The relief I feel about his arrival soon morphs into a different kind of feeling when he’s in the room. He strides in and sits down without a word. He’s wearing a red long-sleeved T-shirt. There’s no sign of a black hoodie. I find myself staring at the rucksack he’s dropped on the floor.
When I tell him I was beginning to think he wasn’t coming, he nods, offers no explanation for his lateness. “I wasn’t going to,” he says. He sits still in his chair, arms folded, staring at the floor.
“I’m sick of it.”
When I comment on how frustrated he seems, he laughs.
“Frustrated? Is that it? Is that all you have to offer?”
His tone is more weary than aggressive. He wants the “tools”—the quick fix, and we’re back to his “I want to get back to where I was before” conversation.
I tell him that therapy isn’t some kind of magic. “I’m sorry. It doesn’t work like that.”
He talks about the effort it took him to come, how he had to walk, rather than take the bus. “Public transport still makes me feel panicky.”
Then Dan speaks about the people he passes on the way. “All so happy and smiling, like they don’t have a fucking care in the world.”
I see how he uses the sense of grievance as a kind of armor. It stops him thinking about himself. How his victim status keeps him comfortably protected in his ironclad suit from any responsibility, from any need to think, reflect, or change.
“It feels unfair,” I offer, “what’s happened to you, and I imagine there’s a part of you that’s pretty angry at having to come here at all.”
He says nothing.
“After our last session, I was left with some concerns about you. Then today, you arrive very late. Missing most of the session. It makes me wonder whether a part of you wanted me to worry about you?”
He rolls his eyes.
“One of the things I was left preoccupied with was something we didn’t get a chance to speak about. The cuts I saw on your arm.”
He shrugs. “What about them?”
“Can you tell me about the cutting?” I say. “When did you start?”
“Years ago.” He is matter of fact. “I mean—it’s just something I do.”
His face softens. “Really—it’s fine. Never deep. Always surface. I’ve never needed hospital treatment for them. I have it under control,” he says. “It’s not a problem.”
He looks at me intently. “You must have seen loads of people who cut themselves. You know it’s not indicative of any other risk factor.”
He has all the right answers.
“It sounds like you’ve been asked about this before?”
“Not really. But I don’t want to waste my time here on something that’s been part of my life. Something that isn’t a problem for me.”
“OK,” I nod. “So, let’s think about you. The reason you have come to the unit.”
When I ask for the questionnaire, he shakes his head. “It made me too anxious. I couldn’t fill it in.”
I feel a sense of frustration. That he’s stopping me being able to do my job and thwarting any attempt at recovery. But I also feel there’s something forced about his truculence, as if somehow he wants to pull me into reprimanding him.
“Let’s go through some of the questions together,” I suggest calmly.
We work through the practical information and the symptoms of his anxiety.
“There are a few other questions now,” I say, “to help me understand a bit more about you.”
He shifts in his seat.
“Can you tell me an early childhood memory?”
He laughs. “Aha. So this is the session when I talk about my abusive childhood. How scared I was of my violent stepfather. What a raw deal I had. How in the telling of my backstory, we’ll understanding the link to my recent trauma. I’ll cry. You’ll hug me. We’ll get down to the ‘real work.’ My Ordinary People moment.”
My face is blank.
“Judd Hirsch? Timothy Hutton?”
He stretches out his arms toward me.
There’s a moment of silence. I don’t know what he’s talking about.
“A violent stepfather? Is that what happened to you?”
He stares back at me. Holds my gaze.
“No,” he shakes his head.
“I wish I did have a ‘big story,’” he says. “Something filmic. A big moment I could tell you about. Something that you would instantly listen to and ‘see.’ Oh yes, I get it.”
Again, that dispassionate gaze. “But there isn’t.”
I comment on his need to impress with a dramatic story. “You do have your own story,” I say gently, “and I’d very much like to hear it.”
He tells me about a family trip to West Wittering. “My parents and my baby cousin. Dad borrowed my uncle’s car. We drove with the top down. Like something out of Thelma and Louise,” he says. He tells me they had fish and chips and ice cream on the beach. “It was a happy day,” he says.
