This memorable novel is both a sort of satirical utopia and a punchy mystery-and-chase adventure yarn; a sort of thriller of ideas. We’re in the late twenty-first century, the world having recently recovered from nuclear war ("the Maelstrom"). Health is the cornerstone of good social order. All adults are fitted with medical nanotech called WatchMe that monitors their physiological well-being, and which also connects internettishly to form an international network helping to promote the health of the global polis. Pathogens have been eliminated, playground climbing frames are designed to flex and catch any children that might fall off, and society takes a positively Mormon attitude to tobacco, alcohol, and caffeine. Everybody is healthy, well-adjusted, and rational. Itoh renders all this sympathetically enough that I found myself, reading as I was in my risk-averse middle age, thinking "sounds like a perfectly lovely place to live"; although at the same time the sense of his world as oppressively stifling is neatly evoked too. The three main characters begin the novel as moody, death-obsessed, don't-fit-in teenagers (or, to use the technical term for this sort of person, as "teenagers"): Tuen Kirie the narrator, Miach Mihie the one who pushes further than the rest, and Cian Reikado, a more biddable soul who goes along with whatever her friends suggest. Bookish Miach persuades the others into a suicide pact, which, though botched, has major consequences for their adult lives. Perhaps from this summary it seems rather narratively too obvious that in a world of perfect health and social balance the reader is invited to identify with the without-cause rebels who want to smoke, drink, and self-harm. But Itoh's conception is cleverer than that, and our preconceptions get bundled over in the novel's surprisingly effective twist ending.

"Project Itoh" ("Proger," as I like to think of him) is good on the worldbuilding. His portrait of a society self-wrapped in metaphorical cotton wool is both polemically exaggerated and perfectly believable: that's because a vision of "mankind trapped inside a giant hospital"—all "pastel pink buildings and lavender scents" (p. 98), where overprotected children are the "world's most valuable resource" and everybody conforms to patterns of behavior that maximize their own and society's best interests—is actually a minimally exaggerated version of our own world—or, at least, the world of the developed West and Pacific rim. . . . I hardly need add: all utopia and dystopia work that way; by exaggerating and extrapolating present concerns. But Itoh is also good on the characterization, and the narrative clips along briskly.

One formal tic is the way the book is littered with passages laid out in "etml," "emotion-in-text markup language," like this:

<anger>

Don’t do that, Mom.

</anger> (p. 47)

Or this:

<panic>

They were all the same. Everyone.

. . .

Humans were like a broken meter whose needle swung back and forth between desire and willpower, always all or nothing, never lingering in between. There was no room for moderation. Even a pigeon had a will of its own. Volition just happened to be a good fit for vertebrates, which was why our brains kept it around.

</panic> (pp. 66-7)

. . . which stays just on the right side of annoying. But these broader-brush touches manage to throw the central metaphorical subject of the novel into sharper relief. It is thoughtful, and it is thought-provoking. I have no knowledge of Japanese at all, and have not seen the original text, but I'm willing to believe that the translator Alexander O. Smith has done an excellent job: the English is fluent and often very evocative, and the various neologisms ("admedistration," "lifeism") are neatly rendered. Harmony is very much worth your time.

