The Silent Patient (3 page)

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.

“Theo. There you are. Join us, join us.”

He spoke with a slight Greek accent, barely detectable—he’d mostly lost it, having lived in England for over thirty years. He was handsome, and although in his sixties, he looked much younger—he had a youthful, mischievous manner, more like an irreverent uncle than a psychiatrist. This isn’t to say he wasn’t devoted to the patients in his care—he arrived before the cleaners did in the morning and stayed long after the night team had taken over from the day staff, sometimes spending the night on the couch in his office. Twice divorced, Diomedes was fond of saying his third and most successful marriage was to the Grove.

“Sit down here.” He gestured to an empty chair by his side. “Sit, sit, sit.”

I did as he asked.

Diomedes presented me with a flourish. “Allow me to introduce our new psychotherapist. Theo Faber. I hope you will join me in welcoming Theo to our little family—”

While Diomedes spoke, I glanced around the circle, looking for Alicia. But couldn’t see her anywhere. Apart from Professor Diomedes, impeccably dressed in suit and tie, the others were mostly in short-sleeved shirts or T-shirts. It was hard to tell who was a patient and who was a member of staff.

A couple of faces were familiar to me—Christian, for instance. I had known him at Broadmoor. A rugby-playing psychiatrist with a broken nose and a dark beard. Good-looking in a bashed-up kind of way. He’d left Broadmoor soon after I arrived. I didn’t like Christian much, but to be fair I hadn’t known him well, as we didn’t work together for long.

I remembered Indira, from the interview. She smiled at me, and I was grateful, for hers was the only friendly face. The patients mostly glared at me with surly mistrust. I didn’t blame them. The abuses they had suffered—physical, psychological, sexual—meant it would be a long time before they could trust me, if ever. The patients were all women—and most had course features, lined, scarred. They’d had difficult lives, suffering from horrors that had driven them to retreat into the no-man’s-land of mental illness; their journey was etched into their faces, impossible to miss.

But Alicia Berenson? Where was she? I looked around the circle again but still couldn’t find her. Then I realized—I was looking right at her. Alicia was sitting directly opposite me, across the circle.

I hadn’t seen her because she was invisible.

Alicia was slumped forward in the chair. She was obviously highly sedated. She was holding a paper cup, full of tea, and her trembling hand was spilling a steady stream of it onto the floor. I restrained myself from going over and straightening her cup. She was so out of it I doubt she’d have noticed if I had.

I hadn’t expected her to be in such bad shape. There were some echoes of the beautiful woman she had once been: deep blue eyes; a face of perfect symmetry. But she was too thin and looked unclean. Her long red hair was hanging in a dirty, tangled mess around her shoulders. Her fingernails were chewed and torn. Faded scars were visible on both her wrists—the same scars I’d seen faithfully rendered in the
Alcestis
portrait. Her fingers didn’t stop trembling, doubtless a side effect of the drug cocktail she was on—risperidone and other heavyweight antipsychotics. And glistening saliva was collecting around her open mouth, uncontrollable drooling being another unfortunate side effect of the medication.

I noticed Diomedes looking at me. I pulled my attention away from Alicia and focused on him.

“I’m sure you can introduce yourself better than I can, Theo,” he said. “Won’t you say a few words?”

“Thank you.” I nodded. “I don’t really have anything to add. Just that I’m very happy to be here. Excited, nervous, hopeful. And I’m looking forward to getting to know everyone—particularly the patients. I—”