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If Haile Selassie, whom some remember as a bit of a biker from his days of exile in the West of England, had been stretched to 6’3” and given a part in Easy Rider, he would have looked rather like Tom Coraghessan Boyle as he appears on the front of the Collected Stories – an improbable confection of soulful eyes, hollow cheeks, frizzy facial hair and black leather. But although the impression that Boyle is a low-life lion of the interstates is strenuously maintained by his publishers – who report that he was a child of the Sixties, ‘a maniacal crazy-driver’ who ate anything he could lay his hands on, bought heroin for £5 a bag and listened to music with Linda Lovelace – his writing suggests an altogether less exotic and more wholesome milieu. Boyle studied at the Iowa Writers’ Workshop and teaches at the University of Southern California, and his fiction often relies on the kind of farmboy irony that may come naturally to Ross Perot, but which appears to have been institutionalised in some American creative writing programmes. In such stories, the setting is the affluent suburbs: the Mercedes is in the garage, the National Geographic is on the table, and the jokes are about new-fangled technologies that don’t work or have unexpected consequences – security alarms, genetic engineering, research on primate intelligence. The implication is always that back on the farm, no one would have been fooled in the first place.

The Road to Wellville is a full-length novel of the same type, exploring the irony that attempting to improve your health can make you sick. On the basis of a couple of popular histories, Boyle has re-created Battle Creek Sanitarium in 1907, and revivified its director, the hyperactive surgeon, health reformer and inventor, John Harvey Kellogg. Kellogg is one of those historical figures who must once have appeared larger than life, but seem strangely diminished in retrospect. His achievements – as the inventor of breakfast cereal, peanut butter and soya milk, and as a pioneer of the sex manual and the exercise record for the gramophone – are not of a type that excites the interest of professional historians, and at present, he lacks even an adequate published biography. In these circumstances, Boyle has done a remarkably good job of reinflating Kellogg to his full, slightly bloated, size; his Kellogg is an impressive piece of characterisation, both historically and psychologically plausible in his altruistic self-importance and rationalistic crankiness.

Kellogg’s principles for ‘biologic living’ involved strict vegetarianism, teetotalism and sexual abstinence, combined with exercise, hydrotherapy, phototherapy and frequent colonic irrigation. None of the ingredients of this ascetic cocktail had then gained the scientific support that some have since received, but the idea that self-denial is good for you held a powerful attraction for the wealthy, who flocked to Michigan to benefit from the sanitarium’s offer of ‘Organised Rest’. As the visitors included celebrities such as John D. Rockefeller Jr, Upton Sinclair, Percy Grainger and the explorer Roald Amundsen, becoming a patient at the sanitarium held a social as well as a therapeutic attraction. Kellogg fostered this aspect of Battle Creek life by organising a constant round of concerts, lectures and uplifting entertainments.

In The Road to Wellville, the central characters are not celebrities, but a youngish couple of exemplary dullness, Will and Eleanor Lightbody, who have come to Battle Creek from Peterskill, New York. Eleanor is a neurotic who has lost her first child; Will is an ineffectual if occasionally violent idler who has been driven to drink by anxiety about his wife. At the sanitarium, they undergo the full range of treatments – grape diets, laughing exercises, sinusoidal baths, marital separation and innumerable enemas – until the conflict between Eleanor’s enthusiasm and Will’s scepticism drives them apart. From this point, the principal focus of the novel is Will’s struggle simultaneously to resist Kellogg’s authoritarian regime and regain Eleanor’s affection. Will finds an unreliable ally outside the sanitarium in the form of Charlie Ossining, a would-be entrepreneur who, with the help of Kellogg’s alcoholic adopted son, is trying to break into the lucrative breakfast food market created by Kellogg’s cornflakes. Ossining, like the Lightbodys (and the author), is from Peterskill, and so plot and sub-plot are able to feed off one another until Boyle manages to round off the whole thing with a series of set-piece climaxes – all of which seem out of place in a novel that is otherwise little more than dramatised social history.

It is difficult to care very much about Will and Eleanor’s tepid relationship, or Ossining’s fraudulent breakfast food business, but both allow Boyle to explore the alternatives to Kellogg’s programme of technological advance and social reform. The rift between the Lightbodys juxtaposes the pseudo-scientific ethos embraced by Eleanor with the carnivorous rural idyll to which Will longs to return, while Ossining’s business ventures contrast unscrupulous commercialisation with Kellogg’s utopian plans for human betterment. The parallels between Kellogg’s programme and subsequent medical orthodoxy – which are highlighted in an epilogue where the elderly Eleanor opens Peterskill’s first health-food shop – invite the reader to take The Road to Wellville as a commentary on the excesses of contemporary health awareness. But as everyone now eats cereal for breakfast, and agrees that a diet of fibre, fruit and vegetables helps to prevent disease, there seems little point to the endless jokes about the sanitarium’s menu. By making fun of Kellogg so indiscriminately, Boyle manages to imply that all illness is either a creation of the doctor’s imagination or the result of harmful treatments – a piece of wishful thinking that shifts the narrative from satire to farce. Boyle’s sanitarium, unlike the medicalised dystopia of The Naked Lunch, is free of pain, except for the pain the doctor causes.

