The Skeleton Cupboard (28 page)

Because the users all converged on the unit at the end of the working day, I eventually put them all together and ran a twice-weekly early-evening group. Group membership was varied: among the regulars were Jessica, thirty-one, a city broker; Sam, twenty-three, an up-and-coming professional sportsman; Isobel, thirty-nine, a club promoter; and Curtis, her fifty-four-year-old professional musician partner. With Chris's help I planned the group carefully: psycho-educational with some cognitive behavioral therapy thrown in and a huge element of sharing, listening and supporting.

Jessica came from an aspirational, high-achieving background, a superbright girl who had massive expectations for herself. Having carved out a career in a male-dominated world, Jessica was determined to be the best; she worked long hours, often sleeping at her desk and brokering huge deals.

The patients had a few minutes to introduce themselves to the group and tell their story. Jessica went first.

“Hello. I'm Jess. I'm thirty-one and I love coke!”

Those who'd done the Narcotics Anonymous program chorused back, “Hi, Jess.”

She giggled. “Well, gosh, I don't know where to start. Actually, there's not much to say! I started using coke three years ago just after work, because the buzz of the job was huge and you didn't want to let that go, so you went on partying.”

Chuckles and nods around the group.

“Yay, you get where I'm coming from!”

Curtis leaned forward and high-fived her.

I felt a bit uneasy; this wasn't supposed to be an affirmation group.

“Thanks!”

Curtis bowed. I caught Jessica's eye and subtly tried to point to my watch.

“Sorry. Well, I loved the high. I loved the energy it gave me. And, God, I loved the weight loss.”

Charlie really was seductive.

“Now I can't get enough of it. I snort for breakfast, lunch and supper. I race like mad throughout the day, and last quarter I exceeded my targets by over a third!” Jessica paused and smiled, waiting for another high five, but the group was silent; her face fell.

“I get the shakes before work meetings and have to snort to calm myself down. I spend all weekend in bed trying not to use but feel so bloody depressed. I hate myself.”

Jessica started to cry; Isobel shuffled her chair closer to her and held her hand.

My university lectures, which barely ever kept up with what I was seeing clinically, had become interesting when they defined the role of the clinical psychologist. Despite my moment of vain madness with the shrink who said I could be a medic, I was now becoming more and more wedded to my brilliant profession.

I loved how as clinical psychologists, our role was to create a formulation—to assess carefully and understand the narrative, the story, behind the presenting problems. Patients presented via their symptoms—in Jessica's case, excessive, out-of-control stimulant use—and so rather than prescribe to get rid of the symptoms, we were training to look at why they existed in the first place. By understanding the “why,” we could enable our patients to create a healthier narrative while challenging the dysfunctional beliefs that underpinned their behavior.

I wanted to take this powerful explanation and shove it up that pathetic shrink's arse. I felt bloody proud to be a member of a profession that did not merely reduce a person to a group of symptoms but dug beneath them in order to try to facilitate real long-term change; it was more than “see, know, fix”; it was a nuanced, humanistic approach to mental health.

Jessica was bright and articulate. She was aware that she had a serious drug problem but clearly needed to understand her narrative. With the help of the group, we pulled her story together.

Jessica was a perfectionist in every way. As a child, she received attention from her parents only when she performed exceptionally at all she undertook. So that was her focus: county cross-country champion, accomplished violinist, slim, fit and with a clutch of top grades, Jessica made her parents very proud of themselves.

Jessica grew up believing that results and top achievement garnered love and respect; to do and be the best was the emotional currency of her family. Over time this belief became entrenched and totally black and white: “To be lovable, I have to be the best.”

This underlying belief drove everything she did, and because there was no room for slack, or, even worse, mistakes, her expectations of herself grew and grew until, when she joined the highly competitive and results-driven financial world of brokering, she couldn't be the best without being superhuman, and that's where charlie came in.

“I find that the better I do, the worse I feel. I always have to do better. Without coke I can't work as long and hard as I want to.”

