One
THE EYES HAVE IT
I sat in an uncomfortable chair in the first office I had ever had and took a deep breath. The word "office" might be an overstatement. George, the friendly elderly porter who had welcomed me to the outpatient psychiatric department-"Welcome to our happy home"-had pointed out that before my arrival the space had been a storage cupboard.
"Storage for what?" I asked, thinking about asbestos.
"Storage for everything: dressings, commodes, the old drug trolley. It was only when the department had to take on more fresh blood that we converted it-some kind of regulation, I think."
"What kind of regulation allows a windowless office?"
George smiled. "Fresh blood see the jumpers."
"Jumpers?"
"The ones that go straight for the windows."
Why on earth had I thought I could do this?
Alone in my office, I put my head in my hands-perhaps it wasn't too late to accept the researcher's job at that TV production company. Christ, I was twenty-two, in my own flat, living in arguably the best capital city in the world. I could have glamour, a better wage, less responsibility. What the hell was I trying to prove here?
The other people in my training course seemed much more competent. To begin with, I was the youngest out of our group of twenty. Most of them had come from research or other clinical backgrounds and I felt intimidated, even though I'd only just met them; they seemed to know stuff. I wasn't looking forward to our time together. I would obviously be the dunce of the class, just as I had been in high school.
Shit. I knew absolutely nothing.
Feeling sorry for myself, I looked around my cupboard; it smelled musty, a complete contrast to the glass, marble and chrome atrium I had walked through downstairs less than an hour earlier. This was a flagship hospital. It had been like entering another world-calm and clean. Even the signs advising against physically attacking the staff were printed in gentle sans serif, muted and almost apologetic for the crassness of their message.
The staff down in the reception area were friendly too-all smiles and uniforms and endless leaflets about patient rights and complaints procedures. It was not a hospital; it was a shiny, upmarket hotel lobby.
I had taken the elevator up to the eighth floor with several hassled-looking members of staff, none of whom had been even remotely interested in the fact that I had just joined the team. I looked at my new staff identity card and made sure it was facing outward. "Clinical psychologist in training." No one gave a damn. I felt like the new kid on the first day of school.
It had taken me five minutes of circling the four-sided eighth floor before I'd located the outpatient psychiatric department-I had dismissed it on circuits one to three because it looked like the entrance to some sort of supply room. Nothing here reflected the opulence of the hospital downstairs.
The grumpy, round-faced woman who greeted me when I finally got to the psychiatric outpatients' reception managed to thrust me my room key, point to the cupboard door and say, "You see them in there," all without once lifting her eyes from Woman's Own magazine.
"Is everything all right?"
Chris, my supervisor, the woman assigned to mentor me throughout my training, stood over me, jolting me back into the room.
"Oh yes. Hi. Gosh. Sorry." I'd been slumped over the desk, lost in thought.
I scrabbled to my feet.
Dr. Chris Moorhead was renowned for being a brilliant supervisor but one hard-core, fiercely intelligent, no-nonsense woman. In my interview for the clinical training course, she never cracked a smile. She didn't make small talk. And she asked the most difficult question: "Why do you deserve a place in this training course any more than all the other people who want it?" After I was accepted, when we were told who our supervisors were to be, more than a few of my fellow trainees sighed with relief when my name was matched with hers. A few second- and third-years laughed and patted me on the back. "Good luck," one said.
A tall, slim, angular woman who had the unnerving habit of maintaining unbroken eye contact, Chris gestured to the man standing just behind her.
"This is Professor Horace Winters, head of the outpatient psychiatric department. Professor Winters, this is my trainee. She'll be here two and a half days per week for the next six months."
The prof offered his hand, making zero eye contact. His words sounded as if they'd been worn smooth by repetition.
"Welcome to the department. I hope you enjoy your time here. I'm always at your disposal. I'm looking forward to the valuable contribution you will make to my team."
With a flourish, he turned and walked out. I wanted to giggle, but Chris clearly wanted further words.
"They very rarely take unqualifieds in this department, but I told them you'd do good."
"Chris, that's so great of you. Thanks."
"Don't thank me. Just don't let me down."
After Chris left, I found a way to wedge some old and slightly damp prescription pads under the tilt mechanism to keep my chair from tipping over. Welcome to the publicly funded great British National Health Service-the NHS.
As I was rearranging my cupboard office, I heard the sound of singing-a small voice growing in volume and then, just as the melody was decipherable, getting fainter again. I could have sworn it was a song from The Sound of Music.
Maybe I was hallucinating. No-it got louder again:
How do you solve a problem like Maria?
How do you catch a cloud and pin it down?
How do you find a word that means "Maria"?
A flibbertigibbet! A will-o'-the wisp! A clown!
It was extraordinary-a little voice, but one with such purity and clarity that it cut through the growing noise of the busy reception area outside my door.
Why was no one else hearing this?
I left my room and looked around. I had two hours before my first appointment, I was alone and I wanted to know who belonged to that voice. But when I stepped out into the waiting area, I was stunned by what I saw, and the song-although still lilting in the background-became peripheral.
If my mother had been there, she would have instructed me not to stare.
When George appeared with two mugs of tea, I was able to tear my gaze away.
"Gender Identity Clinic."
He sat down on a waiting-room chair and gestured to me, telling me to join him, which I did. The sugary orange brew calmed me and brought me back to a clinical state of mind. I inhabit a nonjudgmental space, I reminded myself.
"Gender Identity Clinic?" I asked.
"Yep. The boys come in because they want to be girls. Prof Winters is their man. They get assessed, and if they can live for five years as the gender of their choice, then they get the op, the deportment classes, the whole works."
"The works?"
"Adam's apple shaved, makeup tutorials, how to dress to suit your shape-you can cut off a penis, but you can't rebuild a brick shithouse."
I looked around and had to agree, as much as I hated the indelicacy of George's language. There were some who could only be described as pantomime dames. There were also some incredibly good-looking women here.
There was one mesmerizingly beautiful woman. Slight and delicate, she had the most incredible curtain of straight, shiny black hair hanging down to her waist. She certainly knew how to dress to suit her shape-"classy not brassy," as "my girls," my three best friends, would say. She even gestured in a manner that, despite the slight exaggeration of movement and eyelash flutter, was all believable, even if it was sort of hyperfeminized.
