By the Time You Read This (21 page)

Through his various residencies his supervisors noted the young doctor’s particular affinity for depressed patients; his evaluations were uniformly excellent. His final residency was at the Kensington Clinic, where at the end of six months he was offered a staff position. He was dedicated, sensitive, and up-to-the-minute on the latest medications. His results spoke for themselves.

His first year was all work and success. Somehow along the way he found time to court Dorothy Miller, a nurse at the hospital. She found him a gentle and amusing bundle of nervous tics, what with his shoulder rolling and head shaking, and she admired him. For his part, he found Dorothy attractive, and liked it that she forced him to go to the occasional movie or dinner out, insisting that he live like a human being now and again.

It was during his second year as a full-fledged psychiatrist that he began to experience difficulties. Even thirty years later he remembered the first time the change had really taken hold. For some weeks he had been having more and more trouble listening to his patients. He would suddenly be startled to find they were asking him a question and he hadn’t heard it. Or they had just finished telling him something important and he had not responded. The patient would be sitting there looking at him expectantly and he hadn’t a clue what for.

Then one day a middle-aged man, married twelve years and a father of three, was telling him how deathly depressed he was, how he woke each morning with a groan and a curse because he could not face another day. And Bell felt a surge of anger in his belly. He couldn’t account for it; it seemed quite anomalous. His life was going well, he enjoyed his work and his patient had said nothing in particular to irk him, and yet he had felt anger radiating up from his belly and into his chest—so much so that he had a split-second fantasy of crossing the room and grabbing the man by his collar and shaking him. Hard.

That day the feeling passed quickly, but these surges became more and more frequent. And it wasn’t just this one patient who provoked them; it was all of his patients—at least, all of the depressed ones. It was an alarming development that threatened to become debilitating, and he was afraid to discuss it with any of his colleagues.

It became increasingly uncomfortable for him even to face his patients. He could not bear to hear how they hated themselves. Could not bear to hear them summarize their lives with deep derision. Could not bear to hear how the future held nothing for them, how they were sick of everything, sick of themselves. Especially themselves. It was torture.

And then one day it happened, the anger broke through.

Edgar Vail was a thirty-six-year-old commercial artist, admitted to the clinic after he had tried to kill himself by drowning only to discover that he was a better swimmer than he remembered. There was suicide in his family’s past, and the isolation of life in the present. Contributing factors were the sorrows of a recent divorce and a series of career disappointments. Plenty to be sad about, in other words.

He wanted to paint serious art. In fact, he did paint serious pictures, he just couldn’t get a gallery to handle his work or a single soul outside his immediate circle of friends to buy anything. He was going on about it, staring at the floor and shaking his head, and mumbling how he didn’t know why he bothered painting at all, how he should just throw away his brushes and give up entirely. It was a perfect mirror of his romantic life, he went on, all this effort, all this struggle, and nothing to show for it.

“Why don’t you just kill yourself?” Bell burst out. “Why not just do yourself in, and make a thorough job of it this time?”

Vail looked up sharply. The shock in his usually haunted eyes frightened Bell.

He had tried to recover, saying, “Well, I mean, I certainly didn’t intend it to sound so harsh. I just meant, there you were, you had a bottleful of Seconal at home, and yet you jump into water knowing perfectly well you can swim. My point being that you could have ended all this pain, this terrible pain you suffer from, right there with a few pills, and yet you chose not to. Why don’t we concentrate on what was behind that choice?”

The shock had dwindled in Vail’s eyes.

“I thought for a second there you were actually attacking me.”

“Good heavens, no. Last thing on earth I want to do. Please continue.”

The reassurance seemed to work. Vail sank back into the couch, and into the comfortable assumption that his psychiatrist was trying to help him.

Over the next few months, Bell set himself the task of learning to hide the anger. He tried reminding himself of happy events just before he had a scheduled session. That didn’t work; he simply forgot them in the face of his patients’ misery. He tried exercise, taking up rowing again. It made his muscles ache so much that his temper actually became worse—with everybody, not just patients.

