AFTER LUNCH I PROWLED THE CORRIDORS, looking for an exit. I was intending to sneak outside and have a cigarette, but I was discovered by Indira by the fire escape. She assumed I was lost.
“Don’t worry, Theo,” she said, taking my arm. “It took me months to get my bearings around here. Like a maze with no way out. I still get lost sometimes and I’ve been here ten years.” She laughed. Before I could object, she was guiding me upstairs for a cup of tea in the “goldfish bowl.”
“I’ll put the kettle on. Bloody miserable weather, isn’t it? I wish it would just snow and get it over with.… Snow is a very powerful imaginative symbol, don’t you think? Wipes everything clean. Have you noticed how the patients keep talking about it? Look out for it. It’s interesting.”
To my surprise, she reached into her bag and pulled out a thick slice of cake wrapped in cling film. She thrust it into my hand. “Take it. Walnut cake. I made it last night. For you.”
“Oh, thank you, I—”
“I know it’s unorthodox, but I always get better results with difficult patients if I give them a slice of cake in the session.”
I laughed. “I bet you do. Am I a difficult patient?”
Indira laughed. “No, although I find it works just as well on difficult members of staff too—which you’re not either, by the way. A little bit of sugar is a great mood enhancer. I used to make cakes for the canteen, but then Stephanie made such a fuss, all this health-and-safety nonsense about food being brought in from the outside. You’d think I was smuggling in a file. But I still bake a little on the sly. My rebellion against the dictator state. Try it.”
This was not a question but a command. I took a bite. It was good. Chewy, nutty, sweet. My mouth was full, so I covered it with my hand as I spoke.
“I think this will definitely put your patients in a good mood.”
Indira laughed and looked pleased. I realized why I liked her—she radiated a kind of maternal calm. She reminded me of my old therapist, Ruth. It was hard to imagine her ruffled, or upset.
I glanced around the room as she made the tea. The nurses’ station is always the hub of a psychiatric unit, its heart: staff flow to and from it, and it is where the ward is run from day to day; at least where all the practical decisions are made. The goldfish bowl was the nurses’ nickname for the station, as its walls were made of reinforced glass—meaning staff could keep an eye on the patients in the recreation room, in theory at least. In practice, the patients hovered restlessly outside, staring in, watching us, so we were the ones under constant observation. The small space did not have enough chairs, and the ones that were there were generally occupied by nurses typing up notes. So you mostly stood in the middle of the room or leaned awkwardly against a desk, which gave the space a crowded feel, no matter how many people were in it.
“Here you are, love.” Indira handed me a mug of tea.
“Thanks.”
Christian ambled in and nodded at me. He smelled strongly of the peppermint gum he was always chewing. I remembered he used to smoke heavily when we were at Broadmoor together; it was one of the few things we had in common. Since then Christian had quit, got married, and had a baby daughter. I wondered what kind of father he made. He didn’t strike me as particularly compassionate.
He gave me a cold smile. “Funny seeing you again like this, Theo.”
“Small world.”
“In mental health terms, it is—yes.” Christian said this as if to imply he might be found in other, larger worlds. I tried to imagine what they might be. I could only imagine him in the gym or in a scrum on the rugby field.
Christian stared at me for a few seconds. I’d forgotten his habit of pausing, often lengthily, making you wait while he considered his response. It irritated me here just as much as it had done at Broadmoor.
“You’re joining the team at rather an unfortunate moment,” he said eventually. “The sword of Damocles is hanging over the Grove.”
“You think it’s as bad as that?”
“It’s only a matter of time. The Trust is bound to shut us down sooner or later. So the question is, what are you doing here?”
“What do you mean?”
“Well, rats desert a sinking ship. They don’t clamber on board.”
I was startled by Christian’s undisguised aggression. I decided not to rise to the bait. I shrugged. “Possibly. But I’m not a rat.”
Before Christian could reply, a massive thud made us jump. Elif was on the other side of the glass, hammering at it with her fists. Her face was pressed up against it, squashing her nose, distorting her features, making her almost monstrous.
“I won’t take this shit no more. I hate this—these fucking pills, man—”
Christian opened a small hatch in the glass and spoke through it. “Now is not the time to discuss this, Elif.”
