The Strange Case of Jane O. by Karen Thompson Walker is a novel that was published in early 2025. It was recommended by a dear friend who said it was one of the more fascinating novels that he had recently read. It’s the story of a curiously emotionally disturbed woman and her treatment by a psychiatrist, Dr. Bird. Given my history of having worked as a psychiatrist and psychoanalyst for the last 50 years (recently retired), my friend wanted me to read this and then have a discussion about it. That discussion is soon to occur.
Jane O. has an eidetic memory which appears to allow her to recall in great detail essentially every day that she has lived detail since she was a young girl. As the story began, she recently had a baby boy via sperm donation. She was living with her son in New York City where she was mostly estranged from her parents in California, and she worked as a librarian for the city. It was apparently her first dissociative episode that led her to reluctantly seek psychiatric care in New York. She may have been suffering from a dissociative disorder which is sometimes referred to as a fugue episode. According to the DSM5, the book that defines all recognized psychiatric disorders, “Dissociative disorders are characterized by a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotional, perception, body representation, motor control, and behavior.” Jane claimed to have seen Dr. Bird for one occasion about 20 years earlier although her need for psychiatric attention at that time was never explained. It was Dr. Bird who she sought for help once again.
Dr. Bird was a troubled man himself. Not long after the birth of their baby daughter, his wife died in a pedestrian accident when she walked in front of a vehicle and was immediately killed. He also had been fired from the institution where he worked. He was particularly interested in studying patients who reported premonitions, a topic that would not have been easily recognized as worthy of research by the psychiatric community. When he tried to keep his interest secret and then lied about doing that work, he was terminated. He struggled to get on his professional feet once again, and he opened his outpatient private practice. It was then that Jane O appeared in his life.
The story is about the relationship the two of them had as Dr. Bird worked to understand what was happening with his patient. He clearly found something appealing about Jane and she put her faith in him for a cure. She then had recurrent dissociative episodes which sometimes lasted for hours, but eventually lasted for weeks. He finally came to the understanding that he was overly involved with Jane although they were not reported to have had a sexual encounter with one another. He was constantly thinking about her and looking forward to his sessions with her more than his other patients. As the book came to an end, Dr. Bird announced that he would have to terminate his treatment efforts with Jane and refer her to a psychiatrist who treat her more dispassionately.
It was the very end of the book that requires mentioning. While Dr. Bird had planned to end this relationship, and while he planned to do so after saying goodbye to her, he found himself unable to do so. Rather, as Jane narrated this part of the story, she described that they met and sat on a park bench together for a long period of time without speaking to one another and while holding hands. Finally when Dr. Bird stood up, instead of parting, they walked off hand-in-hand.
The book brings up the importance and sometimes difficulty of maintaining strict boundaries with patients, which the mythical Dr. Bird failed to do. It seems to me that stories about psychiatric and psychoanalytic treatment tend to be only interesting to most readers when there have been boundary violations. Try to think of any story of such treatment in which boundary violations was not a significant theme. Any well-trained therapist should know this and observe the clinical importance of doing so. While it’s true that such mistakes do occur in treatment, I won’t take the time to explain the damaging effect that this causes to patients regarding their own emotional growth, which is the goal of treatment. I’ve been involved as an expert in a couple medical legal cases in which such boundaries were violated which rightfully led the loss of the doctor’s license to practice medicine.
What was the reader supposed to understand about the ending, perhaps that like a shining knight in white armor rescued the damsel in distress and rode off into the sunset to live happily ever after? In reality, that’s not how this works. Rather, it is my thought that these two troubled people were doomed to have a failed and unworkable relationship. With this warning regarding what was clearly a treatment failure, you could read this story and sadly watch how this doctor-patient relationship quickly grew into a dysfunctional one.