It’s an odd story. Disconnected. And it hangs in the air between us. I think about these film references and how they push me further away. Another sort of armor?
“What sort of child were you,” I ask, “growing up?”
“Anxious,” he says, “I was an anxious child. On my own a lot. I watched a lot of films.” As he’s talking he’s absently twisting the handle of a plastic bag around his finger.
“What did you like about films?”
He thinks for a moment, twisting the handle tighter. “Other worlds. Places where anything could happen.”
He pauses. “But mostly,” he says, “they taught me to feel.”
“To feel?” I repeat.
He looks up. A small moment of fragility. It’s like I’m trying to reel him in, slowly, like a slippery fish that I imagine will quickly flip back into the water.
“And what about your parents?” I ask. “How were feelings expressed in the family?”
He’s silent for a long time. I am distracted by the twist of plastic around his thumb. Tight, like a piece of string.
“When I think of my family,” he says eventually, “there’s nothing.”
At first, I don’t understand. I think he’s being obstructive.
“Nothing?”
“A sense of nothingness. A void. Home was a hollow place. I always felt something was missing.” He twists the bag tighter. His thumb is turning purple, like a plum.
“I tried to fill that space with films. With characters who were alive.”
Alive. I think about this for a moment, about his choice of word. “So there was the opposite,” I ask, “something deathly about your own family?”
He releases his grip on the bag. The blood rushes back to the rest of his hand.
“Like I said, I don’t remember much.”
I try to ask some more, but he shakes his head. “I’m sorry—I just don’t remember very much about my childhood. There’s nothing much to say.”
That quicksilver flick of a tail, and he has gone, disappeared in a swirl of murky water.
I refer back to our previous session. How he had said what happened to him in the park felt like a punishment. “Karma, was what you said.”
He stares back at me.
“Karma?” He shakes his head. “I don’t know why I said that. I’m sorry. It was my Billy Bibbit moment. I wasn’t making much sense at all. I don’t remember what I said. I was in a bit of a state.”
I ask some more questions. I get nowhere. The more he retreats, the more I probe, and the less able I am to comment on the process and what’s going on in the room between us.
“Look,” he says, “the park was brutal. I mean, hello? Perhaps I feel bad because of what happened? Does there have to be anything else to unearth? Some great big secret? I mean, who are you? Miss Marple?”
His gaze is unwavering.
“The attack was brutal and traumatic,” I agree, “but from what you said in our previous session, I was left feeling that it had some kind of association for you. You said your flashbacks were of other things. Something from the past, perhaps?”
He’s shaking his head, a mock “beats me” expression on his face.
“I can make something up,” he jokes, “if that would help?”
I take a breath and sit forward in my chair. “Dan,” I say, “something’s happening here. Between us,” I venture. “I feel pulled into the position of having to question you. All this asking, probing, and trying to find ‘the truth.’ It’s stopping me doing my job.”
He looks back at me. Says nothing.
“The sense of injustice and grievance that you carry,” I say, “the parole officers . . . the police . . . the solicitors—it makes me wonder whether you’ve been let down before. Or had an experience of being unfairly treated in the past. Perhaps by parents, or by other people close to you.”
There’s a flash of something across his face. Recognition, I think. He sits still. He is watching me. He looks serious. Attentive.
“And I wonder, too, if that makes it difficult for you to show up and be truly present in the room. To really be here. To risk feeling vulnerable. Because there’s always a danger—that I too might disappoint. That I too won’t do my job properly.”
He looks like he’s taking it all in. Like he is coming on board. I feel the session open out and expand, like a rush of air into the room. Like I am on the edge of a breakthrough. He sits back in his chair, interlocks his fingers, and stretches his arms, as if limbering up before a session in the gym.
“People doing their jobs properly. It’s true—it does raise an interesting question,” he says, and he moves his head side to side, stretching out his neck.
“I’ve been doing my own research about this place,” and he waves a hand between us. “There’s the Matt Johnsons of this world,” he says. “But that’s not the whole picture, is it?”
