Review by Joey Madia
There are few things as sacrosanct as a mother’s rights when it comes to childbirth and issues of custody. The maternal instinct—although it is hard for fathers to acknowledge (I am one, three times over)—is nothing less than a force of nature only mothers can truly understand. The “momma grizzly” label for a fiercely protective mother expresses something very real and nothing less than vital for the evolution of humankind in times of great stress and trial.
This intense energy is the driving force of Carly Rheilan’s well-written, compelling novel, Birthrights. The motherly instinct is not reserved here for biological mother–child relationships only—the true strength of this dark page-turner is the expansion of the maternal instinct to protecting one’s siblings and the health practitioner–patient relationship.
In the dedication, Rheilan writes, “For Joan Davis, who encouraged me to write what I knew.” This is the advice given to all writers at some point in their development. Although we all write about things we do not know about, or simply make up—we are fiction writers, after all—there is great authenticity here. Rheilan’s experience as a psychiatric nurse working for the National Health Service in England, research into criminal justice, and teaching background serve her well in giving this novel—and her others—a chilling realism.
The main character is a psychiatrist named Anna Griffin. A trailblazer in the National Health Service in England, she is against medication as a primary treatment for psychiatric patients, believing that it robs them of agency and makes them living ghosts. One medicine described will put a patient out for 72 hours! Incurring the wrath of her supervisors, Anna is playing a dangerous game of defending her professional ground while also protecting her personal ground because of a plethora of family secrets. Like an army fighting on two fronts, there is a compelling inevitability to her outcomes through the mounting strain and stress.
Living ghosts are a multilevel theme throughout the story. There is an incident from the past never elaborated on, involving a former patient, known only by his name. He hovers over the present like a spectre as Anna’s secrets about a violent incident in her past slowly unfold through her interactions with a cast of well-delineated, interesting characters.
There is a patient with Tourette and another with a psychotic fixation on her. The police would have thwarted him early on if it were not for Anna’s secrets and master plan, which lead her to lie about his attack. Birthrights thrives on the underlying administrative slow rot that has given Douglas Adams, Terry Southern, and CS Lewis in Screwtape Letters fodder for a good chunk of their credits. Jealous nurses and colleagues are looking for ways to destroy her. A couple from Slovakia are a key part of an elaborate scheme Anna unfolds, which is breathtaking in its detail. They are so culturally different, their back stories so rich, that there is inevitability in their not being Anna’s allies. This is no plot spoiler… Rheilan cues us to this from the start. Anna doesn’t trust them, therefore nor should we.
My favorite character is the chief administrator, a conniving career bureaucrat who works the system, his subordinates, the newspapers, and the rapidly deteriorating situation with such vile yet surgical deceit that you will hate and admire him in equal measure. Think Tom Wilkinson or Richard Roxburgh characters at their most smarmy and conniving and you’ll understand.
As we follow Anna into an increasingly complex multifront battle space, the stories of the other characters unfold, their personal foibles and motivations competing with Anna’s ability to see her scheme through to a successful conclusion. It’s here that Rheilan puts her extensive knowledge of this world to full use. One has to wonder, by the end of the novel, who is looking out for the patients, because the medical staff, executives, and journalists are out for themselves. This device works to make Anna, an anti-hero if ever there was one—and anti-heroes have been trending for at least six years—seem to be the only one who actually cares.
Pulling off this kind of moral ambiguity is admittedly difficult. I recently reviewed Arthur Herbert’s The Cuts that Cure. Reading these two books simultaneously taught me a lot as a writer and gave me hope as a reader that this trend of anti-heroes will not only continue but grow in strength, as the world in which we live is increasingly morally ambiguous and those we think are or hope will be heroes often are not.
That’s the kind of complexity that could make novels once again useful to the problems of modern life, rather than beach-burners that you toss in the trash bin on your way to the car.
I also applaud the author for realism in Anna’s attempted execution of her long con. As she goes on the run and adapts disguises and otherwise tries to outwit the authorities… again, no plot spoiler… Rheilan writes it with a realism from which many TV, screen, and novel writers could learn. Netflix’s recent can’t-decide-who-the-audience-and-genre-are disappointment I Care A Lot is instructive here.
If you’re looking for a fast-moving thriller with depth and poignant social commentary, with a strong but flawed heroine struggling against incredible odds, then Birthrights is for you.
AUTHOR: Carly Rheilan