“What do you think about yourself, Jessica?” I asked.

“I like myself when I'm coked up. I feel free and funny and confident, and I can work nonstop.”

Jessica needed support to recognize her limiting and dysfunctional underlying belief and then to have the courage to dismantle it and redefine herself and her worth; unless she was able to do this, charlie would always be her life partner.

Like Jessica, Sam, Isobel, Curtis and all the others in the weekly group had reached a place where their tolerance was so high that they had to use greater and greater amounts of coke with more and more frequency—their dopamine receptors couldn't keep up, and so when their brains crashed, the only thing to do was to reach for more.

Sam's narrative was interesting because coke had a paradoxical effect on him: It let him relax. A bright boy who couldn't sit still at school but was an ace on the sports field, Sam was only happy when he was moving at speed. Sam had to get up intermittently throughout each ninety-minute group session on the pretext of making another coffee for everyone or using the loo.

Reluctantly I discussed him with the shrink—after the day of the awful kiss, I had been avoiding him as much as possible, and our relationship was now cool and cordial. He agreed that Sam was possibly an undiagnosed case of attention deficit hyperactivity disorder, ADHD.

Kids with ADHD are prescribed a form of stimulant that seems completely at odds with their presenting symptoms, but the explanation is straightforward: They have an underfunctioning reticular activating system, RAS. With a lack of endogenously driven stimulation, these kids have to boot up their arousal levels by racing through life. Sitting still is impossible for them.

Luckily for Sam, he had found a career built around his need for speed on the soccer field. The shrink took him in hand and prescribed for the underfunctioning RAS and Sam was eventually able to let charlie go without losing his already well-established athletic prowess.

Isobel and Curtis were wonderful people, but I didn't hold out much hope for them. Though they were a loving couple, their worlds were tied up with using and partying. The using and codependency that united them also bound their relationship. In those days, I wasn't anywhere near experienced enough to help them unravel all of this. But I was grateful for their presence in the group because they were kind and compassionate, and knew way more than I did about the world of stimulants. They helped me out when I got stuck.

I enjoyed running the group, and by the end at least a third of its members were using less. Two people hadn't used for over a fortnight. Isobel's and Curtis's usage fluctuated. Jessica had cut down and began to see me for individual sessions, and Sam was now under the care of the shrink.

The final day of the group came and we all said good-bye with a hug. I liked these people and respected their honesty and was sorry to see them go. And then, in the final moments of the good-byes, Curtis had an explosive sneeze and chunks of his nasal septum whizzed past my right ear and splatted onto the wall behind me. That evening, leaving the unit to go home, I met another group familiar to me: Camped outside the DDU door were the local dealers.

“Come on, guys. You've got no business here.”

My familiarity with the DDU gave me a streetwise confidence very new to me.

These guys were not threatening—in fact, they were rather charming.

“C'mon, Doc, give us a break. You're ruining business for us.”

With acute entrepreneurial skill, the dealers waited for their vulnerable ex-customers to leave the DDU, gave them free samples of the finest on offer and quickly reeled them back in.

“Bugger off or I'll call the police.”

My colleagues and I were fighting a losing battle.

*   *   *

The next morning I took a cramped Tube into town, looking forward to my time with Tom.

It was a bright, sunny, cold morning—my favorite kind of weather—and I wandered toward the unit, sipping a cappuccino. As I got there, I saw a small crowd holding placards gathered around the main door: One had a megaphone and was reciting something, but I couldn't make out what it was.

Pete was standing at the main door gesturing to me. He looked anxious, not his usual laid-back self at all. Worried, I started walking toward him. And then something hit me.

I instinctively put my hand to my forehead and felt warm blood. Then it happened again, this time on my cheek. Putting my head down, I pushed through the angry crowd and ran up the steps to Pete as my back was pelted with more small stones.

“Get inside, quickly.” Pete grabbed my arm and pulled me toward him.