I felt challenged. My clothes-a charity shop man's suit with crisp white shirt, tight vintage Dior belt and Doc Marten shoes-made me feel frumpy.
How can a man look a better woman than me?
I was rescued from this thought by the appearance of two other people coming out of the women's toilets. The smaller of the two was startling. She was wearing the sort of dress that my late grandmother would put on for a family occasion: good material, generously cut, but staid in its blue navy, with a tight, thin red belt, plunging neckline and cheeky sailor-striped T-shirt subtly covering the décolletage. She wore a wig of the brightest yellow perm, held a tiny red clutch in her enormous hand and tottered on blue wedge heels made out of the material that allows room for bunions-the sort of shoe that can be purchased from a catalogue that also sells lawn-aerating sandals, ladies' turbans and slow cookers.
The taller of the two women, at well over six feet tall, was broad, with calves the size of tree trunks and well-defined arms to die for. She wore a tight black dress, lap-dancing shoes with Lucite platforms and vertigo-inducing stilettos, and sported a straight, brown, honey-highlighted Mary Quant bobbed wig with serious attitude.
She was the Adam/Felicia character in Priscilla, Queen of the Desert, or Tony Curtis as Josephine in Some Like It Hot. The smaller woman, however, only managed Terence Stamp and Jack Lemmon-Bernadette and Daphne.
I was mesmerized. "Josephine" caught my eye, winked her giant eyelashes, poked the end of her tongue out from between her red, shiny lips and smiled. I felt hot and looked away.
Someone flew past me singing and then disappeared behind the central lift shaft.
How do you solve a problem like Maria?
How do you catch a cloud and pin it down?
"That's Edith," George explained. "She's an RDP."
"A what?"
"A revolving-door patient."
"And that is?"
"She is admitted by court order and taken into the inpatient ward on the other side of this floor. She is stabilized. She takes her meds independently. She is discharged. Care in the community takes over. There is no care in the community. She drops off her meds, frightens the neighbors, so she comes back in. Revolving door."
I looked thoughtfully at George. He was in his seventies, I reckoned, perhaps ex-military, with his white cuffs visible a precise and equal distance under a pristine black sweater.
"Hello, Edith," said George, looking up at the person whose beautiful voice I'd heard.
"Well, hello, George. And who might this pretty lady be?"
Edith had wandered into the outpatient department and I found myself taking the hand that had been offered by the sweetest-looking woman that I had ever seen.
"Edith Granville, please say hello to our fresh blood."
"Hello, my dear. How are you this blessed day?"
Edith was so small and so smiley and had eyes so sparkly that I was almost too enchanted to reply. This tiny and compact black woman had a crisp white pillowcase pinned to her head. The pillowcase, I soon realized, was an attempt at a nun's wimple. Edith was Mother Superior.
"I know what you thinking, girl, and you's wrong."
"What am I thinking, Edith?"
"You's thinking that I Julie Andrews!" Edith cackled. "Oh, Georgie Porgie! She think I Julie Andrews!"
George was wheezing, bent over double, and coughing up many years of Player's Navy Cut.
"Oh, Edith, no, I don't think you are Julie Andrews. No, not at all!"
"Well, good for you, girlie, because:
When I'm with her, I'm confused,
Out of focus and bemused.
And I never know exactly where I am.
Unpredictable as weather,
She's as flighty as a feather. She's a darling!
She's a demon-
"She's a lamb!" I sang out as hard as I could. Bugger clinical training-there was nothing that an entire childhood of Christmas showings of The Sound of Music couldn't prepare me for.
Edith clapped her hands together as George beamed and I bowed.
"This your first day here, girlie?"
"Yes, Edith, it is."
"So what you think?"
"I think I don't know what to think."
"George, you say she fresh blood?"
"Yes, Edith, that is what I would say she is."
Edith threw her arms around me and held me tight. "Oh, sweetheart, you just joined. So new. Let Edith help you in." Edith took me by the hand, linked arms with George and skipped us all into my cupboard.
"Ah, we called this 'the Shithole.' Commodes, medication-all the shit was here. Yes, indeed, I think it were better when it were a cupboard."
Over the next forty minutes, as I perched gingerly on my chair and George brought us all another brew, Edith initiated me into the realities of my training by telling me her life story.
Born in Tobago in a small village by the Caribbean Sea called Black Rock, Edith was the second-youngest child of nine children. Her father, a Baptist minister, was a man of compassion to his flock, but not, it seemed, to his children. Father-that was his name apparently- traveled far across the width of the island from Plymouth to the capital, Scarborough, and the length from Charlotteville to Sandy Point. He held Bible meetings in Roxborough and Parlatuvier on the beach, and performed miracles in Moriah and on Cinnamon Hill. Father saved lives, and when he was away, the family was also at peace.
But when he wasn't away ministering, he struggled to contain the sin in his home. Edith told of the "whoopin's" and "beltin's" and beatings that had been part and parcel of her childhood. Especially for a young girl prone to daydreaming-a sin, said Father, when in church-and to singing-a sin, said Father, when not a hymn.
Poor Edith-the youngest of the sisters and the favorite of her mother, she was the first to be sent to live with her father's sister, Aunt Charisma, in Shepherd's Bush. It was there that Edith was to really understand how undesirable she was. At this point in the story, Edith broke into song again:
She'd out-pester any pest,
Drive a hornet from its nest.
She could throw a whirling dervish out of whirl.
She is gentle!
She is wild-
She's a riddle,
She's a child
She's a headache-
Edith suddenly stopped singing, and as her head fell backward, her eyes simultaneously rolled up until I could only see the whites. This seemed serious; I tried not to panic.
"Who's a headache, Edith? Tell me."
Edith's eyes closed and screwed up, and tears trickled down her cheeks. Mouth open, she began a low moan, before singing again:
She is wild-
She's a riddle,
She's a child
She's a headache!
She is wild-
She's a riddle,
She's a child
She's a headache!
She is wild-
She's a riddle,
She's a child
She's a headache!
Between bouts of singing, Edith told scrambled stories. "Stinging" was a key word. "Stinging" and "down there." The "downstairs department." Aunt Charisma and scrub, scrub, scrubbing. No dreaming. Bad dreaming. No singing. Bad singing. Only scrub and sting and Lysol.
"You lie, you Lysol. You lie, you Lysol," Edith kept repeating.
