PATIENT X, REF: X389043BMH, DR V. BLOOM
JULY 7, 1999
Our second session starts more easily. We dispense with introductions. X takes a seat with their usual caution. I let the first thirty seconds hover silently.
I begin with my usual question. ‘How are you feeling today?’
‘Tip-top, guv.’
‘Have you been sleeping?’
‘Like a log.’
‘Does it scare you being in a hospital like this?’
‘No,’ says X. No longer mocking me. Or not as obviously.
‘Have you seen your friend recently?’
‘Yes.’
‘Does your friend have a name?’
‘Yes.’
I have been thinking about X’s imaginary friend. A devil on their shoulder, a psychological cushion. I debate whether to include it in my report. The imaginary friend could be both help and hindrance. I am being badgered by social services for a verdict. X’s mother may be in the dock. X is not. Our consultations might take place in Broadmoor, given my need to be on-call for an emergency. But, unlike the others, X is here voluntarily. They can leave.
‘Last time you mentioned the nightmares or bad dreams you sometimes have,’ I say. ‘Let’s explore that a little more.’
If anything, X has grown cannier since our first meeting. Then I was struck by the contrast between the cub-like appearance and the voice, as if they were literate in all things adult. Today X defuses things with silence. They are adapting to the environment. Finding a way to beat me.
‘Doesn’t everyone have bad thoughts from time to time?’
I nod. ‘Every person experiences them differently. How do you experience them?’
‘Sometimes I dream of hurting people.’
‘General people or specific people?’
‘Depends,’ says X. The voice still contains too much wisdom for the rest of the face. ‘Most of the time it’s specific. I want to get back at the people who hurt me. I want them to know how it feels. Tit for tat. Like for like. Medicine tasting.’
I write a note. It gives me a natural moment to formulate the next question. We are getting somewhere.
‘Who are the people who hurt you?’
X shrugs. ‘Other kids at school. Teachers. Adults generally. The world’s full of bastards.’
‘How do teachers hurt you?’
‘They don’t like the fact that I’m cleverer than them.’
‘Do they pick on you?’
‘Yes.’
I decide not to probe too obviously. X will recoil. ‘What do the other kids do?’
‘They don’t like that I’m cleverer than them either.’
‘Is it verbal or physical?’
X doesn’t respond. Then they roll up the sleeve on their left arm. I lean forward and see the burn marks. I try not to react too clearly.
‘How did you get those?’
‘One of them holds me down. The others put out cigarettes on me. Stupid wankers. They find it funny. The teachers don’t stop it.’
‘What goes through your mind when they do this?’
X, true to form, also pauses here. They play for time. ‘You’re trying to determine whether or not I’m a psycho, aren’t you?’
I am used to bluntness from patients. But the voice is so calm that it tilts my balance. ‘What makes you say that?’
‘It’s what you do.’
‘Is it?’
‘The police and the courts and the justice people want you to tell them that I pose no danger to anyone. That I’m not going to go nuts like my mum.’
‘That sounds like you have doubts yourself.’
‘I’m half her. Perhaps she passed it on. Deadbeat mum, deadbeat kid.’
I don’t answer right away. X is sparring with me. I do what the manuals suggest. I feign ignorance, play dumb. ‘Do you think sleepwalking or mental illness is genetically transmitted?’
X smiles. ‘You’re the doctor.’
‘Your file says you read psychology books from the library. I want to hear what you think. Does your friend help you choose those too?’
‘I think madness is like greatness. Some people are born mad. Some people achieve madness. And others have madness thrust upon them.’
‘Which category does your mum belong to?’
X waits. I hear my stomach tighten. ‘Everyone says she’s evil. Must have popped out like that. A wrong ’un from the start.’
‘What goes through your mind when those other kids at school bully you?’
X doesn’t smile or laugh. ‘Revenge.’
‘What type of revenge?’
‘I want them to feel powerless and helpless. I want them to feel pain.’
I don’t make another note. This is what terrifies the box-tickers with their bureaucratic checklists. They put a sentiment like that together with X’s home background and decide safe is better than sorry. That is how teenagers end up in this place for constant treatment. Nature over nurture.
‘Do you ever try to turn those thoughts into reality?’
‘No,’ X says. Then they startle me. ‘Pain is good. It makes my brain work quicker. If people felt more pain, perhaps they wouldn’t be so dumb.’
It is said with almost biblical authority. I wonder again how much pain this child has known. What other secrets lie in that household. There are certain questions the authorities want me to ask. Only then will the lawyerly, clerkish types be satisfied that no blame can trickle back to them.
I am careful here. I am not a therapist who is interested in unpicking the wounds of the past. I believe in looking forward. The past is fertile ground for novelists, historians and poets. But not for people trying to move on with their lives.
‘What do you think triggers those bad thoughts? Those dreams of hurting people?’
X looks dismissive. ‘I don’t like people having power over me.’
‘Is that the same with the teachers too?’
‘Possibly.’
‘What about at home?’
Memories are dangerous things. With enough alcohol, drugs or sleep-related fugues, memories turn into actions. The veteran who hears a car backfire and responds like they’re in a warzone. The child who witnesses a tragedy and, one day, repeats the same motions, violence birthing more violence.
‘Sometimes.’
‘Was that power verbal or physical?’
‘Verbal. I was older than the twins. They were good talkers but weak.’
‘Did you resent your stepdad having power over you and your mum?’
‘Yes.’
‘Did you ever have bad dreams about your stepdad or the twins?’
‘Yes.’
‘Why?’
‘Tom liked to be the big man of the house. He liked to show his power.’
‘Did you ever think about hurting Tom?’
A look of irritation. ‘No.’
‘Did your mum ever talk about hurting Tom?’
‘Yes.’
‘What about the twins?’
X recovers. That flash of annoyance goes. They are poised, ready for anything. ‘Depends if she’d been on the bottle.’
I see the hint of a smile on X’s face. I remember how young they are. That the eyes are deceptive. The soul is a metaphysical concept, not a medical one. Yet I can’t deny it: X’s soul disturbs me. It is like nothing I have encountered before.
One final question for today. A question I must ask.
I clear my throat and prepare myself.
Then I say, ‘Do you ever dream of killing someone?’