The Skeleton Cupboard

 

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About the Author

Copyright Page

 

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For Bruce and our children, Lily and Jack

 

Introduction

MY GRANDMOTHER'S FRONTAL LOBES

Frontal lobe
n.
(
pl.
frontal lobes)
1.
Each of the paired lobes of the brain lying immediately behind the forehead, including areas concerned with behavior, learning, personality and voluntary movement.
2.
A region of the brain that influences higher mental functions often associated with intelligence, such as the ability to foresee the consequences of actions, planning, comprehension and mood.

I first became fascinated by the frontal lobes of the human brain when I saw my grandmother's sprayed across the baseboards of her dark and cluttered house. I was fifteen.

Much later, I discovered that a young woman—eight months pregnant and a heroin addict—had battered my grandmother about the head with an iron fire poker. The woman had been a tenant of my grandmother's and she knew that her former landlady, a German Jewish refugee recently converted to Christianity, had treasures and cash galore stashed among the chaos of her large house, the top two floors of which she rented out.

A few blows to the head, a quick rifle through purses and drawers, and she was off, cash in her pocket to pay off her dealer and secure her next hit. My grandmother lay on the carpet of her front room, bleeding from a large head wound. I don't know whether she was conscious or not. I do know exactly how she died: by slowly asphyxiating, choking to death on her own blood.

Asphyxiation: That was the problem, of course. If only she'd died instantly from the head trauma, the crime would have been treated as murder. If only she hadn't been a stubborn, willful woman—a woman who had fled Nazi Germany pregnant with my father, a woman who had lost many of her family members in concentration camps, a woman who never took anything lying down, except when she was beaten with an iron fire poker.

There she lay, refusing to die, until she choked on her blood. The woman who had beaten her was sentenced to only three years for involuntary manslaughter with diminished responsibility. She had her baby in prison and was out within eighteen months.

Okay, to be honest, I am not entirely sure that my grandmother's brains
were
on the baseboards when I went into her house that day at the age of fifteen. Is that a direct memory or something I told myself later on? In fact, I'm not sure I remember much of that day at all except two things: a massive bloodstain on the carpet and my father making a noise like an animal caught in a trap.

In that moment I became the rational coper. As my darling father howled, I shut down and began to try to understand how and why.

Had she died in pain? Did she know she was dying before she died? What had compelled her murderer to smash her head in? Had the woman planned it? Did she want to kill my grandmother or merely maim her so she could plunder? I wanted to understand the mind of my grandmother's killer—what was she thinking as she struck my grandmother with the poker, as she heard the crack of her skull? How, indeed, could a human brain not stop its gruesome fantasy from becoming a horrific reality?

All these questions about the shit end of life, at a time when I should have been unthinkingly hedonistic. I was fifteen years old, and my frontal lobes were in a postpubertal stage of reorganization, which meant I should have been taking my own risks and thinking bugger all about the consequences.

Beginning that March morning it was only and all about frontal lobes: my grandmother's on the baseboards, her murderer's—clearly underfunctioning—and mine, clicking into a precocious place of calm rationality that I now believe began my journey into the profession of a mental health practitioner.

This book tells the story of my clinical training. It takes place over the course of three years from 1989 to 1992, when I was in my early twenties, during which I underwent a series of placements in different mental health settings and worked with several distinct kinds of patients: troubled children; families in crisis; men and women dealing with the encroaching effects of dementia; those struggling with drug dependency, eating disorders, sexual dysfunction and terminal illness; and, in one case, a sociopath.

After completing my undergraduate degree in psychology at the University of York, in the north of England, I moved back to live in a flat in London, the city in which I grew up. My childhood had been busy, creative and exciting. My father was a successful TV, film and theater director—a brilliant, highly emotional, inspiring man. My mother was a senior operating-room nurse and occasional model. My sister, Katrina, only fifteen months my junior, and I grew up surrounded by art and culture—which I loved—and went to a highly academic all-girls school—which I hated. Life was full of interesting people coming through our house; dinner conversations were always lively and passionate; my mother was a calm, steady presence in the busy, sometimes manic, creative world of my father.