But eventually he mastered his anger by training himself to not even feel it. And the way he did this was to behave just like any other psychiatrist. It came to him one afternoon when he was about to go out rowing. He stopped, with the oars in his hand, and sat down heavily on a bench beside the water.

The Thames shimmered, silver fringed with fire in the last of the afternoon light. He heard the lapping water, the breeze through the leaves, and all the million individual traffic noises. For some moments he had the sense that he was hearing a conversation taking place blocks away. A moment of hideous confusion, one might think, but Bell recognized it as absolute, razor-sharp clarity.

What he had realized in that instant was that you could use the tools of therapy in a brand new way, just as a surgeon might choose to employ his blade. You could ask the same questions, raise your eyebrows in just the same way, show great empathy, positive regard, all the rest of it. And yet you could skew it all just slightly, change the angle by a few degrees, and you could steer your patient in quite a different direction.

The next time Edgar Vail left his office, with a prescription for yet more sedatives, Bell spoke aloud to his book-lined walls.

“Kill yourself and get it over with, you pathetic waste of space.”

The words seemed to echo in the empty room, and Bell felt giddy. He began to laugh. It was all so simple; why hadn’t he seen it before? He laughed with surprise, with shock, with recognition, but also with the sheer hilarity of relief.

It was amazing how easy it was. Pick a patient who is desperately unhappy, take a few sessions to establish trust and empathy, then prescribe a month’s supply of sleeping pills. Barbiturates, they were, back then. Handled correctly, absolutely lethal.

In certain cases, like Edgar Vail’s, where the patient was consumed with self-loathing and yet still fully functional, you had to be sure they were aware of the right dosage. Too much—as Bell knew from his mother’s experience—and they throw up, possibly surviving. Too little, and they just end up with a bad hangover.

In other cases, where a patient was prostrate with the inarticulate grief that had eaten his father alive, Bell had to be a little more artful. In these cases what he did was schedule them for a Monday or Tuesday and send them home with a scrip for one of the tricyclics, something fast-acting. Come the weekend, the patient has the energy to pick up the gun, to climb to the roof, to tie the noose. It was like lighting a fuse. Of the first twenty suicides under his care, probably half came to their end this way. Another twenty-five percent (including Edgar Vail) chose sedatives. The rest had been so far gone they no doubt would have killed themselves anyway. Bell didn’t take credit for those.

But there were problems with the pharmaceutical approach. The simple fact was that it was
too
easy. Really, the drugs did all the work; any psychiatrist could have managed it. Also, it was risky. A large prescription for sedatives does not look good in the medical history of a suicidal patient, as the “wake-up-and-die” effect of tricyclics is well known. He had got into a spot of trouble in Swindon over this. Later on, too, in Manchester, there had been rumours of an inquiry, but that was about his mortality rate, not about over-prescribing per se. In any case, Bell had thought it prudent to move to Canada. He had long ago eased up on the chemicals, and now relied solely on his skills as a therapist.

31

M
ELANIE
G
REENE HAD ONLY
a few weeks to live—that was Dr. Bell’s professional estimate. She had done her homework this time, bringing in three—count ‘em, three!—suicide notes. Not that he would need them. If he couldn’t manipulate a miserable teenager into topping herself, he might as well take down his shingle. There would be no mistakes this time.

She told him about driving to her stepfather’s place, about her plan to tell his new wife about his sexual proclivities, and how seeing the little girl had prevented her. Such failure of nerve was typical with Melanie, and might prove a minor obstacle in getting her to make a decent exit. But only minor.

“What made you stop?” Bell said. “You were going to tell his new wife, why not tell his new daughter what he had done?”

“Well, she’s only around six years old, for one thing. Maybe seven.”

“You didn’t think a six-year-old should hear about such things?”

“No, of course not.”

“These things that were done to you at a similar age? When you were seven?”