“I’m telling you, I’m not taking them no more, they make me fucking sick—”
“I’m not having this conversation now. Make an appointment to see me. Step away, please.”
Elif scowled, deliberating for a moment. Then she turned and lumbered off, leaving a faint circle of condensation where her nose had been pressed against the glass.
“Quite a character,” I said.
Christian grunted. “Difficult.”
Indira nodded. “Poor Elif.”
“What’s she in for?”
“Double murder,” Christian said. “Killed her mother and her sister. Suffocated them while they slept.”
I peered through the glass. Elif joined the other patients. She towered over them. One of them slipped some money into her hand, which she pocketed.
Then I noticed Alicia at the far end of the room, sitting by herself, by the window, looking out. I watched her for a moment.
Christian followed my gaze and said, “By the way, I’ve been talking to Professor Diomedes about Alicia. I want to see how she does on a lower dose of risperidone. I’ve brought her down to five milligrams.”
“I see.”
“I thought you might want to know—since I heard you saw her for a session.”
“Yes.”
“We’ll have to monitor her closely to see how she reacts to the change. And, by the way, next time you have a problem with how I medicate my patients, come to me directly. Don’t sneak off to Diomedes behind my back.” Christian glared at me.
I smiled back at him. “I didn’t sneak anywhere. I have no problem talking to you directly, Christian.”
There was an uncomfortable pause. Christian nodded to himself, as if he’d made his mind up about something. “You do realize Alicia is borderline? She won’t respond to therapy. You’re wasting your time.”
“How do you know she’s borderline if she can’t talk?”
“Won’t talk.”
“You think she’s faking?”
“Yes, as a matter of fact, I do.”
“If she’s faking, then how can she be borderline?”
Christian looked irritated.
Indira interrupted before he could reply. “With all due respect, I don’t feel umbrella terms like borderline are particularly helpful. They don’t tell us anything very useful at all.” She glanced at Christian. “This is a subject Christian and I disagree on frequently.”
“And how do you feel about Alicia?” I asked her.
Indira pondered the question for a moment. “I find myself feeling very maternal towards her. That’s my countertransference, that’s what she brings out in me—I feel she needs someone to take care of her.” Indira smiled at me. “And now she has someone. She has you.”
Christian laughed that annoying laugh of his. “Forgive me for being so dense, but how can Alicia benefit from therapy if she doesn’t talk?”
“Therapy isn’t just about talking,” Indira said. “It’s about providing a safe space—a containing environment. Most communication is nonverbal, as I’m sure you know.”
Christian rolled his eyes at me. “Good luck, mate. You’ll need it.”
“HELLO, ALICIA,” I said.
Only a few days had passed since her medication had been lowered, but the difference in Alicia was already apparent. She seemed more fluid in her movements. Her eyes were clearer. The foggy gaze had gone. She seemed like a different person.
She stood at the door with Yuri and hesitated. She stared at me, as if seeing me clearly for the first time, taking me in, sizing me up. I wondered what she was concluding. Evidently she judged it safe to proceed and walked inside. Without being asked, she sat down.
I nodded at Yuri to go. He deliberated for a second, then shut the door behind him.
I sat opposite Alicia. There was silence for a moment. Just the restless sound of the rain outside, raindrops drumming against the window. Eventually I spoke.
“How are you feeling?”
No response. Alicia stared at me. Eyes like lamps, unblinking.
I opened my mouth and closed it again. I was determined to resist the urge to fill the void by talking. Instead, by remaining silent and just sitting there, I hoped to communicate something else, something nonverbal: that it was okay for us to sit together like this, that I wouldn’t hurt her, that she could trust me. To have any success at getting Alicia to talk, I needed to win her trust. And this would take time—nothing would be accomplished overnight. It would move slowly, like a glacier, but it would move.
As we sat there in silence, my head started to throb at the temples. The beginnings of a headache. A telltale symptom. I thought of Ruth, who used to say, “In order to be a good therapist, you must be receptive to your patients’ feelings—but you must not hold on to them—they are not yours—they do not belong to you.” In other words, this thump, thump, thumping in my head wasn’t my pain; it belonged to Alicia. And this sudden wave of sadness—this desire to die, die, die—did not belong to me either. It was hers, all hers. I sat there, feeling it for her, my head pounding, my stomach churning, for what seemed like hours. Eventually, the fifty minutes were up.
