[Book*hug Press; 2024]

Tr. from Danish by Caroline Waight

After her young son dies, a chemist escapes her grief by developing a pill against it: Callocain. Surprisingly or not, the medicine works. In Blue Notes, a new novel by Anne Cathrine Bomann, translated from Danish by Caroline Waight, hundreds of grieving people get their lives back, returning to work and becoming their “old selves.” But the cost, at least to some patients, is high, even existential. The question, then, is whether they ought to take the pill. More broadly, Bomann, who works as a psychologist when she isn’t writing, asks whether grief should even be a diagnosable condition in the first place. Is grief really “a sickness that devours you”? Is it the inevitable “dark side of love,” or something to be eliminated?

Blue Notes is no quiet meditation on grief: it’s a well-paced and highly readable medical thriller. With its sleuthing protagonists, a shady corporation, and a romance plot, Bomann’s novel often feels less like a philosophical novel and more like the beginnings of a stylish Danish miniseries. Her setting evokes coldness and gloom without feeling oppressive, as in the description of the wintry view from one character’s seaside apartment, “where the gusting wind makes it look like a giant squid is on the seabed, shooting ink up toward the surface.”

Shadi and Anna, two psychology graduate students at Aarhus University and the protagonists of the novel, ask these questions when they set out to write a joint dissertation on Denmark’s recent establishment of a grief diagnosis, called persistent grief disorder. (The diagnosis, Bomann tells us in an afterword, is real; the medication is not.) Thorsten, their advisor, is part of a university research group studying Callocain before it gets final market approval. When the team’s results come in, Thorsten notices something unsettling in the data. But no one in Thorsten’s group listens to his concerns, all too ready to publish their results while Callocain speeds toward the Danish market. As Shadi, Anna, and Thorsten investigate Callocain, they find themselves up against their academic department and the powerful Danish Pharma, the fictional company developing the drug.

While Shadi and Anna are the only ones to take Thorsten seriously, they differ in their views on the grief diagnosis. Shadi sees a grief pill no differently than any other medication, like the pills she takes for OCD and anxiety. Medication can establish a baseline, she says, bringing someone back to a functioning version of the person they used to be. The novel’s depiction of Callocain might support Shadi’s view. While avoiding too much scientific detail about Callocain, Bomann provides enough hints of its effects on the brain to make it seem entirely plausible. Like real pills, it targets certain areas of the brain, dampening their activity. If anxiety, depression, and schizophrenia can be medicated in a similar way, Bomann seems to ask, why can’t grief? But the more combative Anna has her doubts. She doesn’t think that grief should be diagnosed and medicated like a mental health condition, or that it should be “pathologized” at all. She’s skeptical of big pharma, and she rightly senses that something might be off with the pill. Given the reality of a grief diagnosis (called prolonged grief disorder in the US), these questions about diagnosing and medicating grief are well worth asking.

The novel also goes beyond the pills to examine the diversity of grief responses. Anna, whose mother has recently died, withdraws from others, has angry outbursts, and falls behind on her coursework. She also refuses to acknowledge her mother’s death until late in the novel. Her father, by contrast, becomes sad and despondent, staying home most of the time to watch TV, while adopting a feigned cheerfulness in front of Anna. Meanwhile, Elisabeth turns her grief into ambition. Refusing to process her son’s death, she rushes dry-eyed out of a group therapy session, deciding that “[s]he didn’t even fit among the mourners.” Elisabeth’s inability or unwillingness to deal with grief, an inclination shared by others in her society, sets the stage for Callocain.