“I don’t think little kids should even know about them, let alone do them. I mean, do
you
think people should be talking to six-year-olds about oral sex?”

“It’s your feelings that matter, Melanie.”

“Well, I’m not gonna talk to a little kid about that stuff. But the reason I stopped was just pure shock. I mean, bad enough The Bastard’s married again and he’s probably going to put this woman through hell. But to have another little kid. I was just, like, stunned. I nearly got run over by a car. She’s going to go through everything I went through on those fishing trips, on the boat, at WonderWorld.”

Dr. Bell felt his control slipping. There was a sudden heat in his hands and he realized he was imagining choking her, shaking her, screaming in her face, “Can’t you see? You don’t belong here. Do us all a favour and kill yourself once and for all.” It was a struggle to quiet the pounding in his chest. He decided to take Melanie out of the present and back to her traumas.

“What was the worst part of it? Back then, back when you were a little girl. What was truly the worst? Was it the physical pain?”

Melanie shook her head.

She’ll start chewing her knuckles in a minute, Bell thought.

As if he had willed it, her left hand rose to her mouth and paused there as she gnawed on a knuckle.

“There wasn’t usually any physical pain. Just once or twice when he, when he … you know. Oh, God. From behind.”

“Anal sex?”

“Um, yeah.”

“Did you bleed?”

She shook her head, stared at her feet. Bell saw her shiver as The Entity slipped into the room. The shadowed, hooded figure composed of ice and death enfolded the young woman under his caped arm.

“He was usually very careful that way,” Melanie said. “And mostly it was oral. My lips would be numb. Sometimes I was sore between my legs. A few times, when I couldn’t sleep, my mother asked me what was wrong, and I wanted to tell her. Oh, I wanted to tell her so bad.”

“But you didn’t.”

“No.”

“Because …”

“Because I was too afraid. He told me if anyone found out, the Children’s Aid would come and take me away. And he would go to prison.”

“So it wasn’t the physical pain that was the worst. Would you say it was the fear, then?”

Melanie nodded, hugging herself as if it were freezing in the room, though in fact the sunlight through the windows had overheated the office.

“I was afraid all the time. I was terrified of being found out.”

“Because of the consequences you just mentioned?”

“Yes. But also—this was later, when I was thirteen or so—I was afraid of Mom finding out. Because I knew it would hurt her. And because I knew I was taking something that was hers. I was doing something wrong to my own mother.”

“You were sleeping with her husband.”

That should open the spigot, Bell thought, noting the gulping movement in her throat.

“It’s like I was the other woman. It’s …”

The tears would not be stopped. They burst from her with pitiful cries, and she seemed to shatter.

Dr. Bell handed her the Kleenex box and waited. He marvelled at the power of guilt. Properly administered, it was far more potent than any drug.

When there came a lull in Melanie’s sobs, he said: “So you had to deal with the fear. You had to deal with the guilt of stealing your mother’s man. It’s a lot for a little girl to cope with. But let’s go back to WonderWorld. Something you said earlier made me think that WonderWorld might be the worst, but we haven’t gone into any detail yet.”

Melanie nodded. Tears had reddened her eyes, streaked her makeup. The Entity had transformed her into a rag doll.

Generally, in therapy, the patient is allowed to move at their own speed. It’s usually counterproductive to push, the risks being twofold: either the material is too much for the patient to digest, causing them to develop an even thicker armour of denial, or it can unleash a torrent of emotion for which they are not adequately prepared. Depending on the presenting neurosis, this can result in any number of ways of acting out: running away, rages, and, of course, suicide.

And so Dr. Bell prompted his patient for detail. Melanie was young and passionate and had a strong drive to be rid of her pain; Dr. Bell knew he could count on that.

“First, let me be sure I understand you correctly. You were dying to go on all the rides at WonderWorld, and that’s exactly what he promised you. So you get down there, he has you in a hotel room and he won’t let you go on the rides until you satisfy him. For you to get the rides, you had to give him sex.”

