The Silent Patient Read online

  “What drew you to psychotherapy, do you think?” asked Indira Sharma, peering at me over the rims of her owlish glasses.

  Indira was consultant psychotherapist at the Grove. She was in her late fifties with an attractive round face and long jet-black hair streaked with gray. She gave me a small smile—as if to reassure me this was an easy question, a warm-up volley, a precursor to trickier shots to follow.

  I hesitated. I could feel the other members of the panel looking at me. I remained conscious of maintaining eye contact as I trotted out a rehearsed response, a sympathetic tale about working part-time in a care home as a teenager; and how this inspired an interest in psychology, which led to a postgraduate study of psychotherapy, and so on.

  “I wanted to help people, I suppose.” I shrugged. “That’s it, really.”

  Which was bullshit.

  I mean, of course I wanted to help people. But that was a secondary aim—particularly at the time I started training. The real motivation was purely selfish. I was on a quest to help myself. I believe the same is true for most people who go into mental health. We are drawn to this profession because we are damaged—we study psychology to heal ourselves. Whether we are prepared to admit this or not is another question.

  As human beings, in our earliest years we reside in a land before memory. We like to think of ourselves as emerging from this primordial fog with our characters fully formed, like Aphrodite rising perfect from the sea foam. But thanks to increasing research into the development of the brain, we know this is not the case. We are born with a brain half-formed—more like a muddy lump of clay than a divine Olympian. As the psychoanalyst Donald Winnicott put it, “There is no such thing as a baby.” The development of our personalities doesn’t take place in isolation, but in relationship with others—we are shaped and completed by unseen, unremembered forces; namely, our parents.

  This is frightening, for obvious reasons. Who knows what indignities we suffered, what torments and abuses, in this land before memory? Our character was formed without our even knowing it. In my case, I grew up feeling edgy, afraid; anxious. This anxiety seemed to predate my existence and exist independently of me. But I suspect it originated in my relationship with my father, around whom I was never safe.

  My father’s unpredictable and arbitrary rages made any situation, no matter how benign, into a potential minefield. An innocuous remark or a dissenting voice would trigger his anger and set off a series of explosions from which there was no refuge. The house shook as he shouted, chasing me upstairs into my room. I’d dive and slide under the bed, against the wall. I’d breathe in the feathery air, praying the bricks would swallow me up and I would disappear. But his hand would grab hold of me, drag me out to meet my fate. The belt would be pulled off and whistle in the air before it struck, each successive blow knocking me sideways, burning my flesh. Then the whipping would be over, as abruptly as it had begun. I’d be tossed to the floor, landing in a crumpled heap. A rag doll discarded by an angry toddler.

  I was never sure what I had done to trigger this anger, or if I deserved it. I asked my mother why my father was always so angry with me, and she gave a despairing shrug and said, “How should I know? Your father’s completely mad.”

  When she said he was mad, she wasn’t joking. If assessed by a psychiatrist today, my father would, I suspect, be diagnosed with a personality disorder—an illness that went untreated for the duration of his life. The result was a childhood and adolescence dominated by hysteria and physical violence: threats, tears, and breaking glass.

  There were moments of happiness; usually when my father was away from home. I remember one winter he was in America on a business trip for a month. For thirty days, my mother and I had free rein of the house and garden without his watchful eye. It snowed heavily in London that December, and the whole of our garden was buried beneath a crisp thick white carpet. Mum and I made a snowman. Unconsciously or not, we built him to represent our absent master: I christened him Dad, and with his big belly, two black stones for eyes, and two slanting twigs for stern eyebrows, the resemblance was uncanny. We completed the illusion by giving him my father’s gloves, hat, and umbrella. Then we pelted him violently with snowballs, giggling like naughty children.

