“Patient X: The Case-Book of Ryunosuke Akutagawa” by David Peace

Patient X: The Case-Book of Ryunosuke Akutagawa, David Peace (Faber & Faber, April 2018; Knopf September 2018) Patient X: The Case-Book of Ryunosuke Akutagawa, David Peace (Faber & Faber, April 2018; Knopf September 2018)

Fans of modern Japanese literature will not want to skip Patient X. These fans will recognize Ryūnosuke Akutagawa (1892-1927) as one of the most well-known Japanese authors and as having a top literary award—the Akutagawa Prize—named after him. Readers not familiar with Akutagawa will still likely be familiar with his short story “In a Grove”, which is about the widely differing accounts of a murder as related by witnesses and those involved. The famous director Akira Kurosawa used the story as the plot for his film Rashōmon.

David Peace pays homage to Akutagawa in this novelistic retelling of his short life through imagined and vivid retelling of biographical facts, letters, meetings, travels, essays, psalms, stories, news articles, historical events, natural disasters, and hallucinations. Peace’s deep knowledge of Akutagawa, Japanese literature, history, and culture is evident on every page.

For example, Sōseki Natsume (1867-1916)—arguably the most popular Japanese writer, whom Akutagawa reverently called sensei—in real life encouraged Akutagawa to keep publishing (“Go on produce twenty or thirty stories like this one. You will soon be incomparable in literary circles.”) Through Natsume, modern Japanese literature was heavily influenced by the Western ideals of literature, although not necessarily by the West itself. Peace makes this point when Natsume tells Akutagawa of his time in London (in “Jack the Ripper’s Bedroom”):


I had come to this country, this city [London] to learn. The biggest, greatest city on the earth, the centre, the capital of the world. To drink from its cups of knowledge, to taste the wisdom of its harvests, then to return to Japan laden with the fruits of my learning, to share my studies, to teach what I myself had been taught. But here I sat, in this city, in this house, in this attic, on this sofa, parched and starved and close to death, the sum total of my account an unreadable report.


Another legendary Japanese author with a literary prize named after him making an appearance in Patient X is Jun’ichirõ Tanizaki (1886-1965). In real life, Akutagawa and Tanizaki had a dispute about the fundamental nature of fiction, Akutagawa arguing for structure versus Tanizaki’s push for content as most important. Despite that conflict, Peace points out Akutagawa’s fascination with Tanizaki in “A Twice-Told Tale”:


Ryūnosuke, an editor and an older colleague, Jun’ichirõ Tanizaki, were sat at a café table in Jimbōchō, puffing on one cigarette after another, listening to music from a gramophone on the other side of the room, gossiping about politicians, joking about other writers. But Ryūnosuke said very little; in truth he felt in awe of the older writer, not only the strength of his work, but also the sheer power of his personality, his vitality, his utter vitality.


Historical events affecting Akutagawa include the death of Emperor Meiji, the Japanese influence in China, and the devastating Great Kanto Earthquake. The quake, reaching a magnitude of 7.9 and lasting several minutes, struck just before noon on 1 September 1923. The death toll was estimated over 140,000 and much of the city was burned in the subsequent fires. Akutagawa lived with his family in the area at the time, and luckily all survived the earthquake. In “After the Disaster, Before the Disaster”, Akutagawa wonders which of his precious books to haul out of the damaged home:


Then, for some time, Ryūnosuke stared around the room at his library, wondering which books to save and which to forsake: Baudelaire or Strindberg? Flaubert or Dostoevsky? But Ryūnosuke did not want to read poetry. He did not to read drama. He did not want to read short stories or novels. Ryūnosuke picked up a volume by Voltaire. He put it back down. He picked up a volume by Rousseau. He put it back down. Finally, he chose the Bible and The Communist Manifesto.


Akutagawa lived only four more years after the earthquake. His physical health was never good after becoming severely ill while in China. He also worried about his mental health, mainly because his biological mother was sent to an asylum when he was young. He began to experience hallucinations, likely affecting his writing as illustrated in “Saint Kappa,” in which the Biblical idea of hell is transposed on the water-loving demon of Japanese mythology:


Here, death and hell, endless death and endless hell, here his neck endlessly breaking, here his blood endlessly draining, endlessly poisoned and endlessly drowning, here without end, here in the river, the River of Sins, bloody and boiling, here at the foot of the Mountain of Skulls …


Patient X is a challenging read. Its diverse and quickly changing styles, genres, and points-of-view make it difficult to get into a reading rhythm. I found it best to take a break between chapters. Some of the many references to historical events, people, and literature will leap out in familiarity, some won’t, depending on the reader’s background. Ultimately, Patient X gives us a deeply affecting insight into the life and brilliance of Ryūnosuke Akutagawa.

Todd Shimoda is the author of Why Ghosts Appear, Subduction, Oh! A Mystery of 'Mono No Aware', The Fourth Treasure and 365 Views of Mt. Fuji.