“Right.”

“You hinted at this, I think, when you said he had asked you ahead of time for a list of your favourite rides. Sort of a Christmas list. You mentioned the Tilt-A-Whirl.”

“That’s right. If I wanted to go on the Tilt-A-Whirl he, uh …”

“Take your time, Melanie.”

She pulled out the whole array of delaying tactics: looked at her feet, stared at her fingernails, heaved deep sighs, stared out the window, looked at the clock. Finally, when there was no option left short of complete catatonia, she said—and this in a voice so tiny Bell had to lean forward to catch it—”If I wanted to go on the Tilt-A-Whirl, I had to give him oral sex.”

Her right hand rose, fanlike, to cover her face.

“So, it was like a contract. A negotiation, perhaps.”

A shake of the head. “There wasn’t any negotiating. He just told me the way things were, you know. I was eight years old, for God’s sake. I didn’t question him. He was my father. I thought of him as my father, anyway. He’d been living with us a couple of years by then.”

“And did he get what he wanted?”

“Yes.”

“And you got the Tilt-A-Whirl.”

“Yes.”

Bell let her weep again, watched the face crumple and the mucus run, listened to the ugly cries. He didn’t let it go on too long; he needed the momentum.

“And there was the waterslide,” he said. “I believe you indicated that that was on your list.”

Melanie nodded. “I’m feeling a little sick. Do you think maybe …”

“Would you like to lie down? Sometimes going over old pain can be overwhelming.”

“Um, maybe I will.” Melanie got up unsteadily. “It seems like such a cartoon—you know, lying on a psychiatrist’s couch—you see jokes about it all the time. But I’m feeling really dizzy.”

“Lie down, then. No jokes, I promise.”

She lay down, gingerly, feet politely hanging off to one side. She took one of the cushions and was about to place it on the floor, thought better of it and placed it over her genital region. Sometimes patients could be so eloquent without knowing it. A shaft of sunlight made her hair shine.

“You were talking about the waterslide.”

“Yeah. I really wanted the waterslide. I think that was the single most fun I ever had as a kid was flying down that slide. It’s such a thrill, but it feels completely safe at the same time.”

“What did he suggest you do in exchange?”

“He didn’t
suggest
anything. There wasn’t any maybe about it. He just laid down the law.”

“But didn’t you say he told you that if you wanted to go on one ride, you’d have to do this? If you wanted to go on another ride, you’d have to do that? Wasn’t he in effect giving you a menu of choices?”

“I suppose so.”

“And you chose the waterslide?”

“Right.”

“Chose it. You weren’t forced to go on it, were you?”

“I guess not. Oh, God.”

“And what did it cost you? What was the going price of a ride on the waterslide that particular summer day?”

“I had to let him … well, intercourse, I guess.”

“Full intercourse. Vaginal intercourse.”

“Yeah.”

“And you did that?”

He had to wait a long time while she wept.

“And then there was the Wild Mouse,” Bell said. “Your absolute favourite, you said. You couldn’t wait to go on it.”

“Anal sex,” she said, just like that, her voice dead. “If I wanted to go on the Wild Mouse, he had to get anal sex.”

“And did he?”

“Yes. He turned me into a little whore. Just turning eight, and already a prostitute.”

“Keep in mind, Melanie, the age of consent in this country is fourteen years old. Almost twice the age you were.”

It cost Bell a lot to say that, and Melanie received it like balm. He could see the effect right away: her lower lip began to quiver. It cost him, but anything less might have struck her as callous, which could provoke anger and resistance he would only have to break down again. So if a little kindness and understanding added a week or two until endgame, that was just the price of being a professional.

“That’s in Canada,” he went on, “and a lot of people in this country think the age of consent should be much higher. In most other places, it is. In the U. K., anyone under sixteen is considered to be incapable of giving an informed consent. You were seven, Melanie. Just turning eight.”