While Blue Notes presents the nuances of grief and its diagnosis, it ultimately seems to come down against medication—especially in its form as Callocain. Elisabeth and the rest of Danish Pharma, with their overzealous belief in the pill and their dishonest research practices, are the antagonists in the novel. And their creation is truly frightening. Like Brave New World’s soma, Callocain ends pain at the cost of meaningful human connection: certain patients lose all empathy, even for their own pets and children. Their inability to care about others is epitomized by the haunting image of an empty baby carriage left out in one patient’s yard. (Bomann even borrowed the drug’s name from a dystopian novel called Kallocain, hinting at the nightmarish world to come when Callocain is widely available.) It’s difficult, then, to see much of an argument in support of the pill. Empathy and love, the novel suggests, might disappear along with grief.

While Callocain is the novel’s villain, Bomann does not totally villainize its inventor. One out of every four chapters is narrated from Elisabeth’s perspective (the other chapters go to Shadi, Anna, and Thorsten). The novel even opens and closes with Elisabeth’s chapters, so that the rest of the narrative is framed by her experience of losing a child and resolving to end grief, making her far from the faceless, greedy executive one might expect in a novel about big pharma. Elisabeth genuinely wants to help people, not to bolster her ego or gain power. Even her most unethical actions are somehow mild, unnerving but not exactly disturbing. In this way, Blue Notes avoids the darkness or violence of, say, the Nordic noir genre or a true dystopian novel. And Elisabeth’s complex character may certainly be more interesting to many readers than a caricature of a big pharma executive. Yet, portraying Elisabeth—and, by extension, Danish Pharma—in this way has unsettling implications. By painting Elisabeth as well-intentioned but misguided, willing to break the rules but not exactly cruel, Blue Notes largely ignores other incentives that might actually inform the workings of Danish Pharma and the real-world companies it represents. Besides a few offhand remarks from Anna, there’s little mention in the novel of a profit motive—at least, money doesn’t seem to be much on Elisabeth’s mind. It’s troubling, perhaps even dangerous, to suggest that the very real problems of big pharma might be solved if its executives and top scientists simply had more love and empathy.

Blue Notes skirts some of the complexity of these real and timely issues to detail, instead, the psyches of its compelling and well-drawn characters. Bomann seems to agree with Thorsten, whose approach to research is to “[n]ever put the system before the human being.” This credo is particularly evident in Bomann’s depiction of Shadi, who struggles with overwhelming anxiety and self-doubt. Constantly feeling insecure and inadequate, she’s distant from the people around her, such as Anna and her boyfriend, and seems controlled by recurring negative thoughts. When Shadi calls her boyfriend, for example, she tells herself that “[h]e sounds happy. Why can’t she be too? Why does she always have to make things difficult? Sometimes it’s like all she does is drag him down.” Shadi also has OCD. She checks and rechecks the stove, the doorknob, and her dissertation files, afraid that something will go horribly wrong. Admirably, the novel’s depiction of Shadi doesn’t seem clinical or too obviously drawn from the DSM—she isn’t a case study for OCD but a complicated, believable character. Anna is nearly the opposite of the diffident, reserved Shadi. She’s loud and brash, and, as Shadi observes, has “something overwhelming about her.” Unlike Shadi, who does everything ahead of time, Anna waits until the last minute to find a dissertation advisor, and has to pair up with Shadi when Thorsten can’t take on more students. Meanwhile, she’s barely coping with her mother’s death, and her relationship with her father is strained as a result. Despite their differences, then, both characters have difficulties creating and maintaining relationships. Yet, by narrating the development of this friendship, the novel makes a convincing argument for human connection as the antidote to pain and suffering.

Blue Notes appeared in Denmark in 2021 and is set in 2024, a period of years especially full of loss. Bomann couldn’t have known how world events, from the COVID-19 pandemic to international conflicts, would unfold when the novel was published in 2021, yet it’s difficult to look past the real-life turmoil that sits just below the plot. Grief itself might be timeless, but the novel feels very much like the product of a grieving world, a world sick of grief. It asks important questions about how we respond to loss, about what grief means, and about what—or, better yet, who—gets us through it. 

Noah Slaughter writes fiction and essays, translates from German, and works in scholarly publishing. He lives in St. Louis.

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