Алекс Михаэлидес - The Silent Patient

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.