Itoh himself finished the novel in hospital, where he was being treated for the cancer that went on to kill him, and it is not surprising that the latent logic of this manifest fantasy is that of the clinic projected onto the whole world. Indeed, one of the things this novel made me think was: why hasn't the clinic featured more largely in SF and fantasy? Consider how thoroughly the discourses of Medicine have interpenetrated modern life: from media fretting over cancer scares and sexually transmitted diseases, or simply chivvying us over good diets and the dangers of smoking, right through to the largest political debates (U.S. healthcare reform, for instance, and the furious passions it has aroused in its own country). We might even want to argue that the concept of "healthcare" in its broadest sense is one of the keys to the modern psyche. And we might want to note, as a pendant to that reflection, how poorly genre has tuned in to that particular aspect of contemporary life. In SF, medical treatments either collapse entirely in the face of imagined plague or mutation, or else are relegated to the taken-for-granted background to the story, Doctor McCoy-esque magical devices—which is to say, future technology is seen as having disposed of "medical problems" entirely. But this taken-for-granted-ness doesn’t make a great deal of sense. Modern medicine has made extraordinary, marvelous advances in the last century and a half: hygiene, antibiotics, and anesthetic surgery have (it's a cliché, but true) revolutionized our lives. Great swathes of previously fatal diseases are now perfectly curable, some of the worst scourges of human existence have been eliminated altogether, the average human being now lives a longer and healthier life than any of her predecessors on this planet ever did before her. Yet this state of affairs has meant that we are more, not less, obsessed with disease than before. We fetishize healthcare and its paraphernalia (doctors and nurses, hospitals and clinics, drugs and implants and treatments and regimens). The "official" discourse of western medicine is a vast, complex and comprehensively integrated mode of social being; but, even so, our urge to medicalize our existences is larger than it, and has spilled out into bizarre disciplines of "alternative medicine" into which we pour prodigious amounts of money, time, and emotional investment. Politicians employ "spin doctors" to raise their chances of reelection; economists trope inflation and unemployment as social pathologies, for which taxation, interest rates, or other ideological nostrums are pseudo-medical "treatments." Continuing along the political spectrum, more extreme systems attempt to render the atavistic barbarity of mass-murder anodyne by talking about it as a pseudo-medical "ethnic cleansing" of the body politic.

Don't misunderstand me: I am not knocking Western medicine. Chronic childhood asthma would almost certainly have ended my life before I reached majority had not the NHS intervened to save me—a profound fact of my own being in the world about which I never, I hope, grow complacent. The drugs that have kept me alive seem simple enough at point of use: a twice-daily inhalation of a certain chemical compound that prevents my lungs from collapsing down upon themselves and literally choking me to death. But such medicines were not in existence fifty years ago, which means, had I been arrived on the planet at pretty much at any time in history before my actual birth I would likely have died a child. For this, and for certain other, saving, major interventions into the health of my family, I am and will always be very grateful to modern medicine. My point is simply this: we might think it counterintuitive that the fact that medical science's increasing success and facility has resulted in us becoming more anxious and obsessive about medical science. In other areas—communication, say; or transport—technological advances tend to make us blasé, such that we take them for granted. Intercontinental plane flights and iPhones recede into the background of our lives. Medical discourse, I'm suggesting, has on the contrary expanded to fill every cranny of day-to-day existence.

Itoh's novel is one of the few I can think of that comprehends this larger social-cultural truth. This, though, perhaps makes the novel sound more cerebral and chilly than it actually is. In fact, Itoh styles his novel as a thriller: mystery, investigation, global conspiracy, some eye-watering ultraviolence and breathless chase to uncover the truth and save the world. The plot parses its character interrelations according to some pretty melodramatic conceits (the scientist whose research is such a danger to the world turns out to be—the heroine's father!) and perhaps a little too much of the whole is given over to earnest dialogue between individuals swapping grand theories of human personality, evolution, history and the like. Many of these sound like Mustapha Mond's speechifying at the end of Brave New World (a novel to which Harmony owes a perhaps too-obvious debt). But that's all right; melodrama is the idiom of adolescence, and that's one of the things this novel is also about . . . the teenage urge to kick out against a society that wants nothing more than to keep you safe. The urge to self harm, to smoke, drink and have dangerous sex. On the level of plot and character Harmony is sometimes cartoonish, but this doesn't detract from the intellectual content; cartoonishness as such is a perfectly valid aesthetic, after all. Indeed, tonally Harmony has something of the flavour of a Moebius bande desinée: the pastel cities, the ideally yellow deserts and taupe mountains, the various cool items of high-tech goonery, Japanese schoolgirls, sudden splashes of violence, goats with tangles of machinery instead of heads, all that. I hardly need add: Moebiusness is a very good thing. I feel particularly bad that I have only discovered Project Itoh after his death; a sad loss to speculative writing.

Adam Roberts is a writer and critic of SF. He lives a little way west of London.