The Other Side of You

FOURTH ESTATE • London

For Xopher

Who is the third who walks always beside you?

When I count, there are only you and I together

But when I look ahead up the white road

There is always another one walking beside you

…

—But who is that on the other side of you?

The Waste Land, T. S. ELIOT

Table of Contents

Cover Page

Title Page

Dedication

Epigraph

Part I

1

2

3

4

5

6

7

8

9

10

11

Part II

1

2

3

4

5

6

7

8

9

10

11

12

13

Part III

1

2

3

4

5

Part IV

1

2

3

4

Acknowledgements

Also by Salley Vickers

Copyright

About the Publisher

Part I

When I count, there are only you and I together

1

SHE WAS A SLIGHT WOMAN, PALE, WITH TWO WINGS OF DARK hair which framed her face and gave it the faintly bird-like quality that characterised her person. Even at this distance of time, which has clarified much that was obscure to me, I find her essence hard to capture. She was youthful in appearance but there was also an air of something ambiguous about her which was both intriguing and daunting.

When we met she must have been in her forties, but in a certain light she could have been fourteen or four hundred—though when I say ‘light’ I perhaps mean that subtle light of the mind, which casts as many shadows as it illuminates but in the right conditions can reveal a person’s being more accurately than the most powerful beam.

Once I would have known her age to the day, since it would have been part of the bald list of information on her medical file: name, sex, date of birth. Of the last detail I have a hazy recollection that her birthday was in September. She spoke of it once in connection with the commencement of the school year and a feeling that, in the coincidence of the month of her birth and a new term, she might begin some new life. ‘You see, Doctor,’ —when she used my title she did so in a tone that located it at a fine point between irony and intimacy—‘even as a child I must have been looking for a fresh start.’

Doctors are like parents: there should be no favourites. But doctors and parents are human beings first and it is impossible to escape altogether the very human fact that certain people count. Of course everyone must, or should, count. We oughtn’t do what we do if that isn’t a fundamental of our instincts as well as of our professional dealings. But the peculiar spark that directs us towards our profession will have its own particular shape. I have had colleagues who come alive at a certain kind of raving, who perceive in the voices of the incurable schizophrenic a cryptic language, a Linear B, awaiting their special aptitude for decoding. One of my formidably brilliant colleagues has spent her life attempting to unravel the twisted minds of the criminally insane. It’s my opinion no one could ever disentangle that knot of evil and sickness, but for her it is the grail that infuses her work with the ardour of a mythic quest. My colleague, Dan Buirski, had a bee in his bonnet about eating disorders. I used to kid him, a long cadaver of a man himself, that he liked nothing more than a starving young woman to get his teeth into. I said once, ‘You’re no example, you’re a mere cheese paring yourself,’ and he laughed and said, ‘That’s why I understand them.’ He’s lucky with his metabolism, but his grandmother and his two uncles died in Treblinka. Starvation is in his blood and he’s converted that inheritance into a consuming interest in humankind’s relationship with food. It’s a strange business, ours.

And what was my peculiar bent, the glimmer in my eye which has in it the capacity to lead me into dangerous swamps and mires? For me it was the denizens of that hinterland where life and death are sister and brother, the suicidally disposed, who beckoned. Like is drawn to like. Alter the biographical circumstances a fraction and my colleague who worked with psychopaths would make an expert serial killer: she had just the right streak of fanatical perfectionism and the necessary pane of ice in the heart. And for all his badinage, Dan had a hard time keeping a scrap of flesh on him. I saw him once, after he’d had a bad bout of flu, and I nearly crossed myself he looked so like a vampire’s victim. But despite the concentration camps, death wasn’t his particular lure. That was my province.

It was a landscape I knew with that innate sense which people call ‘sixth’, with the invisible antennae that register the impalpable as no less real than a kick in the solar plexus from a startled horse. To some of us it can be more real. It is said that the dead tell no tales, but I wonder. When I was five, my brother, Jonathan, was killed by an articulated lorry. It was my third day of school and our mother was unwell; and because our school was close by, and my brother was advanced for his six and a half years, and was used to going to and from school alone, she allowed him to take me there unescorted. The one road we had to cross was a minor one but the lorry driver had mistaken his way and was backing round the corner as a preliminary to turning round. Jonny had stepped off the pavement and had his back to the lorry to beckon me across. Although he was mature for his age he was small, too small to figure in the mirror’s sight lines. I was on the pavement and I watched him vanish under the reversing lorry and I seem to remember—though this could be the construction of hindsight—that it was not until the vehicle started forward that I heard a thin, high scream, the sound I imagine a rabbit might make as a trap springs fatally on fragile bones.

