54 pages • 1-hour read
The Clinic
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Themes
Content Warning: This section of the guide includes discussion of substance use, addiction, physical abuse, gender discrimination, death by suicide, mental illness, and graphic violence.
Problems in the Addiction Treatment Industry
The Clinic suggests that there are serious problems in the addiction treatment industry. The titular clinic is introduced as “the world’s most expensive rehab” (8), with a staff anchored by “star psychologist” Dr. Max, an “award-winning” expert on addiction. Nevertheless, Meg and Cara witness serious ethical and legal violations at the Clinic. That these abuses occur at such a high-end facility suggests both that unethical practices are common within the industry and that money itself is a contributing factor.
Indeed, greed drives many of the shady business dealings the protagonists uncover. Specifically, the novel identifies insurance fraud as a major problem in the industry. Lutz’s clinic in Florida was closed due to insurance fraud, and he brought the practice with him to the Clinic. During an audit of Haley’s file, Cara discovers that Lutz is charging patients’ insurance companies “a 5,000 percent markup” on unnecessary urine tests (235), which patients were taking multiple times per day. She is shocked to find that, on “one day alone, the charges for various tests and treatments came to over $22,000” just for Haley (235). Nor is the problem simply that Lutz is a con artist. Rather, he is emblematic of a profit-driven industry—for instance, insurance companies that are awash in cash (as their ability to pay for Haley’s marked-up treatments demonstrates) but unwilling or unable to deliver basic services (Cara is horrified when she realizes that paying out Haley’s claims could lead to denying other patients “lifesaving procedures”). That Cara comes to accept Lutz’s argument about overcharging insurers further clarifies that the problem is systemic. Cara believes that she has to defraud insurers to give her patients the best care possible, which implies that quality of care is a secondary consideration for those insurers.
The novel also suggests that this disregard for human life and health can trickle down to the workers at rehabilitation treatment facilities. When Meg arrives at the Clinic, she is put into a coma for two days without being told about this in advance. Meg is “outraged” that she was put into a medical coma without her consent, calling it a “violation.” Max dismisses her concerns, telling her that the paperwork she signed gave the Clinic the right to act as it did, but he later admits to Cara that he disapproves of the practice. He reveals that he has seen Lutz and the Clinic’s nurses use sedation “like a punishment” (114). Both the lack of transparency and outright abuse reveal a fundamental disregard for the autonomy of even the most elite patients. This contributes to the novel’s critique of the commercialized addiction treatment industry, which prioritizes expediency and profit over its purported mission to heal.
The Lasting Effects of Trauma
Several of the novel’s characters are defined by their relationship to trauma. Cara, for example, is still reeling from the misogynistic backlash she experienced after her affair with a former boss went viral, landing her with a reputation as a “chubby, plain-faced man eater” (61). The novel also associates Haley’s diagnosis of antisocial personality disorder (like her sister’s) with a traumatic childhood that taught her to manipulate and compartmentalize as a means of survival. However, it is Meg’s storyline that offers the most in-depth consideration of the nature of trauma and its impact on daily life.
In particular, the novel posits that Meg’s addiction is the result of childhood trauma and explains the mechanism by which this could have occurred. The Clinic’s primary psychologist, Dr. Max Reynolds, argues that the brain retains traumatic memories in order to “protect you from making the same mistake twice” (276). However, what distinguishes these memories from others (beyond their difficult content) is the fact that they are “unprocessed.” Rather than surfacing as concrete recollections, these repressed memories cause “physical emotions” that people may seek to manage through alcohol and drug use.
Addiction is not the only way in which these repressed memories manifest, however. While undergoing alcohol detox, Meg has a recurrence of “an old childhood nightmare” featuring a “man with playing-card eyes” who she believes “hurt me and Haley” (85). As she works through these memories with Max and Lutz, she remembers more and more: The man’s name was Matthew Priest, and he was accompanied by a woman in lingerie, whom Meg identifies as “the queen of hearts” (257). At the end of the novel, it is revealed that Matthew Priest distracted Meg by teaching her to play poker with a set of pin-up cards on the day her mother attempted to die by suicide. Meg did not consciously remember most of this, and what she did recall disturbed her. Nevertheless, the episode is implied to have led Meg to her current job as security at a casino, a setting where cards are commonplace. This hints at a subconscious attempt to reenact her childhood trauma, presumably to work through it. The risky, high-stakes nature of the work is significant as well; as her therapist explains, people with antisocial personality disorder are often drawn to these qualities, but the disorder itself is a response to trauma.
Despite the varied and often destructive ways that trauma manifests in characters’ lives, the novel holds out hope for healing. Meg’s sobriety forces her to confront her trauma directly, and in doing so, she walks away with a better understanding of herself. Though she initially resists some of what she discovers, her embrace of her diagnosis of antisocial personality disorder implies that it is possible to turn the effects of trauma to productive ends.
The Difficulty of Discerning Character
The novel’s depiction of complex, dynamic characters suggests that it is difficult to assess another person’s moral character accurately. In fact, the narrative arcs of Cara, Dr. Lutz, and Haley suggest that moral certainty about others may simply be impossible.
The unfair and inaccurate depiction of Cara’s affair with a former employer establishes that a person’s public persona may not correspond to their true character. Before coming to the Clinic, protagonist Cara found herself the subject of “viral memes” about her affair with her married boss. Cara was forced to endure accusations that she was a “gold digger” alongside derisive commentary on her appearance. Cara, however, insists that she “didn’t know he was married” and that “it didn’t matter to [her] that he owned a hotel group” (61). She later reveals that her affair partner took his “wedding rings off at work” (286), indicating that he deliberately deceived her. Far from the media’s depiction of her as amoral and materialistic, the novel suggests that Cara was hurt and misunderstood by the scandal.
Conversely, Dr. Lutz appears friendly and benign but emerges as the novel’s major antagonist. Lutz’s physical presence and demeanor are intentionally disarming—he wears flip-flops and woven bracelets, affecting a casual air—yet he withholds crucial information from police, compromising the investigation into Haley’s death, and engages in unethical and dangerous business practices. To further complicate matters, those who know about Lutz’s actions do not always see them as unethical. Cara believes that he is being honest when he tells her that he is only taking illegal shortcuts on the fugu drug to save lives. Max echoes Cara, arguing that Lutz is “willing to bend rules” because he is “completely dedicated to helping people” (126). While Lutz’s later willingness to murder his patients reveals these rationalizations to be hollow, the novel’s depiction of Lutz reflects its thematic interest in the difficulty of accurately assessing the moral motivations of another person’s decisions.
Haley, who mostly appears in disguise as Jade, is one of The Clinic’s most complicated characters. Meg comes to believe that Haley is a hero who “protected” Meg in one of her most vulnerable moments, when their mother attempted to die by suicide. This protection continues when Meg enters the Clinic to investigate Haley’s apparent death, as “Jade” tries desperately “to warn [Meg] away” (412). In the novel’s final chapters, Haley also electrocutes herself in order to kill Dr. Lutz and is saved only because she stood on a piece of grounding plastic, though whether she knew this would happen remains ambiguous. Despite these heroic acts, in the final pages it is revealed that Haley pursued her original goal of starting a new life, working with “Dr. Lutz’s criminal contacts” in order to disappear (432). As a figure who defies clear moral categorization until the end of the novel, Haley underscores the problem of accurately perceiving character.
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