bound to be somewhat rocky. The parents were ill-matched in character, as well as history. It was a pattern I recognised. The mother was pushy and ambitious, the father, though something of an intellectual, more passive, content to read about revolution in Marx and Lenin but to let his own life take its course without putting up much fight. They bickered constantly, and as a result my patient left home early, in order to escape an atmosphere which grew increasingly abrasive as her mother’s insatiable discontent was left unassuaged.
My patient was of the type of whom a first impression suggests that either they are phenomenally bright or slightly deficient. When I established that it was the former—though the very bright are almost by definition always also somewhere deficient—I recognised it as the kind of intelligence which is unconscious of its own reach. In my experience this is more often a feature of mental illness than is commonly acknowledged. Living in the world is hard enough, but if you see through it, yet lack the resources to deal with that keener vision, it can be a whole lot harder. I concluded that the school my patient had attended could not have provided the nourishment necessary to feed her potential. There had been none of those inspirational teachers who rescue many hidden intelligences. I thought it likely that the habit of concealment she had perfected at home had acted as a more general camouflage.
The effects of an unhappy beginning are various: shame, rage, anxiety, inhibition, insecurity, self-doubt, a propensity for self-harm; but there is one common factor: a fundamental mistrust, an insidious feeling that the world is not a place where you are welcome or can be at home. It can take a long time to get over that feeling—if it ever can be got over.
My first meeting with Mrs Cruikshank followed her admission to St Christopher’s, the smaller of the two hospitals I worked in. She was a suicide case, a serious one, and it was clear from the start she was not one of your manipulative females trying to make a boyfriend or husband feel guilty with a fistful of painkillers and a bottle of wine. She was saved by one of those chances that make you believe in a beneficent providence. I don’t know why there shouldn’t be one: there’s plenty of evidence of the baleful kind.
The man in the flat downstairs, whom she believed away on holiday, returned unexpectedly over some family crisis and needing his spare key rang my patient. Getting no reply, and assuming his upstairs neighbour was away, and his key being a matter of urgency, he let himself into her flat with a spare key with which he in turn had been entrusted. Having retrieved his own, hanging, as he knew it would be, by the front door, some instinct made him question the state of his neighbour’s flat. He was ex-army, and thus trained in that vigilance which is alert to small disjunctions. Perhaps it was the unusually closed state of all the doors in the hallway, the absolute absence of lights, or notes, or those small signs of incompletion which we leave behind us to remind the world—or ourselves—that we have not wholly gone away. There is a peculiar silence which attends all finalities and maybe this is what Major Wilks noted without quite being aware of what he was sensing. In any event, he defied what I took to be an essentially conservative character and investigated the closed rooms, where he found my patient beneath the heaped blankets, grey-skinned and somnolent and at death’s door.
Indeed, it seems she had all but crossed the threshold and had to be dragged back by medical main force. ‘We nearly lost her,’ Cath Maguire said, in the tone which indicated a suicide was the real McCoy and not a ‘time-waster’ (these were subject to Maguire’s basilisk look, probably more of a deterrent to future episodes of self-harm than any stomach pump). Maguire made sure, if she could, that the suicides got to me. For the reasons I’ve outlined I had a certain success in that department.
My wife, Olivia, would say that I was poor at first impressions. At dinner parties, when people discovered that I was both a psychiatrist and a trained analyst—the two are not synonymous: a psychiatrist is medically qualified and attempts to cure principally with drugs, while an analyst’s training, in Britain at least, is non-medical and the work is done entirely through words—they would often say something along the lines of ‘I’d better watch what I say or you’ll know all about me!’ Irritating, and, as Olivia would be swift to point out, quite off the mark. My disposition prefers to see the best in people until faced with the worst. This is not especially commendable in me: I’m aware that a seeming good nature often stems from fear.
Olivia, however, was adept at picking up the more negative elements of character. ‘A gold-digger,’ she would say contemptuously, when I ventured that some woman we met at a party seemed ‘awfully nice’. Or if I were to suggest that someone was ‘frightfully clever’: ‘Oh, darling, he’s just a stuffed shirt,’ she’d sigh, ‘I had the dullest conversation with him.’ Driving home, as we often were during these exchanges, I would sometimes catch myself flushing in the dark. I’ve often thought it would be no bad plan to drive at night with the light on—people will so often speak their minds in the dark.
In any event, I would tend to spend the first session with any new patient asking pretty mundane questions, hoping I was absorbing the myriad clues which human beings give off even in the simplest transactions: the set of the head, or the jaw, or the shoulders, the arms folded or relaxed, the play of the hands, the flicker of the eyelids, the pallor of the skin, the way the feet make contact with the ground, the pitch of the voice—crucial, for me, I find—the choice of vocabulary, the pace and cadence of the words, how the eyes would meet yours or look away. I could go on: the way the shirt is tucked into the trousers, or skirt, the colours and textures of the fabrics, the way the hair is worn, lipstick, nail varnish, earrings, aftershave, scent, shoes, the telltale signs of smoking, and drinking, the timbre, and frequency, of the laugh, the moisture in the eye, or on the skin, the posture in the chair, the poise of the head, the questions asked, or not asked—particularly not asked.
These signs are all registered subliminally so I have no note of my first meeting with Mrs Cruikshank. Except that I am sure that I asked about her name. Her forename, as I read on her file, was Elizabeth. But when I asked her if she was ‘Liz’, because it’s important to get the name straight from the beginning, she said, in a tone which I can still hear across all the intervening years, ‘No, Elizabeth.’
And there was another thing, though I can’t say I noticed it at our first meeting. She must have had a bag with her because once I had seen more of her I observed she was never without it. A brown leather bag, not bulky, more like a small-sized music case. Although, necessarily, she had to put it down she always made sure to keep it close by.
OLIVIA WAS RIGHT ABOUT MY FIRST IMPRESSIONS OF PEOPLE being at sea. But my second impressions, though I say it myself, are often spot on. I had a habit I’d picked up from Gus Galen, who supervised my analytic training. He told me that all he needed to know about a patient could be written down on a postcard. When a course of treatment finished he said he often looked back and saw that everything that had been uncovered could be discerned in what he had noted there. ‘It’s all in how you interpret information,’ he added. ‘It can take years to understand in your head what your gut knows from the start.’
So I do have a record of the next occasion I met Elizabeth Cruikshank since it was after that meeting that I made my notes. I no longer have access to any official files, and anyway I imagine the bulk of my case histories have either long gone through the shredder or are part of a disconnected account on some NHS database. But of my private postcard distillations there are a few I’ve chosen to retain.
Looking now at the card headed ‘Cruikshank, Elizabeth’, I see handwriting which is recognisably mine but bears the marks of someone younger. The letters are more capacious and better formed, as if my script has shrunk in proportion to my person. Nowadays, I’m conscious that my five feet eleven inches has dwindled, but the worst thing about ageing is not the physical diminishment. My belief that I am equal to ordinary events and encounters is beginning