  There was a heavy snowstorm that night. My mother went to bed and I pretended to sleep, then I snuck out to the garden and stood under the falling snow. I held my hands outstretched, catching snowflakes, watching them vanish on my fingertips. It felt joyous and frustrating and spoke to some truth I couldn’t express; my vocabulary was too limited, my words too loose a net in which to catch it. Somehow grasping at vanishing snowflakes is like grasping at happiness: an act of possession that instantly gives way to nothing. It reminded me that there was a world outside this house: a world of vastness and unimaginable beauty; a world that, for now, remained out of my reach. That memory has repeatedly returned to me over the years. It’s as if the misery that surrounded that brief moment of freedom made it burn even brighter: a tiny light surrounded by darkness.

  My only hope of survival, I realized, was to retreat—physically as well as psychically. I had to get away, far away. Only then would I be safe. And eventually, at eighteen, I got the grades I needed to secure a place at university. I left that semi-detached prison in Surrey—and I thought I was free.

  I was wrong.

  I didn’t know it then, but it was too late—I had internalized my father, introjected him, buried him deep in my unconscious. No matter how far I ran, I carried him with me wherever I went. I was pursued by an infernal, relentless chorus of furies, all with his voice—shrieking that I was worthless, shameful, a failure.

  During my first term at university, that first cold winter, the voices got so bad, so paralyzing, they controlled me. Immobilized by fear, I was unable to go out, socialize, or make any friends. I might as well have never left home. It was hopeless. I was defeated, trapped. Backed into a corner. No way out.

  Only one solution presented itself.

  I went from chemist to chemist buying packets of paracetamol. I bought only a few packets at a time to avoid arousing suspicion—but I needn’t have worried. No one paid me the least attention; I was clearly as invisible as I felt.

  It was cold in my room, and my fingers were numb and clumsy as I tore open the packets. It took an immense effort to swallow all the tablets. But I forced them all down, pill after bitter pill. Then I crawled onto my uncomfortable narrow bed. I shut my eyes and waited for death.

  But death didn’t come.

  Instead a searing, gut-wrenching pain tore through my insides. I doubled up and vomited, throwing up bile and half-digested pills all over myself. I lay in the dark, a fire burning in my stomach, for what seemed like eternity. And then, slowly, in the darkness, I realized something.

  I didn’t want to die. Not yet; not when I hadn’t lived.

  This gave me a kind of hope, however murky and ill defined. It propelled me at any rate to acknowledge that I couldn’t do this alone: I needed help.

  I found it—in the form of Ruth, a psychotherapist referred to me through the university counseling service. Ruth was white-haired and plump and had something grandmotherly about her. She had a sympathetic smile—a smile I wanted to believe in. She didn’t say much at first. She just listened while I talked. I talked about my childhood, my home, my parents. As I talked, I found that no matter how distressing the details I related, I could feel nothing. I was disconnected from my emotions, like a hand severed from a wrist. I talked about painful memories and suicidal impulses—but couldn’t feel them.

  I would, however, occasionally look up at Ruth’s face. To my surprise, tears would be collecting in her eyes as she listened. This may seem hard to grasp, but those tears were not hers.

  They were mine.

  At the time I didn’t understand. But that’s how therapy works. A patient delegates his unacceptable feelings to his therapist; and she holds everything he is afraid to feel, and she feels it for him. Then, ever so slowly, she feeds his feelings back to him. As Ruth fed mine back to me.

  We continued seeing each other for several years, Ruth and I. She remained the one constant in my life. Through her, I internalized a new kind of relationship with another human being: one based on mutual respect, honesty, and kindness—not recrimination, anger, and violence. I slowly started to feel differently inside about myself—less empty, more capable of feeling, less afraid. The hateful internal chorus never entirely left me—but I now had Ruth’s voice to counter it, and I paid less attention. As a result, the voices in my head grew quieter and would temporarily vanish. I’d feel peaceful—even happy, sometimes.

  Psychotherapy had quite literally saved my life. More important, it had transformed the quality of that life. The talking cure was central to who I became—in a profound sense, it defined me.

  It was, I knew, my vocation.

  After university, I trained as a psychotherapist in London. Throughout my training, I continued seeing Ruth. She remained supportive and encouraging, although she warned me to be realistic about the path I was undertaking: “It’s no walk in the park” was how she put it. She was right. Working with patients, getting my hands dirty—well, it proved far from comfortable.