I looked at my watch. “We have to finish now.”
Alicia lowered her head and stared at her lap. I hesitated. I lost control of my reserve. I lowered my voice and spoke from the heart.
“I want to help you, Alicia. I need you to believe that. The truth is, I want to help you to see clearly.”
At this, Alicia looked up. She stared at me—right through me.
You can’t help me, her eyes shouted. Look at you, you can barely help yourself. You pretend to know so much and be so wise, but you should be sitting here instead of me. Freak. Fraud. Liar. Liar—
As she stared at me, I became aware of what had been troubling me the whole session. It’s hard to put into words, but a psychotherapist quickly becomes attuned to recognizing mental distress, from physical behavior and speech and a glint in the eyes—something haunted, afraid, mad. And that’s what bothered me: despite the years of medication, despite everything she had done, and endured, Alicia’s blue eyes remained as clear and cloudless as a summer’s day. She wasn’t mad. So what was she? What was the expression in her eyes? What was the right word? It was—
Before I could finish the thought, Alicia leaped from the chair. She threw herself toward me, hands outstretched like claws. I had no time to move or get out the way. She landed on top of me, knocking me off-balance. We fell to the floor.
The back of my head hit the wall with a thud. She bashed my head against the wall again and again, and started scratching, slapping, clawing—it took all my strength to throw her off.
I scrambled along the floor and reached up to the table. I groped for the attack alarm. Just as my fingers grasped it, Alicia jumped on me and knocked the alarm from my hand.
“Alicia—”
Her fingers were tight around my neck, gripping, choking—I groped for the alarm but couldn’t reach it. Her hands dug deeper—I couldn’t breathe. I made another lunge—this time I managed to grab hold of the alarm. I pressed it.
A wailing scream instantly filled my ears, deafening me. I could hear the distant sound of a door opening and Yuri calling for backup. Alicia was dragged off me, releasing her choke hold—and I gasped for breath.
It took four nurses to hold Alicia down. She writhed and kicked and fought like a creature possessed. She didn’t seem human, more like a wild animal; something monstrous. Christian appeared and sedated her. She lost consciousness.
At last, there was silence.
“THIS WILL STING A BIT.”
Yuri was tending to my bleeding scratches in the goldfish bowl. He opened the bottle of antiseptic and applied it to a swab. The medicinal odor transported me to the sick bay at school, conjuring up memories of playground battle scars, grazed knees and scratched elbows. I remembered the warm, cozy feeling of being taken care of by Matron, bandaged and rewarded for my bravery with a boiled sweet. Then the sting of the antiseptic on my skin brought me back sharply to the present, where the injuries I presented were not so easily remedied. I winced.
“My head feels like she hit me with a fucking hammer.”
“It’s a nasty bruise. You’ll have a lump tomorrow. We’d better keep an eye on it.” Yuri shook his head. “I never should have left you alone with her.”
“I didn’t give you a choice.”
He grunted. “That’s true enough.”
“Thanks for not saying, ‘I told you so.’ It’s noted and appreciated.”
Yuri shrugged. “I don’t need to, mate. The professor will say it for me. He’s asked to see you in his office.”
“Ah.”
“Rather you than me, by the look of him.”
I started getting up.
Yuri watched me carefully. “Don’t rush. Take a minute. Make sure you’re ready. Any dizziness or headaches, let me know.”
“I’m fine. Honestly.”
That wasn’t strictly true, but I didn’t feel as bad as I looked. Bloody scratches, and black bruises around my throat where she’d tried to strangle me—she’d dug so deep with her fingers, she’d drawn blood.
I knocked on the professor’s door. Diomedes’s eyes widened when he saw me. He tutted. “Po po po. Did you need stitches?”
“No, no, of course not. I’m fine.”
Diomedes gave me a disbelieving look and ushered me inside. “Come in, Theo. Sit down.”
The others were already there. Christian and Stephanie were standing. Indira was sitting by the window. It felt like a formal reception, and I wondered if I was about to get fired.