In my mind, I tried to sing ahead, to remember the words, as Edith kept repeating the lyrics, her needle stuck in the groove:
She is wild-
She's a riddle,
She's a child
She's a headache!
She is wild-
She's a riddle,
She's a child
She's a headache!
She is wild-
She's a riddle,
She's a child
She's a headache!
I got it and belted out:
She's an angel!
She's a girl ...
Then there was a complete stop. Not a pause but a stop. Silence. No song. No moans. No lies or Lysol.
The small woman stood with dignity and straightened the pillowcase on her head. She looked me directly in the eyes, and despite the streams of tears still coursing down her cheeks, she extended a hand. "A pleasure speaking with you."
"And a pleasure meeting you, Edith."
"Please call me Maria."
And Maria walked out of the cupboard and across to the other side of the lift shaft, where the inpatient psychiatric department welcomed her with its familiar revolving door.
Seeing her go, I felt really sad. I thought about some of the recent lectures exploring diagnosis and ethnicity we'd heard at school. It had shocked me to learn that there were disproportionately high levels of psychiatric diagnosis and hospital admissions among black and ethnic minorities living in the UK. African or Caribbean immigrants were up to five times more likely to be diagnosed with schizophrenia, due to the cultural insensitivity that was ingrained in our diagnostic procedures. Poverty, racism and culturally rigid definitions of mental illness all contributed to these troubling statistics and I wondered whether Edith was herself a victim. After many years cycling through the revolving door, had her diagnosed illness become a self-fulfilled prophecy?
"As I say," said George, breaking the moment, "welcome to our happy home."
* * *
Alone in my cupboard once more, I shut the door and applied myself to getting the space to look more like a consulting room. As it was, I worried it might be slightly insulting for anyone who came in to see me.
"Welcome to the outpatient psychiatric department. We have designed your treatment environment to match the way you feel about yourself," the office seemed to be saying.
I tidied up: old prescription pads, patient leaflets about fifteen years out-of-date, a guide to electroconvulsive therapy. The thought sent shivers down my spine. I opened a small cupboard next to my desk and shoved the whole lot in.
The chairs needed replacing, so I wandered across the department to see what I could find. In an empty lecture room, I discovered a couple of low chairs. They would do nicely: no disparity in height between my patient and me. I dragged them back past the reception desk without anyone looking up or asking me what I was doing; I probably could have stripped the place entirely and taken it home piece by piece, and no one would have noticed.
Chairs in, positioned at forty-five degrees, it looked better. A few damp hand towels removed some of the visible dust, and then I was on the hunt for a potted plant, which proved more tricky. While considering whether to steal one from a doctor's office more plush than my own, I eventually came upon a bunch of plastic flowers in a small vase in the ladies' toilet. After a rinse and buff with yet another hand towel, they looked rather sweet. I got a coffee table too, and then stood in the middle of my office, pleased with my work.
Nothing to do now but wait for my first patient.
After three years pursuing my undergraduate psychology degree, fierce competition to get into a clinical training course, all the stress of moving back to London, renting a flat in the north of the city and getting myself set up, this was the moment I'd been waiting for. But now that I was here, I felt like running away.
The placement at the hospital was two and a half days a week, with the rest of the week and the odd evening lecture at the university. Effectively, I was seeing patients without any real knowledge of what I was seeing them about: My lectures and the learning I'd need to treat those patients were happening concurrently. Is this what medical doctors in training also went through? Imagine being operated on by someone who has never before put a scalpel into living human flesh.
George brought in another brew, orange, strong and sweet-perfect. He also dumped a pile of notes on my desk.
"Here you go-your first sets of patient notes. Have a read-through."
I sat there looking at the notes; now everything began to feel real.
There had been a long debate among my clinical year group about whether "they" should be called "patients." The psychodynamic lot was against it, believing the term demeans the individual, reduces them to a medical stereotype, colludes with the limited but prevailing medical model of mental health. They believed it was better to use the term "clients." The behaviorists were very much for it: They held that the patients are here for us to treat; they require our intervention; they need the clarity of the well-defined parameters of the relationship between them and us. The psychoanalysts, as usual, were nowhere and everywhere: Why did we want to call them "patients"? What did it defend us against in terms of our own unowned pathology? And equally, what projection did the label "patient" represent in terms of our overidentified pathology?
Oh bloody hell, I had always thought. They are so not my clients-I'm not a solicitor or a prostitute. They are patients and may Sigmund strike me down with the full weight of my unowned fucked-upness. They are patients!
However, as I edged myself into training and grew more accustomed to my little cupboard in the outpatient clinic, over the next few weeks, I soon realized that they were neither patients nor clients; they were people, real people, with lives and stories-vulnerable, sometimes deeply unhappy, interesting people.
My first few clinical sessions had been alongside qualified staff running anxiety-management groups, which helped me deal with my own anxiety as much as anything else. I then started working with an emetophobic woman who was trying to get pregnant and was terrified of the prospect of vomiting with morning sickness; a young man who was struggling with depression after a serious accident; a woman who had begun to have panic attacks on the Tube and in confined spaces; and an elderly man recently bereaved after many years being his wife's sole caregiver. I loved it. I was meeting real people, each with their own challenging story, who trusted me. I felt I was helping.
* * *
A couple of months passed. I discharged my claustrophobic lady, who was now back riding on the Tube. One morning I was sitting in my cupboard, flicking through the notes for a man I was about to see for the first time. It seemed straightforward enough: anxiety and panic attacks. We had had quite a few lectures about those, so I didn't feel as though I was going in totally blind. But a few lectures, some rather self-conscious role plays with my cotrainees and my one discharged patient still didn't allow me to feel quite adequate somehow. What if I made a mistake, made him worse? What if I had a panic attack myself?
A knock at my door and there he was: Ray Robards.
"Good afternoon, Mr. Robards."
"I'm Ray."
We sat opposite each other in the low chairs. We shook hands and then settled into a good mirror position; I felt pleased.
"Here's the thing," said Ray. "I'm a bit freaked seeing you-a head doctor and all. Like, I'm not a nutter, OK. That's the first thing we need to get clear, OK. I'm not a mental case."
"Why would I think you were?"
"In the waiting room, not only was I sitting among a bunch of tranny freaks in wigs, but I also saw some black bird singing something from The bloody Sound of Music. She's fucking insane. I'm not. Let's get that clear."
