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The Great Gatsby
Am J Psychiatry 2009;166:1415-1416. doi:10.1176/appi.ajp.2009.09091369

by F. Scott Fitzgerald. New York, Scribner, 2004, 192 pp., $14.00.

A few years ago a colleague from my internship days suggested rereading classics not read since high school, college, or our twenties. F. Scott Fitzgerald held a personal interest for me, both then and now. We both spent our adolescence and early adulthood in St. Paul (although he four decades before me). For almost a half century, I have lived on the same street where he once lived in an apartment with his mother. Several decades ago, when many of his age-mates were still alive, gossip of his youthful carousing—not yet available in print—was heard. I knew that he “hung around” (or tried to) with a wealthy crowd in a suburb—a group to which he had none of the credentials for membership (wrong ethnicity, religion, ancestry, etc.).

Consequently I came to my first reading of Gatsby with considerable personal awareness of its author. The lead character, Gatsby (obviously a cipher for Fitzgerald himself), was trying to acquire a woman clearly outside of his class-bound reach. For me, as a young single man at that time, the futility of courting in the leisure class reverberated from these pages. Although Gatsby had achieved wealth (or at least access to money, as had Fitzgerald), he could not buy his way into the 1920s Americana elite. From Fitzgerald’s perspective, it was clear that the novel’s hero could not diminish, overcome, or even undermine, much less destroy this class-based structure. On the contrary, even the mere effort to join the ascribed (rather than achieved) class of inherited wealth and power not only would fail ultimately but could be deadly. On a more global level for me at this first reading, Fitzgerald taught through Gatsby (and his own tragic life) that one’s sights were best set within the social and ethnic realities of one’s time and place.

My rereading of Gatsby a half century later did not diminish these earlier lessons, although by 2009, I have made my choices and experienced successes and failures ensuing from these choices. Class never posed the huge obstacle for me that it did for Fitzgerald, perhaps because I took his lesson to heart and found means of circumventing it. I suspect that my society (as I experience and perceive it) is less class-ridden than it was 50 years ago. However, I might not feel the same way were I a member of the American underclass (poor, minimal education, limited prospects, lack of familiarity with society as it exists and functions).

On this second reading, I discovered several elements of the book that I had, amazingly, either not emphasized or had in the meantime forgotten. One of these key features was Gatsby’s upper Midwestern origins as a rural, northern European Lutheran, whose family name was Gatz. Fitzgerald had his novel’s hero changing his ethnicity by changing his name and abandoning his ethnic origins. Since my initial reading long predated my own formal education in anthropology and later studies of ethnicity, I may have been oblivious to the import of this information. Or perhaps I suppressed Gatsby’s several regional-ethnic-class similarities to my own. In any event, Gatsby, unprepared for life in the elite class, repeatedly misread people and events. By contrast, his protagonist Tom was in his element, read people and events accurately, and reacted toward his own survival.

Second, I had forgotten that Gatsby was a decorated combat veteran of World War I, who had seen harsh battle. Fitzgerald—not a combat veteran—cogently described in Gatsby certain behavioral and social scars characteristic of combat veterans, probably through observing World War I veterans who were about his age and of his time. Although Fitzgerald’s description of Gatsby would not justify a diagnosis of posttraumatic stress disorder, Gatsby manifests many characteristics of surviving combat veterans: his social isolation and loneliness, his abandoning of his society’s ethics, his overinvesting in a single, unlikely goal (regaining Daisy, now Tom’s wife). Since my early reading, I spent two years in the midst of war (in Laos, as a general physician and surgeon), returned to the United States to treat veterans with posttraumatic maladies as a psychiatry resident, then worked with refugees for two decades and currently work with veterans. The consequences of war and trauma, as they existed in Gatsby’s values and decisions, were unmistakable, graphic, and even overwhelming in my later reading.

Third, I saw Gatsby’s protagonist, Tom, a compleat member of the moneyed elite, in an entirely new light. Years earlier, in my eyes, he was a brigand and worse. He cheated on his wife, treated his concubine and assorted underlings deplorably, lied, and set a murderer falsely on Gatsby’s trail. Fifty years later, I saw him—despite his many flaws—as protecting his family’s integrity, deftly avoiding a cuckold-murderer, accreting to the wealth inherited to him, and building his network of loyal indentured supporters. At the end, he held the field, with his life, his family, and his holdings intact. He remained true to his class and to his version of the Ivy League code. It is amazing that Fitzgerald, verbally denigrating Tom (through Nick, our guide in the novel), nonetheless permits Tom total victory over Gatsby. Parenthetically, Tom—in his dealings with everyone—reminded me of the challenging VIP (very important patient) that we can encounter in our physician role.

Fourth and last, Gatsby’s funeral reflected his devastated social network: four people attended the event. Mansell Pattison’s network schema suggests that Gatsby was a seriously deranged individual, in the range of a Skid Row alcoholic, an institutionalized psychotic, or a disabled borderline, whose efforts at resolution had run their course (1, 2). Gatsby’s murderer may well have saved him from death at his own hand—another too-frequent end among war heroes.

This return to Gatsby heightened my regard for Fitzgerald’s ability to describe elements of the human condition. He skillfully wove a tale of postcombat tragedy in a man escaping (rather than finding resolve in) his roots. Gatsby was a tragic hero for an entire generation trying to recover from World War I (and later rediscovered after World War II and the Korean and Vietnam conflicts). This second reading also provided insights into my own changes over a half century, wrought by my work and historical circumstance. Although Gatsby’s exploits in war cover only a few pages of this book, for me they redefined Fitzgerald’s Gatsby as a tragic novel on postwar maladjustment, set against the backdrop of class and ethnicity—and not only a commentary on class struggle and ethnic escape.

1.Pattison EM: Social system psychotherapy. Am J Psychother 1973; 27:396–409
2.Westermeyer J, Pattison EM: Social networks and mental illness in a peasant society. Schizophr Bull 1981; 7:125–134


+The author reports no financial relationships with commercial interests.

+Book review accepted for publication October 2009 (doi: 10.1176/appi.ajp.2009.09091369).



1.Pattison EM: Social system psychotherapy. Am J Psychother 1973; 27:396–409
2.Westermeyer J, Pattison EM: Social networks and mental illness in a peasant society. Schizophr Bull 1981; 7:125–134

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