A Mind to Murder

There is only a small number of autonomous psychiatric outpatient clinics in London and it is obvious that these units, dealing as they do with the same medical specialty and organized within a unified National Health Service, must inevitably have some methods of treatment and administrative proceedures in common. A number of these they share with the Steen Clinic. It is the more important to state clearly that the Steen is an imaginary clinic situated in an imaginary London square, that none of its patients or staff, medical or lay, represent living people and that the deplorable events which took place in its basement have their origin only in that curious psychological phenomenon—the imagination of the crime novelist.

—P. D. James

Dr. Paul Steiner, consultant psychiatrist at the Steen Clinic, sat in the front ground-floor consulting room and listened to his patient’s highly rationalized explanation of the failure of his third marriage. Mr. Burge lay in comfort on a couch, the better to expound the complications of his psyche. Dr. Steiner sat at his head in a chair of the carefully documented type which the Hospital Management Committee had decreed for the use of consultants. It was functional and not unattractive but it gave no support to the back of the head. From time to time a sharp jerk of his neck muscles recalled Dr. Steiner from momentary oblivion to the realities of his Friday evening psychotherapy clinic. The October day had been very warm. After a fortnight of sharp frosts, during which the staff of the clinic had shivered and pleaded, the official date for starting the central heating had coincided with one of those perfect autumn days when the city square outside had brimmed with yellow light and the late dahlias in the railed garden, bright as a paintbox, had shone like the gauds of high summer. It was now nearly seven o’clock. Outside, the warmth of the day had
long given way first to mist and then to chilly darkness. But here, inside the clinic, the heat of noon was trapped, the air, heavy and still, seemed spent with the breath of too much talking.

Mr. Burge enlarged on the immaturity, coldness and insensitivity of his wives in a querulous falsetto. Dr. Steiner’s clinical judgement, not uninfluenced by the late effects of a large lunch and the unwise choice of a cream doughnut with his afternoon tea, told him that the time was not yet ripe to point out that the one defect shared by the three mesdames Burge had been a singular lack of judgement in their choice of husband. Mr. Burge was not yet ready to face the truth of his own inadequacy.

Dr. Steiner felt no moral indignation about his patient’s behaviour. It would indeed have been most unethical had any such improper emotion clouded his judgement. There were few things in life which aroused Dr. Steiner’s moral indignation and most of them affected his own comfort. Many of them were indeed concerned with the Steen Clinic and its administration. He disapproved strongly of the administrative officer, Miss Bolam, whose preoccupation with the number of patients he saw in a session and the accuracy of his travelling expense form he saw as part of a systematic policy of persecution. He resented the fact that his Friday evening clinic coincided with Dr. James Baguley’s electroconvulsive therapy session so that his psychotherapy patients, all of them of high intelligence and sensible of the privilege of being treated by him, had to sit in the waiting room with the motley crowd of depressed suburban housewives and ill-educated psychotics that Baguley seemed to delight in collecting. Dr. Steiner had refused the use of one of the third-floor consulting rooms. These had been formed by partitioning the large and elegant Georgian rooms and he despised them as badly proportioned and unpleasing cells, ill-suited either to his grade or to the importance of his
work. Nor had he found it convenient to change the time of his session. Baguley, therefore, should change his. But Dr. Baguley had stood firm and in this, too, Dr. Steiner had seen the influence of Miss Bolam. His plea that the ground-floor consulting rooms should be soundproofed had been turned down by the Hospital Management Committee on the grounds of expense. There had, however, been no demur over providing Baguley with a new and highly expensive contraption for shocking his patients out of the few wits they still possessed. The matter had, of course, been considered by the Clinic Medical Committee but Miss Bolam had made no secret of where her sympathies lay. In his diatribes against the administrative officer, Dr. Steiner found it convenient to forget that her influence over the Medical Committee was non-existent.

It was difficult to forget the irritations of the ECT session. The clinic building had been put up when men built to last, but even the sturdy oak door of the consulting room could not muffle the comings and goings of a Friday night. The front door was closed at six p.m. and patients at the evening clinics were booked in and out since the time, over five years ago, when a patient had entered unobserved, secreted herself in the basement lavatory and chosen that insalubrious place in which to kill herself. Dr. Steiner’s psychotherapy sessions were punctuated by the ringing of the front-door bell, the passing of feet as patients came and went, the hearty voices of relatives and escorts exhorting the patient or calling goodbyes to Sister Ambrose. Dr. Steiner wondered why relatives found it necessary to shout at the patients as if they were deaf as well as psychotic. But possibly after a session with Baguley and his diabolic machine, they were. Worst of all was the clinic domestic assistant, Mrs. Shorthouse. One might imagine that Amy Shorthouse could do the cleaning early in the mornings as was surely the
normal arrangement. That way there would be the minimum of disturbance to the clinic staff. But Mrs. Shorthouse maintained that she couldn’t get through the work without an extra two hours in the evenings and Miss Bolam had agreed. Naturally, she would. It appeared to Dr. Steiner that very little domestic work was done on Friday evenings. Mrs. Shorthouse had a predilection for the ECT patients—indeed, her own husband had once been treated by Dr. Baguley—and she was usually to be seen hanging around the hall and the ground-floor general office while the session was being held. Dr. Steiner had mentioned it at the Medical Committee more than once and had been irritated by his colleagues’ general uninterest in the problem. Mrs. Shorthouse should be kept out of sight and encouraged to get on with her work, not permitted to stand around gossiping with the patients. Miss Bolam, so unnecessarily strict with other members of the staff, showed no inclination to discipline Mrs. Shorthouse. Everyone knew that good domestic workers were hard to get but an administrative officer who knew her job would recruit them somehow. Weakness solved nothing. But Baguley could not be persuaded to complain about Mrs. Shorthouse and Bolam would never criticize Baguley. The poor woman was probably in love with him. It was up to Baguley to take a firm line instead of sloping around the clinic in that ridiculously long white coat which made him look like a second-rate dentist. Really, the man had no idea of the dignity with which a consultant clinic should be conducted.

Clump, clump went someone’s boots along the passage. It was probably old Tippett, a chronic schizophrenic patient of Baguley’s who for the past nine years had regularly spent Friday evenings carving wood in the art therapy department. The thought of Tippett increased Dr. Steiner’s petulance. The man was totally unsuitable for the Steen. If he were well
enough to be out of hospital, which Dr. Steiner doubted, he ought to attend a day hospital or one of the County Council’s sheltered workshops. It was patients like Tippett who gave the clinic a dubious reputation and obscured its real function as an analytically orientated centre of psychotherapy. Dr. Steiner felt positively embarrassed when one of his own carefully selected patients encountered Tippett creeping about the clinic on a Friday evening. Tippett wasn’t even safe to be out. One day there would be an incident and Baguley would find himself in trouble.

Dr. Steiner’s happy contemplation of his own colleague in trouble was punctured by the ring of the front-door bell. Really, it was impossible! This time it was apparently a hospital-car-service driver calling for a patient. Mrs. Shorthouse went to the door to speed them away. Her eldritch screech echoed through the hall. “Cheerio, ducks. See you next week. If you can’t be good, be careful.”