"I make no judgment, Ray."
"That's not what I'm looking for."
"Mr. Robards-Ray. Sorry, Ray. I am clear that you are not insane."
One-nil to the patient.
"OK, if you're crystal on that, then we're fine. So what do you want me to tell you?"
"What do you want to tell me, Ray?"
He looked blank.
OK. This is going nowhere. Too much to and fro-get a clinical grip. Get going.
"Well, Ray, why don't we start from the beginning? Why don't I tell you what I know and we can take it from there?"
"Sounds good to me. By the way, did anyone ever tell you you've got beautiful blue eyes?"
Two-nil to the patient. Don't blush. Shit, too late. Focus. Carry on. Maintain eye contact.
As I felt the familiar feeling of heat and color spread upward from my neck, I turned away to pick up Ray's patient file from my desk. I turned back. Ray was leaning back in his chair, arms spread behind his head, smiling at me.
"You had a series of unexplained dizzy spells at work. Quite worrying by the sounds of it. Can we start from there?"
"Whatever you say, Doc."
Ray sat forward, his gaze never once leaving me. "I used to collect rubbish. I worked the trucks and emptied bins. That's what I did-did it for years with the same team."
I smiled and nodded. Ray wasn't smiling anymore.
"Due to circumstances outside my control, however, I had to change jobs. I was gutted. But a man's gotta work and so I started doing security, working the doors, that kinda stuff."
"You're a bouncer?"
"Spot on, Doc. Clever girl."
"Do you miss doing the dustbins?"
"Doing the dustbins?" Ray laughed, mimicking my accent as if I were the Queen. "Yeah, but as I say, circumstances outside my control."
I was curious, but something stopped me from asking for further information.
"Anyway, Doc, it was"-Ray was counting on his fingers-"about eight months ago, when I first got pains in my chest. Freaked the fuck outta me-excuse my French."
"So you thought you were having a heart attack?"
"No, love, I thought I was coming."
Where were we now? Four-nil to the patient?
"Of course-sorry."
"Apology accepted, my beautiful blue-eyed girl."
This time I had no excuse to turn away and so I decided to front it out. I felt uncomfortable-this wasn't going well.
"To cut to the chase, my old man dropped dead of a heart attack when he was fifty-seven. He did the bins like me. He was an arsehole but didn't deserve to die at fifty-seven. He smoked, drank, the usual, but nothing more than the next bloke. Apparently he had a faulty valve or something."
"So this is when you went to see the cardiologist?"
"Right. They wired me up, got me running on one of them treadmill things. I had a what-d'you-call-them?"
"ECG?"
"ECG and every bloody test, but apparently"-Ray thumped his chest hard with his fist-"strong as a bloody ox."
"That must have reassured you."
"No, sweetheart, it didn't. Not at all. 'Cos I kept having these bloody attacks, as I call them, and they were coming more often and lasting longer, and like a bloody nancy boy I started fucking fainting. On the job."
"How did the frequency of the attacks change?"
"In English, please."
"Sorry. How many more were you experiencing? Did they become daily?"
"Yeah, but I could cope with those. The boys would see them coming and take me off the door until they passed. Problem was, also I'd get them sometimes in my sleep."
"That must have been really frightening."
"Bloody terrifying." Ray rubbed his face with his hands. The mask was slipping, the bravado disappearing. "I can only explain it like you're drowning. You wake up and you can't breathe-like you are trying to get to the surface but know your chest will explode before you do. I'd get to the window and open it and try to breathe, but nothing would go in-it was like my lungs had just packed up."
Ray stopped abruptly. Beads of sweat appeared on his forehead. I could see his breaths becoming faster and shallower. His large hands gripped the arms of the chair. He was beginning to panic.
Thank God for my few weeks sitting in on the anxiety-management group. I began to feel in control. Perversely, that felt good, despite the obvious discomfort of the man sitting opposite me.
"Ray, I want you to breathe slowly."
"I fucking can't breathe."
Ray was rasping, his pupils dilating. I leaned forward and took his hands in mine.
"Ray, look at me. Look at me. OK, now listen to me. I am going to count and you are going to count with me. OK? Here we go. One ... two ... Count with me, Ray. Three ... four ... That's it. Good. Five ... six. Slow it down."
Ray was squeezing so hard I thought he was going to break my fingers.
"OK, Ray, now I'm holding a candle in front of you and I want you to blow it out in three breaths. Good. Now a little farther away-stronger breaths. Good. OK, Ray, keep blowing as I pull the candle closer to me. That's it."
A few minutes later Ray was sitting more calmly in his chair, drinking a cup of water. I sat back and felt good-really good. I'd brought his panic down.
I started taking a detailed history. The poor guy, I thought. No wonder he doesn't want to be here in the outpatient psychiatric department-he'd been through every other department in the hospital. Every part of him had been checked-heart, lungs, bloods, brain.
Classic. The medics sell the patient on the idea that their diagnosis will make it all better, and then when they draw a blank, they throw them over to the mental health services. "Sorry, mate-thought you were ill, but actually, as it turns out, you're not, so you must be bonkers."
I began to chide myself for being so easily intimidated by an obviously frightened and vulnerable man. I looked him in the eye.
"I can see that you have had the real runaround in this hospital. In fact, you probably know the inner workings of each department better than most of the managers!"
Ray smiled. "Yeah, this place could do with a quality-control audit!" His smile faded.
"OK. So now you're here, in this department. What we need to think about is what these panic attacks mean."
"Mean?"
"Yes-why are you getting them? What do they represent?"
"Represent? Look, Doc, sorry, but I just want whatever pills or whatnot I can take to control these bastards."
"It's not quite as simple as that."
"Why not?"
"OK, the thing is, yes, you are getting panic attacks. Severe ones. Yes, they affect your body and so theoretically it should just be possible to prescribe medication to calm everything down, but that isn't going to solve the problem. In fact, aren't you taking some meds already?"
"Yeah. Those little pink pills. And something at night-begins with 'D.'"
"Diazepam? How do you find them?"
"The pink pills are OK. They calm me down a bit. But I hate the night stuff 'cos I feel like shit next morning."
"Groggy?"
"Like I been on a major bender the night before."
"OK, so the medication needs to be reviewed, but-"
"But nothing, Doc. Give me my new pills and I'm on my way." Ray was beginning to get agitated.