Although I had long been fascinated by mental health and the inner workings of the human mind, when I graduated from university I thought I wanted to work in film and TV, making documentaries about social issues. Quite unexpectedly, I managed to get into a postgraduate training program for clinical psychology and decided that a further three years would allow me to make authentic films and TV programs about mental illness. I wanted to demystify and destigmatize it, to stop the judgments of those with real difficulties who required care and compassion. Mostly, however, I wanted to explore the workings of the human mind and all its dark corners and perhaps, I now recognize many years later, I was still looking to answer the fundamental question that hit me full in the face at the age of fifteen: Why do some brains allow their host to kill?

Now, almost twenty-five years later, I still practice clinically. I also write regular columns for several newspapers and magazines, produce and host television documentaries and advise the British government on child and social policy.

While I recognize that rage and grief were underpinning my career choice—I wanted to understand how disturbed mental functioning can lead to destructive behaviors—I now realize that my three years of clinical training took me to a deeper place of understanding that enabled me to accept the complexities of who we are and how we function. Throughout my training I met people who were struggling with mental health difficulties—difficulties that were affecting their quality of life, their relationships with others, the choices they made. Some of these people frightened me, others left me emotionally drained and wanting to weep for them, yet none of them really helped me answer the question that began my journey into mental health: Why do we kill those whom others love?

*   *   *

This is the story of my training. I was a well-meaning but inexperienced young woman who had to learn on the job: I spent half the week at University College London, receiving lectures and attending courses in models and approaches in mental health. I wrote essays and case reports about the psychological models and theories I was studying, completed a dissertation and took exams. I spent the other half of each week on a series of six-month placements, attempting, with regular supervision, to apply what I was learning in the classroom.

These placements fell under the auspices of the British National Health Service, and I spent time in hospitals, clinics, mental health outpatient units and GP practices. I saw patients referred to me by many different specialists in health and mental health. These patients were struggling with acute, chronic and at times profoundly debilitating mental health difficulties. Some were mildly impaired, others were dealing with long-standing issues. Occasionally there were patients who presented such a degree of risk to themselves or others that they had been deemed extremely mentally unwell and so unable to function or were involuntarily committed by judges and law enforcement officers.

Over three years I completed six six-month placements, which were structured to provide a complete training experience across the age span and full spectrum of mental health issues by the time I qualified.

There is no other way to narrate the training of a clinical psychologist than to tell the stories of those I encountered. This book highlights the specific cases that helped to establish my thinking as a doctor and profiles the individuals whose stories I still think about today, nearly twenty-five years later. However, because confidentiality is a core principle of my profession, I have changed the names and circumstantial details of all the people I write about. The characters in this book are constructs drawn from real clinical practice and influenced by the many incredible people I had the privilege of meeting during my training.

I dedicate this book to them.

Tanya Byron

London, 2014

 

One

THE EYES HAVE IT

I sat in an uncomfortable chair in the first office I had ever had and took a deep breath. The word “office” might be an overstatement. George, the friendly elderly porter who had welcomed me to the outpatient psychiatric department—“Welcome to our happy home”—had pointed out that before my arrival the space had been a storage cupboard.

“Storage for what?” I asked, thinking about asbestos.

“Storage for everything: dressings, commodes, the old drug trolley. It was only when the department had to take on more fresh blood that we converted it—some kind of regulation, I think.”

“What kind of regulation allows a windowless office?”

George smiled. “Fresh blood see the jumpers.”

“Jumpers?”

“The ones that go straight for the windows.”

Why on earth had I thought I could do this?

Alone in my office, I put my head in my hands—perhaps it wasn't too late to accept the researcher's job at that TV production company. Christ, I was twenty-two, in my own flat, living in arguably the best capital city in the world. I could have glamour, a better wage, less responsibility. What the hell was I trying to prove here?