Diomedes sat behind his desk. He gestured to me to sit in the remaining empty chair. I sat. He stared at me in silence for a moment, drumming his fingers, deliberating what to say, or how to say it. But before he could make up his mind, he was beaten to it by Stephanie.
“This is an unfortunate incident. Extremely unfortunate.” She turned to me. “Obviously we’re all relieved you’re still in one piece. But that doesn’t alter the fact that it raises all kinds of questions. And the first is, what were you doing alone with Alicia?”
“It was my fault. I asked Yuri to leave. I take full responsibility.”
“On whose authority did you make that decision? If either of you had been seriously injured—”
Diomedes interrupted. “Please don’t let’s get dramatic. Thankfully neither was hurt.” He gestured at me dismissively. “A few scratches are hardly grounds for a court-martial.”
Stephanie pulled a face. “I don’t think jokes are really appropriate, Professor. I really don’t.”
“Who’s joking?” Diomedes turned to me. “I’m deadly serious. Tell us, Theo. What happened?”
I felt all their eyes on me; I addressed myself to Diomedes. I chose my words carefully. “Well, she attacked me. That’s what happened.”
“That much is obvious. But why? I take it was unprovoked?”
“Yes. At least, consciously.”
“And unconsciously?”
“Well, obviously Alicia was reacting to me on some level. I believe it shows us how much she wants to communicate.”
Christian laughed. “You call that communication?”
“Yes, I do. Rage is a powerful communication. The other patients—the zombies who just sit there, vacant, empty—they’ve given up. Alicia hasn’t. Her attack tells us something she can’t articulate directly—about her pain, her desperation, her anguish. She was telling me not to give up on her. Not yet.”
Christian rolled his eyes. “A less poetic interpretation might be that she was off her meds and out of her mind.” He turned to Diomedes. “I told you this would happen, Professor. I warned you about lowering the dose.”
“Really, Christian?” I said. “I thought it was your idea.”
Christian dismissed me with a roll of his eyes. He was a psychiatrist through and through, I thought. By that I mean psychiatrists tend to be wary of psychodynamic thinking. They favor a more biological, chemical, and, above all, practical approach—such as the cup of pills Alicia was handed at every meal. Christian’s unfriendly, narrow gaze told me that there was nothing I could contribute.
Diomedes, however, eyed me more thoughtfully. “It hasn’t put you off, Theo, what happened?”
I shook my head. “On the contrary, I’m encouraged.”
Diomedes nodded, looking pleased. “Good. I agree, such an intense reaction to you is certainly worth investigating. I think you should keep going.”
At this Stephanie could restrain herself no longer. “That’s absolutely out of the question.”
Diomedes kept talking as if she hadn’t spoken. He kept looking at me. “You think you can get her to talk?”
Before I could reply, a voice said from behind me, “I believe he can, yes.”
It was Indira. I’d almost forgotten she was there. I turned around.
“And in a way,” Indira said, “Alicia has begun to talk. She’s communicating through Theo—he is her advocate. It’s already happening.”
Diomedes nodded. He looked pensive for a moment. I knew what was on his mind—Alicia Berenson was a famous patient, and a powerful bargaining tool with the Trust. If we could make demonstrable progress with her, we’d have a much stronger hand in saving the Grove from closure.
“How long to see results?” Diomedes asked.
“I can’t answer that,” I said. “You know that as well as I do. It takes as long as it takes. Six months. A year. Probably longer—it could be years.”
“You have six weeks.”
Stephanie drew herself up and crossed her arms. “I am the manager of this unit, and I simply cannot allow—”
“I am clinical director of the Grove. This is my decision, not yours. I take full responsibility for any injuries incurred upon our long-suffering therapist here,” Diomedes said, winking at me.
Stephanie didn’t say anything further. She glared at Diomedes, then at me. She turned and walked out.
“Oh, dear,” Diomedes said. “You appear to have made an enemy of Stephanie. How unfortunate.” He shared a smile with Indira, then gave me a serious look. “Six weeks. Under my supervision. Understand?”
I agreed—I had no choice but to agree. “Six weeks.”
“Good.”
Christian stood up, visibly annoyed. “Alicia won’t talk in six weeks, or sixty years. You’re wasting your time.”
He walked out. I wondered why Christian was so positive I would fail.
But it made me even more determined to succeed.