"Ray..." I leaned forward and touched his beginning-to-clench fist. He grabbed my hand and my heart leaped into my mouth. "Listen, Ray. There are many things that we can do. Pills are part of it, but I am not the one to do the pill side of things for you. My role ... my role is to help us understand why you are having the panic attacks, because-"
"Doc, look-"
"Because, Ray," I continued with a note of firmness to my voice, "because ... Think of it this way. You've got a wound that is infected, right? And that infection is treated by pills and creams, which temporarily relieve the soreness but do nothing to get rid of the underlying infection itself. We need to investigate what is causing the infection, and why it is preventing the wound from healing."
I shrugged. "Panic attacks can happen for a variety of reasons, most usually stress and anxiety. Something has happened or is happening in your life that leaves you feeling anxious. That makes you increasingly vulnerable to panic attacks." I sat back.
Ray looked evenly at me. "So, my dad was an arsehole. Is that what you wanna hear from me? Dad was an arsehole, useless. Mum was my life but died when I was nine. Is this right? Dad left us to our own devices, and my devices ended up getting me thrown into jail for a few short and one longish stretch. Am I getting anywhere, Doc?"
"Ray, I-"
"No, listen. My childhood was shit. Nothing like yours was, I expect. Total shit. But so were the fucking childhoods of most blokes I grew up with. So what? It was hard. We were poor. I had no mum-poor Ray. Bullshit."
Ray wasn't breathing too quickly this time. In fact, he was very still and very focused. I tensed in my seat. Something about the dynamic between us had shifted, like a change of air pressure. I scanned the room quickly. I realized I was looking for the panic button-there should be one in every room. I just wanted to know it was there. Where the hell was it? There. Other end of the desk. I hadn't given this any thought when I was first positioning the chairs for the session, and now I couldn't reach it from where I was sitting. My mouth was suddenly dry.
"Tell me about your life now, Ray." I wanted to keep him talking, to calm him down.
Ray took off his jacket and revealed his muscular torso, covered only by a Gold's Gym undershirt. Both arms were adorned in tattoos, and, as far as I could tell, so were his neck and chest.
"Here's my life, Doc."
I looked at the ink on Ray's skin. There were dragons and what looked to be a large cobra coiled around one arm. There was a nude woman on his other forearm and under that a list of names.
"Who are Brittany, Bethany and Brandon?"
"My kids."
I forced a smile, nodded. "Tell me about them."
"I love them."
"I'm sure you do."
"No, you don't 'I'm sure you do.' I would kill for them."
I believed him and that frightened me.
"They are all I have."
There was a long pause. I itched to say something, but instinct and a recent lecture on the importance of the "therapeutic silence" stopped me.
"Brit is seventeen. She's at beauty college-nails, hair, that kinda stuff. Beth is a bit wild. She's fifteen and has a kid, another on the way. Brandon is ... He's my lad, my boy, my little mate."
Ray stopped and began to hug himself with his powerful tattooed arms. As his hug tightened, he bent farther forward, as if he were trying to curl up into himself.
"Ray, what's going on? Your chest...?"
What came next shocked me.
It started with a groan, like Ray was in pain-not anxious, panic pain but a pain so physical, so visceral, that it shook me to my core. The first groan was guttural, seeming to push out from the depths of the big man and go on for ages. Ray was bent over double, his fists clenched into his sides. The groan continued for so long that I began involuntarily gulping for air-as if I could breathe on his behalf.
Then, like a diver reaching the surface, he pushed his head back and gasped-loud gulps that had the effect of releasing one small tear from the edge of his left eye, which traveled slowly down his check, meandering around the deep wrinkles in his face and finally dripping into his open mouth.
And then, suddenly, Ray punched at where he felt the tear tickle his top lip; the punch had such force that his nose started to bleed.
I felt both afraid and awestruck by the ferocity of the emotion from a man who had seemed so locked in, so unyielding. With a little stab of shame, I also realized how exhilarated I felt-I had done this. I had enabled this unhappy man, a man who, I assumed, would not normally allow himself to cry, to access his pain. We were now getting to the root and I felt myself relax.
Oh my God, you can actually do it. You can actually do this job.
It was extraordinary; it was a privilege; it was a total high.
"When I first held him, I told him I would never leave him. He'd never lose me." Ray's voice was low and hoarse, his throat ripped by sobs. "He was the most beautiful boy-everyone said he looked like an angel. He did. The girls were cute, but he was in another league. He was in the Champions League."
Ray began to uncurl his body and with a sigh rubbed his hands over his face, smearing the blood from his nose into a red mustache. He took a drink, sat back and looked at me.
"I can see that this is painful for you."
But Ray didn't seem to hear me. In fact, he didn't even seem to be looking at me. He was somewhere else.
"I couldn't bear to be away from him. I did everything for him-fed him, changed him. I even slept with him. When I went to the gym, I took a photo in a frame so I could look at him the whole time. We were mates; he was my best mate-my best little mate. He was my life. Oh fuck." Ray began to sob again, this time quietly.
"I fucked it up with the girls. Well, I didn't-their bitch of a mother did. She was bad, proper bad-got her girls, didn't want to know me anymore. She'd start picking at me and I'd spend more time out of the house than in it-I had to, because I knew if I didn't, I'd have fucking lamped her. She wanted that-she wanted to be the victim, so she could take my girls away from me and get me out of her life.
"She called me useless and a failure, a fucking waste of space. She told me I wasn't worth nothing to no one. That even if my mum had been alive, she'd have said the same and thought the same. She said that if Mum were around, she'd have been ashamed of me."
Ray paused, sniffing loudly before taking a tissue from the box that I offered him. He blew his nose noisily and looked into the tissue. "Christ."
"Only a small bleed. It's stopped now. It looks OK."
Ray looked up at me as if he was, for the first time, suddenly becoming aware of my presence in the room. He looked dazed, a rabbit in headlights.
"Hearing those words about your mother must have been very tough for you, Ray."
"Yeah, tough." Ray gave a small smile. "Tougher for the bitch who said them, though. I put her in the hospital." Ray chuckled to himself.
"And yourself inside?"
"Yeah. It was one of the smaller stretches. Assault but diminished responsibility 'cos of her goading and my steroid use."
"Right. How is she now?"