  I remember my first visit to a secure psychiatric unit. Within a few minutes of my arrival, a patient had pulled down his pants, squatted, and defecated in front of me. A stinking pile of shit. And subsequent incidents, less stomach-churning but just as dramatic—messy botched suicides, attempts at self-harm, uncontained hysteria and grief—all felt more than I could bear. But each time, somehow, I drew on hitherto untapped resilience. It got easier.

  It’s odd how quickly one adapts to the strange new world of a psychiatric unit. You become increasingly comfortable with madness—and not just the madness of others, but your own. We’re all crazy, I believe, just in different ways.

  Which is why—and how—I related to Alicia Berenson. I was one of the lucky ones. Thanks to a successful therapeutic intervention at a young age, I was able to pull back from the brink of psychic darkness. In my mind, however, the other narrative remained forever a possibility: I might have gone crazy—and ended my days locked in an institution, like Alicia. There but for the grace of God …

  I couldn’t say any of this to Indira Sharma when she asked why I became a psychotherapist. It was an interview panel, after all—and if nothing else, I knew how to play the game.

  “In the end,” I said, “I believe the training makes you into a psychotherapist. Regardless of your initial intentions.”

  Indira nodded sagely. “Yes, quite right. Very true.”

  The interview went well. My experience of working at Broadmoor gave me an edge, Indira said—demonstrating I could cope with extreme psychological distress. I was offered the job on the spot, and I accepted.

  One month later, I was on my way to the Grove.

  CHAPTER FOUR

  I ARRIVED AT THE GROVE pursued by an icy January wind. The bare trees stood like skeletons along the road. The sky was white, heavy with snow that had yet to fall.

  I stood outside the entrance and reached for my cigarettes in my pocket. I hadn’t smoked in over a week—I’d promised myself that this time I meant it, I’d quit for good. Yet here I was, already giving in. I lit one, feeling annoyed with myself. Psychotherapists tend to view smoking as an unresolved addiction—one that any decent therapist should have worked through and overcome. I didn’t want to walk in reeking of cigarettes, so I popped a couple of mints into my mouth and chewed them while I smoked, hopping from foot to foot.

  I was shivering—but if I’m honest, it was more with nerves than cold. I was having doubts. My consultant at Broadmoor had made no bones about saying I was making a mistake. He hinted a promising career was being cut short by my departure, and he was sniffy about the Grove, and Professor Diomedes in particular.

  “An unorthodox man. Does a lot of work with group relations—worked with Foulkes for a while. Ran some kind of alternative therapeutic community in the eighties in Hertfordshire. Not economically viable, those models of therapy, especially today…” He hesitated a second, then went on in a lower voice, “I’m not trying to scare you, Theo. But I’ve heard rumblings about that place getting axed. You could find yourself out of a job in six months.… Are you sure you won’t reconsider?”

  I hesitated, but only out of politeness. “Quite sure.”

  He shook his head. “Seems like career suicide to me. But if you’ve made your decision…”

  I didn’t tell him about Alicia Berenson, about my desire to treat her. I could have put it in terms he might understand: working with her might lead to a book or publication of some kind. But I knew there was little point; he’d still say I was making a mistake. Perhaps he was right. I was about to find out.

  I stubbed out my cigarette, banished my nerves, and went inside.

  The Grove was located in the oldest part of Edgware hospital. The original redbrick Victorian building had long since been surrounded and dwarfed by larger, and generally uglier, additions and extensions. The Grove lay in the heart of this complex. The only hint of its dangerous occupants was the line of security cameras perched on the fences like watching birds of prey. In reception, every effort had been made to make it appear friendly—large blue couches, crude, childish artwork by the patients taped to the walls. It looked to me more like a kindergarten than a secure psychiatric unit.

  A tall man appeared at my side. He grinned at me and held out his hand. He introduced himself as Yuri, head psychiatric nurse. “Welcome to the Grove. Not much of a welcoming committee, I’m afraid. Just me.”

