major road junctions and mobile phones; that my plumbing will break down—and my bladder; that I will be locked out of my house; that along with my keys I may lose my mind. And, of course, my presence in the world has always had a touch of the provisional about it.
But then, as it seems to me now, from my present vantage point, I was in the thick of things. It is a commonplace that it is part of life’s tragedy that while it must be lived forwards it can only be understood backwards; but maybe it can only be appreciated backwards as well. In any case, in those days I had some sort of notion that I knew what I was doing. Perhaps without that feeling we can’t survive.
There’s a party game in which someone goes out of the room and those left pick a member of the group whose identity is gradually revealed through answers to the ignorant interlocutor’s questions: If X were a film what film would he or she be? If a book what book? If a colour, car, item of clothing, meal, country, dog, flower, painting…? And so on. I don’t know when it was that I found that this was a handy device for formulating an impression of the person whose essence I was in a sense trying to discern. After a couple of meetings I would jot down, for example, ‘red, ferret, Jane Eyre’, or ‘bulldog, jeep, Ian Fleming’, you get the idea. I used this as a kind of shorthand to myself, a way of setting in my mind the co-ordinates of the personality I would be sitting with.
The postcard I’m looking at is a little dog-eared and faded but the writing is firm. The comments are few:
Cruikshank, Elizabeth.
Suicide.
Elegant. Guarded.
Attractive voice. Quiet.
Azure blue. Swallow.
A hinterland person.
Beside the word ‘Swallow’ the initials ‘JA’ have been crossed out.
Another lesson I learned from Gus was to ask, ‘What do I want to do with this patient?’ Not, as he was at pains to point out, should or may I do, or even can I do, but what, in a world without consequences, do I want to do? In theory, this could produce some disturbing answers, though the number of shrinks who actually want to have sex with their patients is fewer than you might imagine. But it’s not unusual to want to hold or hug or touch the hand or shoulder of those we feel for, even in circumstances where to feel for another’s pain is not an inherent part of what is expected of us. Most doctors, if they permitted themselves, would admit to those normal, everyday human impulses which the nature of the work obliges us in practice to check.
Such inclinations take more intangible forms, too. At that time, Jane Austen was my staple reading, a bulwark, I dare say, against my more disturbing professional encounters. For me to think of someone as a character in Jane Austen was a compliment. But, truth to tell, psychiatric patients are not really Jane Austen people. The Austen world has its quota of narcissists, hypochondriacs, low-grade psychotics and the marginally depressed. But none would fetch up in a psychiatric unit. What the postcard, with the crossed-out initials of my favourite novelist, reveals to me now is that here was someone who, from the first, counted for me, and counted enough that I associated her with my own inner world.
My room at St Christopher’s was a pleasant one, overlooking the back garden, and the chairs were arranged to ensure a view both for myself and my patients. In my mind’s eye, I see Elizabeth Cruikshank, looking out at a quince tree. This tree was a refugee from the days when this part of the hospital was a substantial private house, with the kind of garden that included orchards and well-stocked herbaceous borders. Most of this land had been sold off and was now taken up by the blocks of flats surrounding the hospital, whose inhabitants made occasional protesting petitions at being obliged to live cheek by jowl with the mentally disturbed. The beds at the front of the hospital had, by this time, acquired a municipal look: lobelias and scarlet salvias. But where a corner of the original gardens had been annexed, a couple of the old fruit trees had been preserved.
In spring, the quince was lit with a pale pink translucent blossom, but it wasn’t spring when Elizabeth Cruikshank and I met. That autumn the south coast was experiencing unusually foul weather. She arrived regularly and on time, lowered herself, in a way which suggested extreme fragility, into the blue brocade chair which was once my mother’s, and sat, as the wind whipped the branches of the old quince, saying nothing but staring out at the tree, which seemed to hold for her a persistent fascination.
There are different qualities to silences and in my job you learned to read them, like an old-style weatherman observing skies or an experienced fisherman reading surfaces of water for signs of imminent fish. I, for one, welcomed them. There are few jobs where you are paid to sit quietly and in the silences ideas have come to me which voluble transactions would have scared away. My patient sat wrapped in her invisible mantle to protect the wounds which had brought her to me, while I sat, a little at a distance, at a discreet angle from her, saying nothing too. There was no antagonism in her demeanour. It conveyed only a lack-lustre indifference, as if I was part of the furniture of a cell—a nun’s or prisoner’s—an unregarded bystander to her pensive preoccupation.
I have no accurate recall of the number of meetings the two of us sat like this and I became somewhat used to sitting, at my odd angle, alongside her. Her mute presence did not disturb me, other than through my growing sense of the extent of this uncharted pain.
But one day, when the weather was particularly violent, after staring a while at the tree outside, she volunteered, ‘It could blow down in that wind.’
‘Yes, it might,’ I agreed, trying to conceal any off-putting excitement.
She made no follow-up to this, so after a decent pause I hazarded, ‘Do you feel you might blow down too?’ The grey eyes grazed mine and looked away. ‘Or you mightn’t survive a storm?’
She made a gesture, as if shrugging the invisible protective mantle closer round her, but we had made some sort of contact so I pressed on.
I first met Gus Galen at the big biennial conference on anxiety and depression. He would probably be either thrown out or not taken on at all by today’s medical faculties. The son of an East End tailor, he was one of those annoying prodigies who won a scholarship to Cambridge at sixteen, read Greats, became a classics don, gave that up and trained as a medic, specialised in neurology and then found he took more interest in the impalpable than the substantive workings of the mind. By the time we met he’d had, I surmised, a fairly raffish past but there was a childlike innocence in him, which shone in his mild, slightly protuberant hazel eyes. These eyes fixed you with a guileless stare which the susceptible found hard to resist. But he also had a talent for making the kind of simple-sounding observation which permanently affects the way you think and feel.
I met him pacing the pavement outside the hotel where the conference was held and which I’d left to stretch my legs and take a breath of air. He had gone outside to smoke one of the dreadful miniature cigars that I was to learn he was never without.
‘Tell me, dear boy,’ he said (everyone was either a ‘dear girl’ or ‘dear boy’ to Gus, unless they were a ‘bitch’ or a ‘baboon’), darting over to catch my arm—he was a big man but with that nimbleness which big men, in defiance of gravity, sometimes display. ‘What did you think of Collier’s paper?’ Steve Collier was a hard-line drugs psychiatrist.
‘I thought it was pretty crude,’ I risked. For all I knew Gus was Collier’s best friend.
‘The man’s a bloody baboon,’ said Gus, and I felt I had passed some test. ‘Fancy a stroll?’
We walked down to the Thames and alongside the greygreen river,
