: raising his head, Ryūnosuke chanced to look up towards the sky above the River of Sins and saw the gleaming silver spider thread, so slender and so delicate, slipping stealthily down through the silent darkness from the high, high heavens, coming straight for him!

Ryūnosuke clapped his hands in joy. If only he could take hold of this thread and climb up, then perhaps he could escape from Hell. And maybe, with luck, he could even enter Paradise. Then he would never again be driven up the Mountain of Guilt or plunged down into the River of Sins.

No sooner had the thought crossed his mind than Ryūnosuke grasped the spider thread and started climbing with all his might, higher and higher, hand over hand, climbing and climbing.

Hell and Heaven, though, are thousands of leagues apart, so it was not easy for Ryūnosuke to escape. He soon began to tire, to tire until he could not raise his arm for even one more pull. He had no choice but to stop to rest, and as he clung to the spider thread, he looked down, far, far down below.

Now Ryūnosuke realised that all his climbing had been worth the effort: the River of Sins was hidden in the depths of the darkness. And even the dull glint of the terrifying Mountain of Guilt was far down beneath his feet. At this rate, it might be easier than he had imagined to climb his way out of Hell. Twining his hands in the spider thread, Ryūnosuke laughed aloud. “I’ve almost done it! I’m almost saved.”

But then what do you think he saw? Far down on the spider thread, his selves, his legion of selves—son and father, husband and friend, lover and writer, Man of the East and Man of the West—had followed after him; his selves and his characters, too—Yoshihide, Yasukichi, Tock and all the rest—his many creations and, of course, his sins, his countless, countless sins: his pride, his greed, his lust, his anger, his gluttony, his envy and his sloth. All had followed after him, clambering up the thread with all their might like a column of ants! This slim thread seemed likely to snap from his weight alone: how could it possibly hold so many of his selves, his characters and his sins? And if the fragile thread were to break midway, then Ryūnosuke would plunge back down into the Hell he had struggled so mightily to escape. Yet from the pitch-dark River of Sins, still the unbroken column of his selves, his characters and his sins came squirming up the gleaming silver thread in their hundreds—in their thousands—and Ryūnosuke knew he would have to do something now or the thread would break in two.
Ryūnosuke raised his head again, looking up the spider thread. He was so close to Paradise, so very near. He could see the light of the water, he could glimpse the face of Jesus, even hear His weeping, now feel His tears wet upon his own face. But no matter how hard he tried to pull himself up, no matter how far and fast he climbed, Ryūnosuke knew his selves, his characters and sins would always follow after him, always catch up with him.

Ryūnosuke let go of the spider thread.

And at that very instant, at that very moment, as Ryūnosuke fell back down into the darkest depths, the spider thread broke at the very place where he had been hanging from it.

Behind Ryūnosuke, all that remained was the dangling short end of the spider thread from Paradise, softly shining in the moonless, starless sky.


At the edge of the Lotus Pond in Paradise, Buddha and Christ watched everything that happened. And when, in the end, Ryūnosuke sank back into the River of Sins, Buddha resumed His stroll, His face now tinged with sorrow. But Christ remained kneeling beside the pond, before the water, staring down through the lotus leaves, watching the pictures in the peep-box, weeping, weeping and weeping into the crystalline pool—

In girum imus nocte et consumimur igni . . .

We go round and round in the night, the endless night, consumed by fire, by fire, in the night, by fire—

Fire consumed by fire . . .

But the lotuses of the Lotus Pond still swayed their perfect pearl-white blossoms, and from their golden centres still wafted a never-ending fragrance. Yet I think it must be close to twilight in Paradise now.


Excerpted from "Patient X"
by .
Copyright © 2019 David Neil Peace.
Excerpted by permission of Knopf Doubleday Publishing Group.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Reading Group Guide

1. Discuss the author’s preface for Patient X. How does this section establish the tone and style for the book? What themes are touched on in this preface that echo throughout the book?

2. Consider the section “After the Thread, Before the Thread.” What is the effect of starting the novel with this passage? How does the tension between Eastern and Western religions emerge throughout Patient X? Discuss Akutagawa’s interest in Christianity and his fixation on Christ as a figure of literature and spirituality.

3. In the section “The House of Books” (page 23), the words “And your own frugality, and your own guile” are used repeatedly. What is the significance of this phrase? What effect does this repetitious language have on the narrative?

4. In the first section of “Hell Screens,” Akutagawa states, “The first act of the human tragedy starts when an individual becomes the child of certain parents.” How does this scene, and its graphic depiction of birth, lay the groundwork for the rest of the narrative? What does this statement assert about Akutagawa’s own sense of his identity? Discuss his childhood and parentage, and how issues of uncertainty shaped his worldview.

5. In Patient X, Peace blends fact and fiction, dreams and reality, reminiscence and projection. How does this constant oscillation destabilize the idea of “truth” in storytelling? Which sections, if any, were difficult for you to determine as fact or fiction?

6. Akutagawa’s interest in Poe undergirds his work and influences his own writerly impulses. Consider Poe’s public stature and his descent into “madness.” Does Akutagawa romanticize the decline, or does he approach it with trepidation?

7. How does Akutagawa’s awareness of his mental health play into the narrative? Consider his experience with his mother’s mental health and how that shapes his understanding of himself from an early age. By the end of the novel, what does Peace’s interpretation of Akutagawa’s decline assert about the treatment of mental health throughout history? In the consideration of art?

8. What does Akutagawa embrace about Japanese identity? What does he reject? Consider his experiences with Western culture. Which aspects does he find compelling? How do his contemporaries view his interest in Western culture?

9. Discuss Akutagawa’s relationships with women. How would you describe his feelings towards marriage? Parenting?

10. How did you interpret the “Jack the Ripper” section of the novel? What does this interaction reveal about colonialism? About Akutagawa’s own impulses as a man bridging the Eastern and Western worlds during this time period?

11. Throughout the narrative, intertextual materials are used to provide historical context for significant moments in Akutagawa’s life. How does this interplay of fact and fiction help to ground the narrative?

12. Discuss the death of the Emperor and the subsequent suicides of General Nogi and his wife. What effect did this have on Akutagawa? How are death and honor linked in Japanese culture? How does the idea of honor play into Akutagawa’s own choice to take his life?

13. In the section “Saint Kappa,” the voice of the novel changes from third person to first person to provide a different lens on Akutagawa’s life. Why do you think Peace chose to employ a roving narrative lens throughout Patient X?

14. What is the significance of concluding Patient X with a straightforward biographical recounting of Akutagawa’s life? Compare this narrative style and tone with that which is utilized throughout the book.

15. The thirteen sections that comprise Patient X utilize a wide variety of stylistic modes, perspectives, and genres. Consider the metafiction angle of this project. What does Peace’s interpretation of Akutagawa’s life assert about the inner lives of writers? What elements of the read struck you as most moving? Most chilling?

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