  Yuri was good-looking, well built, and in his late thirties. He had dark hair and a tribal tattoo creeping up his neck, above his collar. He smelled of tobacco and too much sweet aftershave.

  Although he spoke with an accent, his English was perfect. “I moved here from Latvia seven years ago, and I didn’t speak a word of English when I arrived. But in a year I was fluent.”

  “That’s very impressive.”

  “Not really. English is an easy language. You should try Latvian.”

  He laughed and reached for the jangling chain of keys around his belt. He pulled off a set and handed it to me. “You’ll need these for the individual rooms. And there are codes you need to know for the wards.”

  “That’s a lot. I had fewer keys at Broadmoor.”

  “Yeah, well. We stepped up security quite a bit recently—since Stephanie joined us.”

  “Who’s Stephanie?”

  Yuri didn’t reply, but nodded at the woman emerging from the office behind the reception desk.

  She was Caribbean, in her midforties, with a sharp, angular bob. “I’m Stephanie Clarke. Manager of the Grove.”

  Stephanie gave me an unconvincing smile. As I shook her hand, I noticed her grip was firmer and tighter than Yuri’s, and rather less welcoming.

  “As manager of this unit, safety is my top priority. Both the safety of the patients, and of the staff. If you aren’t safe, then neither are your patients.” She handed me a small device—a personal attack alarm. “Carry this with you at all times. Don’t just leave it in your office.”

  I resisted the inclination to say, Yes, ma’am. Better keep on the right side of her if I wanted an easy life. That had been my tactic with previous bossy ward managers—avoid confrontation and keep under their radar.

  “Good to meet you, Stephanie.” I smiled.

  Stephanie nodded but didn’t smile back. “Yuri will show you to your office.” She turned and marched off without a second glance.

  “Follow me,” Yuri said.

  I went with him to the ward entrance—a large reinforced steel door. Next to it, a metal detector was manned by a security guard.

  “I’m sure you know the drill,” Yuri said. “No sharp objects—nothing that could be used as a weapon.”

  “No lighters,” added the security guard as he frisked me, fishing my lighter from my pocket with an accusing look.

  “Sorry. I forgot I had it.”

  Yuri beckoned me to follow him. “I’ll show you to your office. Everyone’s in the Community meeting, so it’s pretty quiet.”

  “Can I join them?”

  “In Community?” Yuri looked surprised. “You don’t want to settle in first?”

  “I can settle in later. If it’s all the same to you?”

  He shrugged. “Whatever you want. This way.”

  He led me down interconnecting corridors punctuated by locked doors—a rhythm of slams and bolts and keys turning in locks. We made slow progress.

  It was obvious not much had been spent on the upkeep of the building in several years: paint was crawling away from the walls, and a faint musty smell of mildew and decay permeated the corridors.

  Yuri stopped outside a closed door and nodded. “They’re in there. Go ahead.”

  “Okay, thanks.”

  I hesitated, preparing myself. Then I opened the door and went inside.

  CHAPTER FIVE

  COMMUNITY WAS HELD IN A LONG ROOM with tall barred windows that overlooked a redbrick wall. The smell of coffee was in the air, mingled with traces of Yuri’s aftershave. About thirty people were sitting in a circle. Most were clutching paper cups of tea or coffee, yawning and doing their best to wake up. Some, having drunk their coffees, were fidgeting with the empty cups, crumpling, flattening them, or tearing them to shreds.

  Community met once or twice daily; it was something between an administrative meeting and a group therapy session. Items relating to the running of the unit or the patients’ care were put on the agenda to be discussed. It was, Professor Diomedes was fond of saying, an attempt to involve the patients in their own treatment and encourage them to take responsibility for their well-being, although this attempt didn’t always work. Diomedes’s background in group therapy meant he had a fondness for meetings of all kinds, and he encouraged as much group work as possible. You might say he was happiest with an audience. He had the faint air of a theatrical impresario, I thought, as he rose to his feet to greet me, hands outstretched in welcome, and beckoned me over.

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