BOOK REVIEW / Love is . . . a ravening parasitical creature: 'Dr Haggard's Disease' - Patrick McGrath: Viking, 14.99

The sepia-soaked world of Patrick McGrath's fiction recreates an England of dank back-alleys and smoky pubs, of wilting aspidistras and sodium lamps and clinging fogs. It is Ealing Comedy turned noir, where butlers are fiendish, malignant schemers; country squires are demented patriarchs; landladies are screeching harpies. And at the centre of each story is a mind hovering over the abyss. In The Grotesque we were conducted through the labyrinthine paranoia of one-time scientist and full-time misanthrope Sir Hugo Coal. McGrath's second novel Spider scuttled around the twisted psyche of Dennis Cleg, a schizophrenic boy who imagines his father to be 'a weasel with blood on his paws'. These were feverish studies in derangement, each spiralling unmercifully towards a revelation that is no less appalling for being entirely inevitable.

In keeping with them, an enigma broods at the dark heart of Dr Haggard's Disease, a tale of amour fou set in the uneasy days of pre-Blitz London. The eponymous doctor, as we first see him, is a broken man, impaled on the cross of a desperate and doomed passion. To Haggard's coastal refuge, a rambling mansion where he maintains a fitful practice, comes a young fighter-pilot, who happens to be the son of the woman he loved and lost.

The pilot's inquiries about his now-dead mother force the doctor to retrace his via dolorosa, from the first stirrings of love to the bitter end of the affair. Memories persecute Haggard as relentlessly as the Furies - 'it soon became apparent that if I did suppress them, the feelings weren't dissipated but instead were literally damned, as though in a reservoir, and when the floodgates opened . . . then out it all poured, with torrential violence, leaving me weak, racked, sobbing and unutterably wretched.'

The appearance and demeanour of the pilot, to Haggard's mind, is powerfully reminiscent of his mother, and, finding solace in this familial resemblance, he addresses his memoir to the young man. But what exactly is the state of Dr Haggard's mind? As a surgeon at St Basil's Hospital his distracted air and occasional incompetence are the target of his chief's fierce opprobrium, while his private life is miserably confined within the gloom of his Victorian block bedsit. A chance encounter with the senior pathologist's wife, Fanny Vaughan (a Keatsean allusion later echoed in the book) turns his sad-sack life inside out. He is engulfed by an obsessive love, and typically identifies it as a disease: 'I needed to nourish my love upon her being, as though my love were a ravening parasitical creature which if it could not feed upon her would feed instead upon its host, causing agony.'

Haggard will come to know agony all right, and its cause is not simply a broken heart but a broken hip. The steel pin (pointedly nicknamed Spike) which holds together the bone he fractured in an accident serves as a wrenching reminder of his brief liaison, and his recourse to the tender mercies of morphia provide the first indication that all is not what it appears in the doctor's life.

McGrath's manipulation is as artful here as it was in Spider, where the smell of gas permeated to ominous effect. A pattern emerges: the narrator is seen at the outset as a pitiful figure, tormented and traumatised by another's cruelty. Gradually the portrait takes on deeper and darker hues, and we begin to feel that the victim is rather more complicated - and unreliable - than we first assumed. In the case of Dr Haggard one feels a terrible surge of compassion, whelmed as he is in the gulfs of obsessive love - a doctor at sea - yet his dependence on morphia to quell Spike's torture elicits some bizarre lines of thought.

Surgery and sexuality become creepily intertwined as the horrors of the operating theatre make a stage on which to replay his grand passion: 'My mind wandered constantly. Faced with a suppurating abscess, I saw the smooth white skin of your mother's breast. Removing a dirty dressing, and finding a black patch of necrotic tissue, I imagined placing delicate kisses on her belly. Encountering death, I remembered her clinging to me and gasping with pleasure . . .' Disease becomes inextricably linked with desire, until Haggard sees them as one.

The measured cool of McGrath's prose is essential to his design. Sentences slide elegantly over the eye - we are, it seems, in the hands of a master-narrator - until, too late, we realise the story has been constructed as a trap. The nagging doubt we have spent most of the book suppressing suddenly lurches out at us with horrifying clarity. Looking back at the path we have been guided along, and the hints which have been thrown our way, we accept that the conclusion is pitiably, painfully obvious. Dr Haggard's Disease has kept us guessing at something we have probably known from the start. I haven't read a novel as piercingly truthful about the loss of love since Greene's The End of the Affair; and I haven't read a novel as morbid and as upsetting about the loss of sanity since, well, since Patrick McGrath's last novel.