He leans forward.
“The thing is,” he says slowly, “you haven’t—have you?”
He’s looking at me, waiting, in a way that makes me feel exposed. Like he’s looking right through me.
“Haven’t what?” I say, my throat suddenly dry.
“Haven’t always done your job properly.” His neck clicks as he moves it to the side. “You haven’t been able to help everyone—have you?”
I feel everything slow right down. As he speaks, I see the pictures in my mind. The ones I try to keep away. David’s shoulder against the bathroom door. Tom’s boot on the floor. His blue lips. The smell of vomit. The bleached white of the ICU.
You haven’t been able to help everyone—have you?
I know exactly what’s coming. I feel caught in my seat. Trapped by his cool steely gaze. My palms suddenly sweaty. I look up. I am consumed by anxiety.
“Mark Webster,” he says quietly. “It didn’t turn out very well for him—did it?”
Mark Webster?
It’s not what I expect. Not what I expect at all. I feel a momentary flood of relief. A feeling of escape. Then, it comes. A thud of confusion. I blink back at him, wide-eyed with surprise.
“Mark Webster?” I repeat slowly.
He nods. His face impassive.
There’s a giddy moment when I can’t focus. The shock of hearing his name after eight . . . or maybe nine years.
“Freedom of information,” he shrugs, as if reading my mind. “I looked him up. An inquest is a public inquiry.”
I stare back at him.
“If you’re going to get your car fixed, you’d want to check out the credentials of the mechanic, wouldn’t you.”
This is when I should keep quiet. This is when I should explore what’s going on between us. To find out what led him to carry out his research. To wonder with him what his motivation might have been. But in the moment, I am floored. I don’t ask any of these things. I feel trapped, like a butterfly under a pin. I clear my throat.
“Mark Webster was very unwell,” I say, and I can feel my cheeks are burning. “His suicide came in the aftermath of a terrible family tragedy. He was in a state of despair.”
“I’ll say,” he nods, “letting a four-by-four roll over his own baby. Careless,” he adds, looking straight at me. I’m not sure whether he means Mark or me.
“It was a horrible accident.”
All of a sudden, I am back in that first session with Mark as he told me what had happened. It was the weekend his wife was out for a friend’s birthday. Her first trip away since the baby was born. How proud he was that he’d taken the two kids out. How well he was managing. How his son, a toddler, was standing on the porch as he unclipped the baby car seat, how he placed his daughter on the driveway by the back of the car as he gathered the bag from the trunk. How he felt for his phone in his pockets. It was after he went back to collect his phone from the dashboard that the car rolled down the drive. I close my eyes briefly as I remember his tortured face. How he howled like an animal into his hands.
I struggle to find the right words. “There was an inquest,” I say, “and much as the outcome was terrible and tragic, it wasn’t seen to be preventable.”
“I read that you’d seen him for his appointment that day.”
“I did.”
“Dead plants . . . dead patients,” he says, swishing his hand around the room like a windscreen wiper, “it doesn’t exactly inspire confidence.”
“Mark Webster was clinically depressed after the accident. He was intent on killing himself,” and then I stop myself. I have said too much. None of this is relevant.
“It was a difficult case.”
“So, what you’re saying is that you can’t, in fact, help everyone.”
He sits tall and strong in his seat. In contrast, I feel suddenly small, my hands holding on to the side of the chair.
It was the first year of my promotion to director of the unit, eight years ago. I was experienced. I’d been practicing for years. I didn’t see it coming. Mark was getting better. We’d extended the contract. He was upbeat in the appointment that day. The flashbacks had been less frequent. He’d been sleeping better. He was airy. Light. Unencumbered. What I realized afterward was that this state of mind arose from euphoria—from the decision he’d already made to end his life. It was, he must have concluded, the only solution to what he saw was an insurmountable problem. We had our session. He thanked me, and he left. He stopped to have a coffee and a pastry in the park, called his wife, then took the Jubilee Line to Green Park, where he threw himself in front of a train.