“It’s not like I didn’t know what he was doing. By the time he took me to WonderWorld, he’d already introduced me to all of it.”

“Nevertheless, Melanie, we’re talking about rape here.”

“All right.”

It was hard, sometimes, to be so comforting. It went against the grain, felt as if he were working against himself. But it was also necessary. They had to believe you were on their side, that you were saving them from themselves.

“So, would you say, then, we’ve gotten to the worst of things, Melanie? He made you feel like the Other Woman. And he made you feel like a whore. It’s as if he turned WonderWorld into a House of Horrors.”

She sat up suddenly, gripping the edges of the couch. “WonderWorld wasn’t the worst,” she said. “Despite everything that happened there? WonderWorld wasn’t the worst, not by a long shot.”

“I must have misunderstood, then. You’re telling me there were other times, other places, when your stepfather did even worse things to you?”

“No. Not things he did. WonderWorld was as bad as it got, physically. But he did those same things to me in other places. Even at home, if you want to know the truth. Even in my mother’s bed, sometimes. Can you imagine? That Bastard. In my mother’s bed. But even that wasn’t the worst.” She lay back again, her rib cage rising and falling with laboured breathing. “The worst was the boat.”

“The fishing trips you mentioned before? The camping and so on?”

Melanie shook her head. “No. This was a different boat. A beautiful cabin cruiser. I think he must have borrowed it or something, or maybe he was looking after it for someone. It was just a couple of times, when I was about eleven. There was the time my mother was on the boat. But there was another time when it was just me and him. It was toward the end of the whole business. He took a lot of pictures.”

“Sexual poses. Like before?”

“Some of them were normal. I guess so he could show them to Mom—you know, ‘Here we are still in the marina. Here we are at the island.’ But a lot of them were completely pornographic. I just hope to God he didn’t put them on the Internet. That’s all I need, for someone I know to come across them.”

“Do you think that’s likely?”

“I don’t know. He used to spend a lot of time on his computer. I mean, you hear about stuff like that.”

“Tell me more about the boat. What do you remember most, when you think about those times?”

“Lying in the bed at night. It was Trout Lake, you know, dead calm most of the time. And once it got quiet, dead dark. The rocking was just so gentle, it was like you were suspended in some warm, sweet place where nothing bad could ever happen to you. And yet, …”

Dr. Bell let her have the hesitation. Her momentum toward revelation was palpable.

“And yet,” she said again. “Oh, I feel sick, remembering …”

“You’re safe here. Truly safe. Not like the boat.”

She looked up at him. “You know what I think about all this stuff, don’t you? I mean, you know that I know it was wrong. That it was sick and perverted and illegal and all the rest of it.”

“Yes, I know you think that. But just because a thought occurs to you doesn’t make it true.”

That one went right by her, as he knew it would. She was turned so inward at this moment, he could have nominated her for sainthood and she wouldn’t have heard it.

“Like I say. It felt wonderful to lie there in the dark. To listen to the little waves against the hull, I guess you call it. To hear the breeze flapping the little pennants on the back of the boat. It should have been the most peaceful, restful feeling in the world. But there’s no way I could sleep. He was in his bed on one side of the cabin, I was in mine on the other. It was hot, so I was wearing just pyjama bottoms, and he never wore anything to bed, he always let it all hang out. So quiet, but I couldn’t sleep a wink. I was completely tense and wide awake.”

And it wasn’t because you were afraid, that you couldn’t sleep, Dr. Bell was almost tempted to say aloud. It wasn’t because you were afraid of what he would do, and it wasn’t because you wanted your mother. That wasn’t why you couldn’t sleep. Eleven, twelve years old, doesn’t matter. It wasn’t because you were angry. I know exactly why you couldn’t sleep. The only question is whether you can bear to reveal it to me. To reveal the worst part of yourself and have it accepted, not judged, was the very crux of therapy. Without those moments there is no therapy, no progress, no healing, there’s just talk. Hours and hours of talk.