“What the fuck is going on?”

I staggered into the waiting area and peered out of the window.

“AIDS: God's punishment for homosexuality,” said one placard. There were more: “Die, you gay bastards”; “Let the faggots burn in hell.”

“The religious nuts. Let me have a look, sweetie. You OK?” Pete examined my cuts and called a colleague to bring some antiseptic wipes and plasters. “Fucking nutters. We never know when they are coming.”

I looked out of the window again and caught the eye of a young woman, her face twisted with hate.

“Slag!” she screamed at me. “Homo-loving whore!”

I flipped her the bird as Pete pulled me away.

“Don't, sweetheart. That's what they want us to do. Ignore them and they'll soon go away.”

To hell with them and their discriminatory religious ideology.

*   *   *

“Why should I die when this fucking disease decides it's the time? Why should I endure the pain or drown in my own Pneumocystis pneumonia, fucking PCP? I want to die now.”

Tom, discharged from the ward, having recovered from his PCP, was sitting upright and opposite me in my office. And what a way to start a session.

“I'm not sure I get what you're saying here, Tom.”

He smiled. “Yes, you do. You know exactly what I'm saying.”

How do you ask someone if they seriously want to kill themselves?

Taking my lead from Chris's approach, I asked, “Are you telling me you are thinking about suicide?”

Tom chuckled and then coughed hard, his lungs having just been cleared from the PCP that clogged them up on a regular basis. I handed him a glass of water.

“Thinking? Oh, sweetheart, I have so done thinking. I know what I have to do.”

“So why haven't you done it, then?”

Again my comment was met with the most electrifying smile. “I like your style. Pete was right: You are a minx!”

I pressed on. “Tom, what have you planned to do?”

Tom reached forward and pulled a few tissues out of the box on the small table between us, and then, after dipping them into his glass of water, he started to dab his face; a layer of expertly applied Pan Stik concealer was wiped away.

What was revealed took my breath away but I tried not to show it. Tom's beautiful face was blemished by Kaposi's sarcomas—two small brown and purple tumorous lesions eating into his skin. He looked utterly vulnerable.

“Call me vain, sweetheart. Call me shallow. But the condom sex I can do, if and when I get it. The monthly monster dose of antibiotics is bearable. But this…” He gestured toward his face. “This is fucking monstrous. I have become the sodding Elephant Man.”

“How you look on the outside doesn't define who you are on the inside.”

“Oh, come on, sweetheart. You're not counseling a bloody anorexic here.”

I wasn't going to back down.

“Tom, I just got stoned.”

“Well, very nice for you, darling.”

“No! Not
stoned
. I got stones chucked at me.”

Tom nodded. “Ah yes. The compassion of the narrow-minded religious. Such horribly unattractive people. Were you hurt?”

“No.”

“That's my girl.”

“But here's the thing, Tom. They all want you dead. They love the virus: It justifies their prejudice. Why buy into that?”

“I'm not buying into what they want. I'm deciding what I want.”

“Have you tried before?”

Tom pulled up the sleeves of his linen shirt and revealed thin scars on both of his wrists. “Take a look at those babies.”

“So what happened?”

“What happened is that I'm a fucking coward. What happened is that I couldn't cut deep enough because it stung so much, and then I couldn't wait to bleed long enough, so I called a friend. I'm a fucking coward.”

It had started raining outside. Tom closed his eyes. “I love that noise.”

“Me too, Tom.”

“When I was a young, arrogant buck, my first collection at London Fashion Week was shown outdoors. And oh fuck, did it tip it down!”

We both laughed.

“What happened?”

“My clothes clung to the most beautiful bodies; their shape was gone, but they outlined something far more beautiful. I was panicking, but the models went onto the open-air catwalk and what I had designed found its own beauty.”

“So you started your career designing for a wet T-shirt contest?”

Tom clapped his hands. “Darling, you know you are right! Indeed I did! And that year I won ‘Young Designer of the Year.'”