Making the pharmakon into the pharmakos is always a seductive idea, but the possibility of scapegoating the remedy must exercise a peculiar fascination in a society where a billionaire was recently able to persuade one-fifth of voters that he could solve the nation’s social and economic problems by dispensing with government. Small wonder then that The Road to Wellville has been made into a Hollywood film with Anthony Hopkins as Kellogg, the purveyor of iatrogenic disease. But if government causes political problems, psychiatrists madness, and doctors illness, how do the people live? How is it possible to survive in a society where being part of the solution automatically makes you part of the problem?

One answer to this question is given in a story called ‘Modern Love’. Having eaten a distinctly Kelloggian meal of ‘cold cream-of-tofu-carrot soup and little lentil-paste sandwiches for an appetiser and a garlic soufflé with biologically controlled vegetables for an entrée’, two lovers watch The Boy in the Bubble, a film about the germ-free adolescence of a child without an immune system, and then put on full-body condoms for sex. But their promising, if intactile, relationship ends when, for wholly trivial reasons, the man fails an exhaustive medical examination taken at the insistence of the hypochondriacal woman. As in The Road to Wellville, it is the doctor who invents the diseases that keep the sexes apart; the suggestion is that anyone who conforms to the divisive morality of public health will eventually find themselves sealed into a private bubble and deprived of the reassuring intimacy of human contact.

The contrast between the isolated world of modernity and the tactile ‘way of the centuries’ is, in part, the usual comic juxtaposition of the body against reason, common sense against professional expertise, the familiar past against the uncertain present. But in Boyle’s writing, these dichotomies are given an almost obscurantist degree of polarisation, with the result that the proffered alternative to the isolation created by dysfunctional expert systems is not rational communication, but primitive communion. As the abstract of his PhD (a collection of short stories, not, as the publishers claim, a study of Victorian literature) puts it: there is an ‘opposition between the primitive (irrational) and the civilised (rational) poles of man’s nature’, and in ‘a universe in which certainty is both essential and impossible, superstition is no less viable than rationality.’

This is a philosophy with a long history. In the 20th century it might almost be called the unofficial social theory of the novel. But Boyle’s version is particularly unsatisfactory because he gives little evidence of being able to imagine what the superstitious intimacy of human relationships might actually be like. He appears to have no feeling for the primitive values he espouses. On the contrary, the characters he realises most successfully are self-absorbed egomaniacs like Kellogg; and in The Road to Wellville, it is not just the doctor who keeps people apart, but the author, who devotes much of the novel to the thoughts and actions of solitary males – Will Lightbody seething in his room, Charlie Ossining wandering the streets in search of a break, Kellogg fantasising omnipotently in his private office.

When Boyle’s characters do manage to connect, interaction is usually lubricated by water or alcohol. In ‘Greasy Lake’, one of his best stories, three teenagers have to drive to the shores of the lake in order to find the drunken excitement for which they have been searching unsuccessfully all evening. And even in The Road to Wellville, Will is drawn to Charlie by drink, has a climactic conversation with his nurse in a rowing boat on a lake, and a showdown with Eleanor at the side of a river. This parallel between water and alcohol (and the dangers inherent in both) is made explicit in ‘If the River Was Whiskey’, the story of a family splitting up as the result of the man’s alcoholism. Father and son talk only when sharing a beer or fishing on the lake, but when the father dreams of being separated from his son, he sees him drowning.

There are many such drownings in Boyle’s fiction (including one in The Road to Wellville); his lakes are littered with floating corpses, in case we forget that water and alcohol can dissolve individuality as well as lubricate sociability. The starkest of these stories is ‘Drowning’, in which a girl sunbathing at the edge of the water is repeatedly raped while, five hundred yards along the beach, the one person who might have saved her swims out to sea and drowns unobserved. It is a chilling but unsatisfactory tale, and it raises the question of whether the author could have written a convincing story in which the victim and her potential saviour were not just well-greased monads moving in synchronisation, but individuals able to intervene in one another’s lives. No doctor sealed the bathers into separate bubbles, but Boyle gives them no more chance of meeting than the lovers in ‘Modern Love’, or the estranged Lightbodys in The Road to Wellville.