Notes to John by Joan Didion

Notes to John consists of the notes drafted by writer Joan Didion after regular sessions with her psychiatrist, Roger MacKinnon, during the early 2000s. Didion updates her partner about what was discussed during each session and adds further insights of her own. The notes were discovered near Didion’s desk after she died.

I have mixed feelings about books published after an author’s death under their name. How confident are publishers that the notes, diaries, or other records left behind by a dead author were meant for public scrutiny? Were Didion’s notes to her partner John Gregory Dunne intended to be read by people other than John, who is also now deceased? There are ethical issues around posthumous publication, particularly related to privacy and consent.

It seems extraordinary that Didion could recall lengthy conversations with her psychiatrist near-verbatim, with many exchanges quoted word-for-word. Yet elsewhere in the book, Didion comments that at times she was unable to remember anything a speaker had said, due to emotional overload and stress. Sometimes  “couldn’t remember a phone number long enough to dial it”.

The focus of many sessions is on Didion’s strained relationship with her adopted daughter Quintana Roo Dunne, who later died aged 39. The words ‘guilt’ and ‘guilty’ appear multiple times throughout the book, with pain and despair also prevailing themes. Topics covered include suicide, disordered eating, substance addiction, alcoholism, depression, and parent-child interdependency. The notes mention writing projects Didion had underway during the period that she saw MacKinnon, and her anxiety about how to keep her work life under control when her family life was often chaotic.

Doctor-patient confidentiality is a fundamental principle in medical ethics. Was it appropriate for Didion’s psychiatrist to divulge discussions held with Quintana’s own psychiatrist (Dr Kass), which Didion then recounts in detail? Had Quintana given permission for her records to be shared, and for the two psychiatrists to codesign her treatment plan? It’s almost certain that Quintana did not give her consent for extensive information about her mental health and addictions to be disclosed in this book, given that she died before Didion.

Few would argue with MacKinnon’s observation that Quintana’s life was being managed by multiple others:

…[Quintana’s] readiest conclusion [is] that there’s a united front – the two of you together, her friends, Dr Kass, whoever is at the moment exhibiting concern – trying to manage her life.

MacKinnon suggests that Didion and her daughter “had been for too long two people in the same skin”. There is evidence of Didion’s ongoing struggle to allow Quintana to make her own choices, in the face of a strong parental urge to protect her daughter.

I said I didn’t understand where the impulse to protect ended and the impulse to control began. They seemed, for a parent, the same thing  …  I said we realized that we had tended to overprotect Quintana.

Many of the notes focus on MacKinnon’s efforts to help Didion to explore not only her mother-daughter relationship with Quintana but also Didion’s relationships with her own parents. At times scathing, at times supportive, MacKinnon encourages Didion to be more self-accepting.

Sure, you may have made mistakes as a mother. Every parent alive makes mistakes with their children, and their children – most of them – live through it. What Quintana is going through is something you didn’t cause. And you can’t fix it. All you can hope for – all we’re working towards here – is for the two of you to develop a closer relationship in the hope that this will ease the internal pressure she feels to drink, or escape.

The sessions also address how Didion could learn to “deal more effectively” with other people in her life. Some of Didion’s reflections about family relationships are intensely personal, yet we have access to only one side of the story.

…we began talking about families, my brother and I, my brother and his relationship with his children, Quintana’s relationship with his children. I said I thought those children had been encouraged growing up to see one another as potential threats and this extended to Quintana, so they had never been close.

Additional context about other family members, friends and acquaintances is provided in footnotes – although it is curious that there are details about some people but not others.

MacKinnon’s approach at times appears highly prescriptive. Didion recalls the scripts he provided to enable her to communicate better with Quintana: he told Didion what to say and how to say it.

Didion questions whether she is making progress in her sessions and whether she is capable of “sort[ing] out the truth and untruth” in her view of her life. She observes that a friend had once told her that “while most people she knew had very strong competent exteriors and were bowls of jelly inside, I was just the opposite”. Consider that reflection when looking at the book’s cover photo, taken by renowned photographer Annie Leibovitz. A hunched and unsmiling Didion, arms crossed tight, stares upward, surrounded by objects from both her work and her personal life. Just visible on the book’s spine is a framed photo of a young girl, presumably Quintana, propped on Didion’s desk.

The original notes are held in the Didion/Dunne archive at the New York Public Library and are available to any library user. Most of the notes are from 2000 – 2001, although Didion was seeing MacKinnon until 2012, shortly before he retired. The book provides insights into MacKinnon’s world too. He describes the demands of his work as a psychiatrist and the personal toll this takes.

It’s a very draining thing to give. I know that. Doing what I do, dealing all week with patients who depend on me, when the weekend comes, I want to think about nothing. I don’t want to see any cries and whispers movies.

Notes to John is a confronting and uncomfortable read that challenges readers to consider their own family dynamics, particularly the inherent complexity of the parent-child relationship. It will be of most interest to people hungry for more information about the enigmatic Didion, and to those who have read Blue Nights (2011), Didion’s account of Quintana’s life and death.

Reviewer: Anne Kerslake Hendricks

HarperCollins