"How the fuck do I know how she is now? Apparently she can feed herself again. More's the shame. I did her a favor, all those days on a liquid diet she'd have lost that big fat arse of hers. I reckon she'll have larded it on again." Another laugh.
"And the girls?"
"No. Nothing. Nix. Nada. Tried to contact them via relatives. The little one doesn't want to know me-she's an old slag like her mother. Two kids already..." Ray shook his head and tutted. "Brit sends the occasional message, but she doesn't want to meet up. Don't blame her."
Ray picked up the plastic cup, which was empty. I pushed my untouched water toward him. He took long, slow gulps.
"You really do have beautiful eyes."
"Tell me about Brandon, Ray."
He winced. "Oooh. Nasty doc. Nasty girl with the beautiful eyes. Like a shark, aren't you, sweetheart-sniff blood, circle a bit and then in for the kill."
"I'm sorry. I just-" I stopped as Ray put up his hand.
"Shush, sweetheart. I was joking. No problems, babe. You're just doing your job."
He leaned right back in his chair, pulling his arms upward and lengthening his legs forward as he stretched out his body with a grunt. He clicked his fingers at each joint. He was huge.
"Brandon. Yeah, my boy. The little lad I had with the other one, the cruelest cunt of cunts. My boy. My little mate. We did everything together. He was perfect. Beautiful. Clever. Funny. He loved me and I..."
"Where is Brandon now, Ray?"
I was expecting the worst.
"He's everywhere. That's the fucking problem-he's everywhere. He's in every song they play on the fucking radio. He's in the fucking stuffed toys that my old boss keeps shoving into the radiator."
I looked confused.
"Of the truck."
Ray took another drink. "He's on my arm. He's in my heart." Ray thumped his chest again. Hard. "He's in every fucking buggy I see and every bloody advert for nappies."
Silence again. Ray leaned forward and hung his head down toward his lap. I felt my heart pounding and took a deep breath.
"Is Brandon dead, Ray?"
Ray looked up, startled. "What did you say?"
"Oh, Ray. I'm sorry. I didn't mean..."
"Is he dead? You ask, is he dead?"
And then, just as loudly as he had been sobbing, he started laughing with such ferocity that I couldn't be sure whether it was only laughter or coupled with the rawest of grief. Unable to think of anything else to do, I leaned forward, proffering the tissue box; Ray took one and held it over his face with both hands, his body convulsing with emotion.
The fear was back. I'd drifted into deep water and now, unable to feel any ground beneath my feet, I began to worry. Introduction to anxiety management was one thing, but grief? Our first bereavement workshop wasn't scheduled for another week and I just didn't have a clue.
A sudden movement and I was jolted by Ray grabbing my hands-his face coming near to mine. I was now not only out of my depth, I was bloody scared.
"Oh, you beautiful-eyed goddess. You sweet little angel. You."
Ray gazed into my eyes and held the pause just long enough for me to begin to fear that I was going to be sick. He was so close to me that I felt his slow, warm, nicotined breath on my cheek. I didn't know what to do. Was this a good therapeutic moment that I had to contain, be the strong maternal figure who doesn't desert him or goad him, or do I begin to listen more acutely to the alarm bells in my head and find a way to close this session down?
Shit, I didn't even know what the time was-had fifty minutes elapsed? There was no clock on the wall, and I was too afraid to insult Ray by looking down at my wrist. He dropped my hands, sat back and, as if reading my mind, looked at his watch.
"Fucking hell, Doc, you're good. Got me going there for over half an hour. Oh yes, you did. Think we might have got to ... What's it called? The root? What do you reckon, sweetheart?"
I tried to swallow imperceptibly and made a mental and physical effort to steady my voice as I spoke.
"Ray, can I begin by saying that I admire you. You are a man of courage."
"I am?" Ray smirked and I doubted that he was used to compliments.
"Real emotional courage. We've never met before. You've had a real shock being referred to this department-"
"The nuthouse?"
"And, Ray, you have found the strength to talk openly about your children and the pain of their losses to you, especially your little boy."
"I didn't lose them, love. They were taken from me."
"Yes, I understand that you would think that, Ray. Totally I do. And yes-your first wife ... partner ... who you seemed to have a sadomasochistic relationship with-"
"I did?"
"It seems that way, Ray. She set you up to make her the victim and you the attacker."
I was feeling back in my stride.
"So it was her fault, then?"
"I guess it's more complicated than ascribing fault. It's about understanding the dynamics of a relationship."
"Oh, I see." Ray clearly didn't.
"Let's put it another way. In relationships we inhabit roles. Often these roles reflect pieces of previous relationships that we have had with significant others"-bloody hell, speak English-"with people we love and care about the most. And I wonder, Ray, whether both the women with whom you have had children and whom you clearly have very bad feelings about-well, I wonder whether these women were selected by you because they were easy not to attach to and would one day leave you-just like your mother did."
Ray looked blank.
"It's difficult making attachments when previous experience says that with a close relationship, loving attachment is followed by heartache." I paused and wished that I hadn't given Ray my water. "You choose a woman who you know ultimately you can't love and the relationship plays itself out to its bitter end, which is horrible and painful for all, but at least it's safe. Familiar."
"Right, Doc. I did all that. Yeah, 'course I did."
"Ray, I'm not saying you consciously made it happen. I just-"
"Nah. I see that. Yeah, clever."
Another silence and a chance to glance down quickly. There were only ten minutes of the session left-time to wrap up, set some homework tasks for Ray to practice to manage his anxiety and book in next week's appointment.
"So, Ray, I think we need to pull everything together."
"Fair enough, Doc."
"OK. Well, what have you got out of this session?"
Ray laughed-more lightly this time. I was encouraged.
"I got that the panic starts from my head. I got that even talking about the fucking attacks can bring them on. I got that it was crap between me and the cunts because I couldn't be-what was it, Doc, attached?"
"That's right, Ray."
"And I got that I miss my kids and that is why I get stressed and that is why I panic."
I wanted to cheer. I wanted to hug Ray and shout, "Bravo!" at the top of my voice. I'd taken him from zero insight to a man of several hypotheses in less than forty-five minutes. Instead of cheering, however, I decided to compose myself to say what had to be said.