I doubt there was a bone left unbroken in my brother’s body when the lorry drove off, leaving the mess of shattered limbs and blood and skin which had been Jonny. I believe I saw what was left of him, before I was whirled away in the big, freckled arms of Mrs Whelan, who lived across the street and had heard the scream and rushed me into her house, which Jonny and I had never liked because it smelled of dismally cooked food, and terrified me by falling on her knees and dragging me down with a confused screech, ‘Jesus, Mary and Joseph, the blessed lamb, may he rest in peace.’

Afterwards, I didn’t know where my brother was but I was pretty sure it wasn’t with Jesus, Mary or Joseph. The belief I clung to was that Jonny was still in the pine tree he had assured me was ‘magic’, on whose stately curving boughs we used to swing together in Chiswick Park. I heard him more than once, when I was allowed back to play there. He was singing ‘He’ll be coming round the mountain when he comes’, which was the song our mother sang when we were fretful, the two of us, on long car journeys. Later, when Mother had my twin sisters, born one behind the other within the hour, she sang other songs to them.

From that time onwards, it was always ‘the girls’ and ‘Davey’. I, Davey, was the wrong side of the unbridgeable fissure that had opened up in our family, and although I’m sure my parents loved me I was a reminder of that small bloody mess they’d left behind. The lorry driver never recovered and had to be pensioned off, unfit for work. But my mother was made of sterner stuff. She had in her a fund of life that was not to be defeated even by life’s only real enemy. She was not a woman who lived on easy terms with her emotions. She was the daughter of a judge and her upbringing, though liberal, had not bred in her a place for the easy expression of the finer shades of feeling. And I knew, too, though nothing in her outward demeanour ever gave this away, that if she could have chosen which son she had to lose it would not have been Jonny.

I didn’t blame her. After that, I was never going to be right for her again. I was the living witness to a calamity, the deeper reaches of which she could not afford to acknowledge if she was to continue to hold her self, and our family, together. Very likely she blamed me for the catastrophe. Why wouldn’t she? I blamed myself for it.

My mother, for my father’s sake, for them to go on together, and for the family to survive, had to set her shoulders and turn her back on the disaster. She faced a choice, and she made it by abandoning me and jumping the ravine which had opened with Jonny’s death to the other side. It was a leap to the side of life and the proof of this came in the form of my twin sisters, apples of my father’s eye and each other’s best companion.

For a long time I was expecting my lost brother to come round that mountain, with all the confidence with which he had stepped off the kerb of the pavement and into the lorry’s fatal path. He was my closest companion, my hero, my single most important attachment to life. And when he didn’t come, and I heard only the echo of his voice in my ear, as I swung alone on the low pine branch, pretending, for my mother’s sake, that I was enjoying myself, a part of me wanted to go after him, for company.

2

AT THE TIME I AM SPEAKING OF I WORKED IN TWO PSYCHIATRIC hospitals in the south of England: a big red-brick, mock-Gothic pile in Haywards Heath, and a cosier, less oppressive place near Brighton on the south coast. In addition, I had a small private practice, where occasionally I saw some paying patients.

From her appearance Mrs Cruikshank might have been one of those. She had the voice and mannerisms of someone born middle class. But I came to learn that this was part of a wellcrafted veneer—like a piece of good furniture, she had a discreet sheen which was far from ordinary. In fact, she was the child of two immigrants, her father an Italian communist, who had come to England before the war, her mother, a refugee from the prerevolutionary Yugoslavia, the illegitimate daughter of one of those two-a-penny Eastern European counts, or so she claimed. When I got to know her better, my patient told me she thought this may have been a compensating fantasy for the fact that her mother worked for a time as a dinner lady in the local primary school, the one her own daughter attended. Possibly the idea had conferred on the child a tincture of the aristocratic. Fantasies, if they are convinced enough, are also an element in the reality which shapes us and there was a tilt to my patient’s narrow nose which might have given an impression of looking down it.

She was the only child of a marriage that, given the natural antagonism of the backgrounds, was 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.

3

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 to be eroded. I am apprehensive now over matters that would have been unimaginable to me then: of trains, and timetables, 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.