Although better known for his existentialist drama in which the nature of sanity is a recurrent theme, it is in his fiction that Samuel Beckett most directly addresses psychiatry. Unafraid to use for his raw materials life's grimmest situations - loneliness, despair, the decay of both body and mind - Beckett fashions them into prose masterpieces. As in real life they are often relatively plotless and despite their harrowing themes, darkly and philosophically comic.

In his 1938 second novel, Murphy, the eponymous hero (and also the fictional father of Ken Kesey's more animated Randall P. MacMurphy) shuns almost every aspect of conventional existence - work, respectability, marriage and money. Nevertheless, to quell the anxious urgings of his lover, Celia Kelly, Murphy takes up employment as a male nurse at the Magdalen Mental Mercyseat - clearly modelled on the Bethlem Royal Hospital - in north London. This role might appear implausible; Murphy after all is chronically depressed, socially phobic, alogic, avolitional, devoid of appetite and reduced to spending much of his time in darkness, bound naked to a rocking chair. However, he demonstrates surprising aptitude for the job: ‘Another melancholic, convinced that his intestines had turned to twine and blotting-paper, would only eat when Murphy held the spoon’. Beckett questions what it means to be sane, depicting the underqualified and sadistic nurses as the real lunatics and the psychiatrists as having ‘text-book attitude(s)’ and ‘complacent scientific conceptualism’; only the ‘seedy solipsist’ Murphy can meaningfully connect with the patients. Although the institution offers Murphy temporary sanctuary from the commotion of the outside world, his pursuers close in and, driven to greater despair after a circular game of chess with Mr Endon (‘the most biddable little gaga in the entire institution’), Murphy wanders away from his post and later self-immolates in his hospital garret: ‘The gas went on in the w.c., excellent gas, superfine chaos. Soon his body was quiet’.

Beckett visited his friend Geoffrey Thompson at Bethlem Royal Hospital in Kent while researching the novel and he demonstrates considerable insight into the operations of a psychiatric hospital. Irish psychiatrists may also nod as they note that Beckett knew the correct respective roles of two well-known South Dublin mental institutions in Stillorgan and Dundrum. In addition, Beckett had recently begun psychoanalysis with Wilfred Bion and the novel can be read as a metaphor for the process of his treatment. Similar characters to Murphy appear in many of Beckett's later works, always in retreat from so-called normal life, and struggling pitifully and often grotesquely to uncover meaning, where, for Beckett, no meaning existed. Murphy is a highly entertaining and accessible introduction to the themes that continued to preoccupy Beckett in his later, increasingly spare and experimental prose works, most notably the trilogy of Molloy, Malone Dies and The Unnamable.