"You are right, Ray. This is about loss. Losing a mother so young. Then you have to manage the loss of your girls. Most especially, I believe that all this is about the death of your little son. The death of Brandon haunts you, Ray. You are stuck in your grief, and every trigger that reminds you of him-what you see by day or dream about at night-sets off these horrible attacks."
I sat back. Ray sat forward.
"Sweetheart, he's not dead-I never said he was dead. I just don't have no contact with him."
What?
"He's not dead?"
"Nah, nah, nah, nah, nah. Nah. He lives in Basingstoke with his cunt of a mother, been there since I broke her face."
The next couple of minutes were a blur. I struggled to manage the shock at being wrong-footed by Ray, and my annoyance at making such a stupid mistake.
Assumption is the mother of all screw-ups.
Ray seemed in good spirits, though. I was able to run smoothly through the diary that I wanted him to keep every day, logging each of his panic attacks and how they affected him in terms of his thoughts, his feelings and finally his behavior. I then went on to teach him a couple of techniques to distract himself when he knew he was about to be triggered, in order to stop his mind hurtling toward the anxious thoughts and the accompanying bodily sensations.
"Stop myself thinking and freaking out by counting backward in threes from a hundred? I can't even count forward that far," Ray joked, and I smiled, glancing at my watch-only five more minutes and then, I hoped, the appearance of George and another orange brew.
"OK." I stretched back to my desk to get my diary. "Shall we put in the same time for next week?"
"Whatever you say, my beautiful-eyed girl. But before I go, can I show you something?"
"Of course you can." I smiled, writing Ray's next appointment in my diary, and then looked up at what I assumed would be a photo of Brandon he'd taken from his wallet.
Except that it wasn't a photo of Brandon. Instead, I found myself looking straight down at a shining switchblade, its point about a millimeter away from the tip of my nose.
"Oh, sweetheart. My beautiful-eyed doc."
With the blade still in its position, Ray began to trace my eye sockets with his fingertip.
He will kill me.
I'm not sure what happened next. Images flooded into my brain: women sucking liquidized food into broken mouths pinned together with steel; women in wheelchairs; little children screaming as their mothers are pummeled and beaten.
I closed my eyes and struggled to breathe.
"Open your fucking eyes. Open your eyes, my pretty doc."
Ray pushed his finger hard into my eyelids and, with a small squeal, I opened my eyes.
He smiled. "Good."
He stared at me and, in total panic, I stared back. His eyes were gray, the right flecked with brown. I saw David Bowie, Ziggy Stardust.
Oh Christ. Oh God. Please help me.
He eased the point of the blade away from the end of my nose and for a moment I could take a breath. Maybe that was it. Maybe he'd made his point, reasserted his dominance after his vulnerability in the session and was ready to go.
I was wrong.
Very gently, Ray placed the blade flat side against my skin, next to my left eye.
"I want these eyes."
I began to cry.
"Oh, sweetheart. My beautiful-eyed doc, please don't cry. No. Shush now. No tears now, baby." Ray caught the tears on his fingertips and then licked them off. "Oh yes. You taste good. Very good."
He stroked the flattened blade around my left eye. "These are deadly weapons, you know, sweetheart. Little blue laser traps. And, boy, do you know how to use them, baby. Oh yes. One look and you are straight into one side and then straight out the other. Those eyes. Blue and innocent, but used to finding out all the secrets-aren't they, sweetheart."
Without understanding why, I felt like I had to nod.
"Yes. You know what I'm talking about, my baby. Blue searchlights." Ray raised his arm in a mock Nazi salute. "I vill mek you speek!
"You thought you'd got me, sweetheart. I saw it in that pretty little butter-wouldn't-melt sweet little princess face of yours. Young girl like you-Little Miss Know-It-All-thinks she can get inside a bloke like me. Just some thick, useless nothing like me. He's rubbish and he collects rubbish. Shit living with shit. That's what you thought, sweetheart, wasn't it?
"You know, I've met loads like you. Little Miss Do-Gooders. The ones in prison are the fucking worst. Patronizing fucking dried-up old cunts who can't get a man, so they have to spend their time with those of us locked behind bars who can't get away from them and their ugly mugs and whining fucking voices. They think that we need them and that makes them feel good. Do you know, princess, I think it makes them hot. It makes them horny. They are more fucked up than we are. Pathetic. They are easy-just like you were, sweetheart. Easy bait, easy fodder-so fucking easy to fool.
"What got you first? The tears? Did you think you was doing well when you saw the tears? Did you think that the tears meant you was getting somewhere? Did you think, Oh, bless him. Look at all these tears that he's never shed for his poor dead mum and his arsehole of a dad and his kids? That's what you thought, was it, sweetheart? About them tears? Same tears as these?" Ray closed his eyes and then opened them suddenly. A tear trickled obediently down his cheek, and he smiled.
"Trick I learned inside when I was fourteen. Gets you all every time. Every fucking time." The tears continued. "Oh boohoo. Poor me. Poor Ray-no mum, bastard for a father. Shit life. Poor little Ray."
He started to laugh silently but with a violence that made his whole body shake. The end of the blade jabbed into the soft skin of my temple.
I yelped.
Ray looked alarmed. The tears stopped and he pulled away the blade.
"Oh, sweetheart. No way. Oh fuck, baby. No."
He grabbed the tissue box and offered it to me. Shaking, I dabbed the edge of my eye; a small speck of blood stained the tissue.
"Don't worry, sweetheart. Only a small bleed."
"Ray, I need to leave this room."
"I'm sorry, sweetheart, you can't, not yet. Not till I'm finished."
"Finished what, Ray?"
"Finished with you, my beautiful blue-eyed baby girl."
"We have finished, Ray. It's time to go."
"No, babe. We finish when I say, and I say we haven't finished."
Later on, when I was thinking this all through, I couldn't be sure what it was that had been said in that moment, but suddenly the situation shifted for me.
No fucking way, mate. This is my office, and this is my session. We finish when I say, and I say now.
Outwardly I remained passive, but inwardly I felt busy.
Confront him. No, he'll kill me. Talk him down. No, he'll kill me. What, then? What?
And it was then as if descending from the heavens that Sigmund appeared to me, and with blinding clarity, I knew exactly what to do.
"That's a big knife, Ray."
He said nothing.
"A beautiful knife. And such a big, long blade. It really is beautiful. Can I touch it?"
Still saying nothing, Ray slowly offered me his blade.
