PATIENT X, REF: X389043BMH, DR V. BLOOM
JULY 2, 1999
Cranfield Ward, Broadmoor Hospital
Our first session today. We get the child-friendly meeting room with its plastic toys and colouring books. It is embarrassingly pre-school for a teenager. X is early, brought in by a nurse. I immediately see a difference in them. Most teenagers have a slightly droopy gait, like new machines in need of oiling. Their over-long arms flail, the back curves. They are still children acclimatising to their ever-changing bodies.
But X isn’t like that. Or not quite. There is a composure to them that almost takes the breath away. They are still childlike, of course. But the events of the recent past have clearly accelerated the ageing process. X looks older than their years. More than that, X’s brain is clearly developed in a way that’s uncommon at their age. I have decades on X, but it feels almost like meeting an equal.
X sits down. They stare around my office, then say, ‘So you’re the mind doctor.’
I wait, deciding on the best tone. ‘I’m a clinical psychologist,’ I reply. ‘I specialise in sleep-related disorders. Insomnia, sleepwalking, night terrors, dream analysis, that sort of thing. Does the mind interest you?’
I already have a good idea that it does. But I don’t spoon-feed my patients. Some want empathy. Others demand parental sternness. The third category – the rarest – seem to want nothing from me at all. They have a hunger to know how their brains are wired. They are also by far the most dangerous.
X frowns now. ‘There’s a line I read once. “The mind is its own place and can make a heaven of hell and a hell of heaven.” Milton, I think. Smartarse.’
My face betrays me. I look impressed. X notices the expression like a small victory. The eyes judge me.
‘You like Milton?’
‘Like is an overused term. Milton is Milton. Whether I like him or not has nothing to do with it.’
The Oxbridge erudition seems at odds with the accent. I feel ashamed for even thinking that. But it’s the first thought that occurs. I have the patient notes. I know about the mother, the home life, the stepdad, the stepsons. I know about the suicide attempts, the bullying at school, the hell of childhood. And, now, the hell of adolescence. But I need to find out for myself. ‘Did you study Paradise Lost in school?’
‘I found it at the library. School is boring. No one ever learns anything there.’
‘Do you often go to the library?’
‘My friend takes me.’
‘Who’s your friend?’
‘That’s very existential. Or should it be ontological? I’m still on the poetry section. I haven’t read the philosophy section yet. My friend is my friend is my friend.’
A compulsion to show off? A defence mechanism? ‘How long has this friend of yours been taking you?’
‘Since it happened.’
I play along. I’m not sure whether this friend is real or part of a rich and disturbing fantasy life, an escape from trauma. I suspect the latter. The reports all note X’s loner status and anti-social behaviour. And we both know what the ‘it’ is. That night, when X found themselves in a house of horrors, steeped in blood. I imagine X in a quiet corner of the library with a gnarled, billowy copy of Paradise Lost and an imaginary companion. Seeing the visions of the book translated into real life.
‘Did your mum ever take you to the library?’
X smiles. ‘My mum drinks. The library doesn’t serve alcohol. The two don’t exactly fit.’
‘How much did your mum used to drink?’
‘Why don’t you ask her?’
‘I’m asking you.’
‘Enough to make her crazy, if that’s what you mean.’
I am silent. Later, of course, I will regret it. I should stamp my authority here, provide boundaries. But X intrigues me. Most teenagers fake worldliness. X doesn’t need to fake anything. They seem to be two steps ahead, anticipating my next question.
‘What does the word “crazy” mean for you?’
X smiles again, as if the question is amusing. ‘The same thing crazy means for most people.’
‘Can you give me an example?’
‘When Mum drinks she starts sleepwalking. The more she drinks, the more she sleepwalks. That makes her crazy, psycho, nuts, mad, bonkers. Take your pick.’
‘Has she always been a sleepwalker?’
‘Yes.’
‘What’s it like when your mum sleepwalks?’
‘She looks normal but she isn’t there. It’s someone different. Like I told you, she becomes crazy. She doesn’t respond to stuff.’
‘So you’ve seen her sleepwalking?’
‘Yes.’
‘How many times?’
‘Enough.’
Usually, the first session is all warm-up. But I’m not going to get more out of X that way. Specifics are needed. ‘Is that what you saw on the night of the murders?’
‘Why?’
‘I’m curious.’
‘Yes.’
‘You’re certain?’
‘She didn’t know who I was. The lights were on but no one was home.’
‘Where did you find her?’
‘In the bedroom.’
‘What did you do?’
X sighs. ‘I tried to get the knife. Then the bitch turned on me. I fled and called him. And we all lived happily ever after.’
‘Did your mum come looking for you?’
‘No. She stayed put.’
‘She didn’t recognise you at any point during this episode?’
‘No.’
‘Did you witness your mum stab either of the twins in the bedroom?’
‘Not specifically.’
‘How can you be sure she did?’
‘She had the weapon. She was covered in tomato ketchup. Didn’t have to be Einstein to make the connection.’
I nod. ‘I suppose not.’
My brief is simple. I’m to provide a psychological evaluation of Child X which will be used by social services in determining the next stage of care. Is the child irreversibly damaged by what they witnessed that night. Are they suffering from years of mental or physical abuse. Do they require urgent psychological or psychiatric care. Are they fit to be fostered, reintroduced to the education system, resilient enough to cope with a new identity and foster family. To put their old self behind them.
I look at X and know how much power I hold. One note here, a signature there, and their future will be different. It is one of the few times in my professional life when I can’t summon the distance needed. I wonder what it must be like for any child to have gone through so much. To have a ring-side seat to such events. I would invent an imaginary friend too. We all would.
‘What do you think sleep does to your mum?’ I ask. ‘What was she usually like?’
X continues to look at the walls. ‘Drunk. Angry. Embarrassing. IQ of an orc. She can’t think things through like I can.’
I don’t respond immediately. X is tantalising me, suggesting an answer then withdrawing it. ‘Do you consider that a weakness?’
‘Don’t you?’
After a beat I say, ‘What about when your mum was sleepwalking? What were the changes you noticed?’
X mimics my pause, unsettling me further. ‘She was like an animal, I guess. An animal moving in for the kill. Like a nightmare.’
There is total silence. I am too absorbed to notice anything peripheral: the time, whether it is light or dark outside, the nature of my next appointment. There is just X. This thin, strange teenager with eyes that haunt me.
This is the most important question. The one I must answer. A diagnosis that will either liberate X or haunt them until their dying day.
‘So,’ I say. ‘Why don’t you tell me about your nightmares?’