John Grantham had only been chief executive for six weeks. He was brilliant. He supported me at the inquest. I was cross-examined, and my notes were pored over with a fine-tooth comb. As I explained my risk assessments and had them scrutinized by two separate independent mental health expert witnesses, my hands were shaking so violently I had to hook them on to the side of the witness box. My assessment concluded there had been a risk reduction based on the information he brought to the sessions. In the event, the care was seen to be “more than adequate.” There were no grounds for negligence or a failure in our “duty of care.” Sitting here in front of Dan feels like I’m back in the inquest all over again.
I’d been haunted by the small huddled shape of his wife, Jane. Her tight pale face of grief. Struggling to comprehend the loss of both a baby and a husband in the space of four months. She looked up when I spoke. I looked over at her. I didn’t want to avoid her. What I wanted back from her was something—some hatred or admonishment. There was nothing. Her face was impassive. She was too distraught for blame.
Mark’s brother was the one holding all the fury. He spoke eloquently and passionately about his need for some explanations. A world-famous clinic. Renowned. The devastation to the family. A widow . . . a son left without a father . . . At the end of his evidence, he looked across at me. What went wrong? What I remember most about Jane was her distracted, vacant expression. Her constant movements, pulling at her cardigan, checking her bag, her coat, her scarf, patting them feverishly to make sure they were still there. As if, having lost half the members of her family, she was now obsessively keeping tabs on all her things, keeping everything close to hand, making sure that nothing else went astray.
I saw a lot of my supervisor, Robert, over that time. “It’s a myth,” he said, “that we can always save people. Risk assessments can give an illusion of control. That we can somehow nail things down. That mental health is predictable. Black and white. If people didn’t become mentally unstable, there would be no need for mental health services.”
I nodded. I knew he was right. But I still felt fragile.
“You also know that if someone wants to kill themselves, has thought it through, has planned it in the way Mark Webster had—there is nothing we can do to stop them. Nothing,” he repeated, shaking his head. “Even patients on a twenty-four-seven watch can find a way,” he reminded me. “When a patient is angry with himself, the despair can be too great. There’s nowhere to go. At the time, suicide can feel like the only response to such despair and fury. Mark Webster saw it as the only way out.”
Robert, John, the doctors who were expert witnesses, everyone agreed. Neither I nor the Trust were found wanting. It was quite simply a tragedy that was unpreventable. I would have said the same to any member of my team. Nothing you could have done. I didn’t believe it. I felt the guilt. I waded through it like treacle. Afterward, I was hypervigilant on risk assessments. I was overly cautious. For months, I’d wake in the night, seeing the dark tunnel and a tall, suited man stepping off a platform. I’d sit upright with sweat pouring off my face. Over time, things slowly got better. And then, six years later, there was Tom.
I breathe in and out. I sit up straighter in my chair. I release my hands from their grip on the armrests and move them to my lap. I begin to move back into my body. Take up my role.
“Dan,” I say firmly, “we can spend what little remains of today’s session on the tragic suicide of Mark Webster. We can talk about my professional capabilities, my possible failings, and my deficiencies as a therapist . . . but I don’t think this is really about Mark Webster, I think this is about you and your reluctance to—”
Before I can finish, he stands up abruptly, looking at his watch.
“I need to go,” he says, “my mate said he’d pick me up, so I wouldn’t have to get the bus.”
He’s speaking quickly and moving fast. “Sorry to duck out early,” he says, like I’m a friend in the pub. “I’ll see you next week.”
He is gone.
I ring Robert. I’m standing by my desk, looking out of my window as I leave him a message. “I need to make an appointment,” I say, “as soon as possible.”
And that’s when I see them coming out of the entrance to the clinic. Dan and Hayley in animated conversation as they walk together across the hospital car park.
I stare at them, a strange feeling in the pit of my stomach. But for all that I do notice, I don’t see what’s going on in front of me. I don’t pick up what Dan is doing. That in directing my attention to what he wants me to see, he is stopping me focusing on the very place I need to look.