I gently cupped my hands around its shaft. "That is long. Long and hard. It's beautiful, Ray."
Still no sound except his breathing-quiet but getting faster. My mouth felt like it was stuffed with wool.
"Yes, Ray, you are right. I am a little princess, but make no mistake about it-I know a good blade when I see one. I'm not completely inexperienced, you know."
Ray looked at me and I worked hard to look right back. Everyone and everything was calm.
"Can I stroke it, Ray?"
Exhaling, Ray closed his eyes and nodded and then opened them again to watch his blue-eyed goddess gently place her fingertips on the broad, flat edges of his long blade and slowly stroke them up and down the cold steel shaft.
Ray's breathing quickened, and as I continued to stroke the knife, he closed his eyes. I knew that this was my moment.
"Ray, I'm done. Thank you. You can put it away now."
His eyes still closed, Ray flicked the blade's safety catch and the knife retracted into itself. Silence. Ray continued to exhale audibly.
OK, I told myself. Six paces to the panic button. Ten to the door. Stay with me. We're going to count. One ... two. That's it, keep it steady. Three ... four. Take your time. Five ... Reach out and ...
"You cunt!"
Huge hands encircled my neck as I launched myself at the panic button. A siren went off and Ray shook me like a rag doll, my feet lifted off the floor. I felt like I was drowning.
And then, as I was about to go under, I saw the most incredible sight. In an explosion of light, the door to my room flew open and two large women burst in. While one punched Ray right in the face, the other kicked him hard in his testicles with the full force of her Lucite stiletto.
As I fell to the ground, "Josephine" caught me in her strong arms and held me into her muscular body and enormous breasts. She smelled of sweat, musk and heavy foundation. I snuggled into her, feeling safe.
Next to me, Ray was now being held facedown on the floor by two security guards, his arms locked behind his back. Crouching down next to Ray with her knee pressing onto the back of his head, "Daphne" slipped open her little red clutch and pulled out a warrant card. As I was helped out of my office, Ray was being read his rights.
* * *
First placement, first critical incident debriefing. I was still shaking, and now I had to meet my clinical training supervisor to talk about what had gone wrong.
Chris came into the room and I stood up, like a child when the teacher arrives. I suddenly felt stupid. Chris didn't seem to notice. She threw her bag down and put her large takeaway coffee cup on the table.
Dr. Chris Moorhead-she who was renowned for being a hard-core and brilliant clinical supervisor-sat opposite me, staring. And here I was, the trainee she'd asked not to let her down only a few weeks earlier. I'd royally screwed up.
Chris was the one who would decide after each of my training placements, over the following three years, whether I would pass to the next, whether I would one day qualify.
"How are you doing?" she asked.
"I'm fine. You?"
Chris stared straight at me. "I'll start again, and this time, please answer me honestly. How are you doing?"
"I'll survive!" I smiled.
"Final time. Think carefully before you answer. How are you doing?"
To my horror, I burst into tears.
"I don't know."
Chris rummaged in her large bag, pulled out a packet of tissues and handed me one. "You have had a pretty big shock."
I couldn't stop crying. I wanted to apologize to her, ask for another chance. I couldn't get the words out.
"This sort of thing happens. Generally not so early on, though, so I'm sorry that it happened to you."
I smiled and shook my head.
"Tell me as much as you can remember about the session." She handed me a glass of water.
As I took it, I could see my hand shaking. I took a deep breath and tried to describe as much as I could remember: estranged from three children; obsessional love for youngest child, only son; ability to cry at will; my eyes; his knife; Freud and the penis. Shock does odd things to memory and I'm not sure how much she'd have understood. It all sounded bizarre.
I took a deep breath. "I'm sorry."
She raised her eyebrows.
"I know I have messed up big-time. It won't happen again."
"How did you mess up?"
I took a deep breath. "I should have seen it coming. I know this looks bad." Chris opened her mouth to speak, but I had to keep talking: I just couldn't bear to hear what she was going to say. I kept saying sorry.
She handed me another tissue. "Your nose is running."
Embarrassed, I blew my nose.
"I am not clear why you are apologizing."
This was torture.
"For messing up with the patient, for causing a scene in the department, for potentially compromising your reputation and the reputation of the clinical course, for..."
She raised her hand to silence me. "Did you know he had sociopathic tendencies?"
"No. Sorry."
"Did you know he was armed with a knife?"
Again I shook my head. "No."
"What's with all the mea culpa? When I interviewed you, I thought you were more confident." Chris sat back in her chair, took a gulp of coffee. "Please don't do a Mother Teresa on me, and please, please don't next pull out your sword and fall on it. OK?"
I took a deep breath. "I just want you to see that I am worth another chance."
Chris pushed a critical incident form across the desk toward me and handed me a pen. "Let's start with you filling this out."
I did. My hand was shaking.
Chris leaned over to look. "You need to write that bit out again-you've joined the 'l' and 'i' together so they look like a 'u.' He didn't attack you with a 'fuck knife,' did he?"
I looked up at her and saw a deadpan face. Her mouth twitched and we both started laughing.
"OK, I don't expect you to speak, but just try to listen. Mistake number one: They don't have to cry in the first session for you to be doing your job well. Leave that to the social workers.
"Mistake number two: Think about where you put the chairs and where you sit. If you need to ask them to excuse you as you make your way past them to push the panic button, then you are screwed.
"Mistake number three: If you ever feel out of your depth, then find a reason to leave and leave. This is a job, not a calling. If you want to save with self-sacrifice, then find a nunnery.
"Mistake number four: If they want to show you something, do not take your eyes off them as they reach for it. We do telling in our profession, not showing. Leave that to the drama therapists.
"Mistake number five: This was mine. I should have made sure that the department had screened this sociopath before you got him.
"Mistake number six: Don't discount Sigmund, because it seems you pulled him out in your hour of need and he came through for you. You crudely emasculated your patient and then cleverly rejoiced in his switchblade penis.
"Overall, well done. You did better than I would have expected from someone so inexperienced. Take a long weekend off and I'll see you next Wednesday."
So she made one mistake and I made five, but still I did a good job. Sigmund helped me out, my eyes were still in their sockets and all was well with the world.
But what about Ray? I couldn't help but feel that I had totally and utterly let him down.
Copyright © 2015 by Tanya Byron