Алекс Михаэлидес - The Silent Patient

“I want to ask you something. About Alicia.”

“Alicia Berenson?” Diomedes gave me a strange look. “What about her?”

“I’m curious what kind of therapeutic work is being done with her. Is she in individual therapy?”

“No.”

“Is there a reason?”

“It was tried—and abandoned.”

“Why was that? Who saw her? Indira?”

“No.” Diomedes shook his head. “I saw Alicia myself, as a matter of fact.”

“I see. What happened?”

He shrugged. “She refused to visit me in my office, so I went to see her in her room. During the sessions, she simply sat on her bed and stared out of the window. She refused to speak, of course. She refused to even look at me.” He threw up his hands, exasperated. “I decided the whole thing was a waste of time.”

I nodded. “I suppose … well, I’m wondering about the transference.…”

“Yes?” Diomedes peered at me with curiosity. “Go on.”

“It’s possible, isn’t it, that she experienced you as an authoritarian presence … perhaps—potentially punitive? I don’t know what her relationship with her father was like, but…”

Diomedes listened with a small smile, as if he were being told a joke and anticipating the punch line. “But you think she might find it easier to relate to someone younger? Let me guess.… Someone like you? You think you can help her, Theo? You can rescue Alicia? Make her talk?”

“I don’t know about rescuing her, but I’d like to help her. I’d like to try.”

Diomedes smiled, still with the same sense of amusement. “You are not the first. I believed I would succeed. Alicia is a silent siren, my boy, luring us to the rocks, where we dash our therapeutic ambition to pieces.” He smiled again. “She taught me a valuable lesson in failure. Perhaps you need to learn the same lesson.”

I met his gaze defiantly. “Unless, of course, I succeed.”

Diomedes’s smile vanished, replaced by something harder to read. He remained silent for a moment, then made a decision.

“We’ll see, shall we? First, you must meet Alicia. You’ve not been introduced to her yet, have you?”

“Not yet, no.”

“Then ask Yuri to arrange it, will you? Report back to me afterwards.”

“Good.” I tried to conceal my excitement. “I will.”

CHAPTER SEVEN

THE THERAPY ROOM WAS A SMALL, narrow rectangle; as bare as a prison cell, or barer. The window was closed and barred. A bright pink box of tissues on the small table struck a discordantly cheerful note—presumably it was placed there by Indira: I couldn’t imagine Christian offering tissues to his patients.

I sat on one of two battered, faded armchairs. The minutes passed. No sign of Alicia. Perhaps she wasn’t coming? Perhaps she had refused to meet me. She would be perfectly within her rights.

Impatient, anxious, nervous, I abandoned sitting and jumped up and walked to the window. I peered out between the bars.

The courtyard was three stories below me. The size of a tennis court, it was surrounded by tall redbrick walls, walls that were too high to climb, though doubtless some had tried. Patients were herded outside for thirty minutes of fresh air every afternoon, whether they wanted it or not, and in this freezing weather I didn’t blame them for resisting. Some stood alone, muttering to themselves, or they paced back and forth, like restless zombies, going nowhere. Others huddled in groups, talking, smoking, arguing. Voices and shouts and strange excitable laughter floated up to me.

I couldn’t see Alicia at first. Then I located her. She was standing alone at the far end of the courtyard, by the wall. Perfectly still, like a statue. Yuri walked across the courtyard toward her. He spoke to the nurse standing a few feet away. The nurse nodded. Yuri went up Alicia cautiously, slowly, as you might approach an unpredictable animal.

I had asked him not to go into too much detail, merely to tell Alicia the new psychotherapist at the unit would like to meet her. I requested he phrase it as a request, not a demand. Alicia stood still as he spoke to her. But she neither nodded nor shook her head nor gave any indication of having heard him. After a brief pause, Yuri turned and walked off.

Well, that’s it, I thought—she won’t come. Fuck it, I should have known. The whole thing has been a waste of time.

Then, to my surprise, Alicia took a step forward. Faltering a little, she shuffled after Yuri across the courtyard—until they disappeared from view under my window.

So she was coming. I tried to contain my nerves and prepare myself. I tried to silence the negative voice in my head—my father’s voice—telling me I wasn’t up to the job, I was useless, a fraud. Shut up, I thought, shut up, shut up—

A couple of minutes later, there was a knock at the door.

“Come in.”

The door opened. Alicia was standing with Yuri in the corridor. I looked at her. But she didn’t look at me; her gaze remained downcast.

Yuri gave me a proud smile. “She’s here.”

“Yes. I can see that. Hello, Alicia.”

She didn’t respond.

“Won’t you come in?”

Yuri leaned forward as if to nudge her, but he didn’t actually touch her. Instead he whispered, “Go on, honey. Go in and take a seat.”

Alicia hesitated. She glanced at him, then made a decision. She walked into the room, slightly unsteadily. She sat on a chair, silent as a cat, her trembling hands in her lap.

I was about to shut the door, but Yuri didn’t leave. I lowered my voice. “I can take it from here, thanks.”

Yuri looked worried. “But she’s on one-on-one. And the professor said—”

“I’ll take full responsibility. It’s quite all right.” I took my personal attack alarm out of my pocket. “See, I have this—but I won’t need it.”

I glanced at Alicia. She gave no indication she had even heard me.

Yuri shrugged, obviously unhappy. “I’ll be on the other side of the door, just in case you need me.”

“That’s not necessary, but thanks.”

Yuri left, and I closed the door. I placed the alarm on the desk. I sat opposite Alicia. She didn’t look up. I studied her for a moment. Her face was expressionless, blank. A medicated mask. I wondered what lay beneath.

“I’m glad you agreed to see me.” I waited for a response. I knew there wouldn’t be one. “I have the advantage of knowing more about you than you do about me. Your reputation precedes you—your reputation as a painter, I mean. I’m a fan of your work.” No reaction. I shifted in my seat slightly. “I asked Professor Diomedes if we might talk, and he kindly arranged this meeting. Thank you for agreeing to it.”

I hesitated, hoping for an acknowledgment of some kind—a blink, a nod, a frown. Nothing came. I tried to guess what she was thinking. Perhaps she was too drugged up to think anything at all.

I thought of my old therapist, Ruth. What she would do? She used to say we are made up of different parts, some good, some bad, and that a healthy mind can tolerate this ambivalence and juggle both good and bad at the same time. Mental illness is precisely about a lack of this kind of integration—we end up losing contact with the unacceptable parts of ourselves. If I was to help Alicia, we would have to locate the parts she had hidden from herself, beyond the fringes of consciousness, and connect the various dots in her mental landscape. Only then could we put into context the terrible events of that night she killed her husband. It would be a slow, laborious process.

Normally when beginning with a patient, there is no sense of urgency, no predetermined therapeutic agenda. Normally we start with many months of talking. In an ideal world, Alicia would tell me about herself, her life, her childhood. I would listen, slowly building up a picture until it was complete enough for me to make accurate, helpful interpretations. In this case, there would be no talking. No listening. The information I needed would have to be gathered through nonverbal clues, such as my countertransference—the feelings Alicia engendered in me during the sessions—and whatever information I could gather from other sources.