The Skeleton Cupboard (7 page)

As I understood it, Sigmund Freud was a coke addict who fabricated the father-rape-wish-fulfillment scenario of his abused female patients in order not to upset the conventions of the time. Fathers and uncles were busy raping their daughters and nieces, but this wasn't the moment to out them. So Sigmund snorted another line and created the most damningly misogynist theory of all time. As I had seen firsthand with Ray, there may be a time and place for Freud, but Imogen's case wasn't it.

That analyst was not going to treat Imogen. I didn't like him and I didn't like the way he worked. And he knew it.

As I was sitting there, staring at Imogen, the words were just not coming. I had to move past my own frustration and relax. But it is very hard to relax when you are looking into the eyes of a mute little girl who wants to be dead. You don't want to relax; you want to run at her and pull her into your arms, hold her and then shake her until she tells you why. You long to say, “Why do you want to die? You're twelve years old.”

My other problem was that I couldn't shift my focus from the angry red welt around her neck—that welt rendered us both mute. And while I knew silence could be a therapeutic tool, it was clear to me that this time it reflected the powerlessness that both Imogen and I felt. I wasn't good enough for her. She wasn't good enough for life.

I could feel my anxiety rising—my frontal cortex was shutting down. Soon I would be limbic, running only on raw emotion, and this was not a good place to be. I had to think, be rational, reconnect with the practitioner in me.

I ought to have felt more prepared for Imogen. I had tried to plan my psychological therapy session with her earlier in the day, but my meetings with Chris had become increasingly shambolic. That morning I'd rushed into Central London, but she had arrived at her office at the university late, stinking of cigarettes and cursing the people who'd been at the meeting she just left. Throwing her bag onto a chair, she began to make a Pot Noodle.

“OK, speak. I'm listening.”

“Well, to be honest, I'm not sure where to begin. I had prepared an agenda, but I'm not sure we can fit it all in. I mean, I was expecting an hour.”

“How's it going with the silent, self-starving one?”

I wasn't sure what disgusted me most—the smell of synthetic chicken, the accompanying sounds of slurping, the neglected dribble down her chin or the lack of an apology for being so bloody late.

“I'm not sure there's time.”

Chris continued to eat, pausing only to wipe her mouth with the back of her hand. I drew a deep breath.

“Imogen Trent-Evans, twelve-year-old daughter of Mary Trent and Jim Evans. Mary, magazine editor, lives in London; James is now in Los Angeles with his partner, Angus. Mary has remarried—Jake Robins, a male fashion model—and they have, sorry,
had
Maisie, who was five when she drowned in the family pool last August. Imogen, an obsessive skipper and self-harmer, has—”

An abrupt slurp. “Stop! For Christ's sake, you're not presenting at a sodding ward round.”

“Sorry, not sure what you mean.”

“Tell me Imogen's story. About the child. I want to see her and hear her.”

Blushing had always pissed me off—a sign of weakness, unintended vulnerability. That day I could do nothing except glow a rosy pink, and, to my horror, feel tearful. Chris wasn't sympathetic.

“OK, you feel uncomfortable here. Get over it. You have talent, but you are way too self-consciously righteous for my taste. If I am late, I am late. If I want you to present to me in a different way, then present to me in a different way. If this all feels too much, there's the door.”

Chris lit a cigarette. “So, how does this child make you feel?”

“She makes me feel protective. She makes me want to look after her.”

“And behind these obvious rescue fantasies?”

“Would you mind not smoking?”

Chris walked to the window, opened it and, with her backside pushed toward me, leaned out and blew smoke at Tottenham Court Road.

She looked over her shoulder. “I think this girl frightens you.”

“I am not frightened of her. I just feel so
sad
for her. She's only just twelve. She lost her sister eight months ago. Bloody hell, the poor kid found her baby sister floating facedown. She never sees her mum, never, because the woman runs her magazine with more care than she gives her kid. And her gay dad is … well, he's on the other side of the world. To add to the bleakness, there's the housekeeper, Miriam, who speaks very little English but was the girl's constant other until the mother fired her after Maisie drowned. And finally, to complete this happy home, there is a grief-stricken model of a stepfather, Maisie's dad, who spends his entire time sobbing whenever he comes into the unit.”

“A model of grief, or an attractive grieving man?”

That was funny and we exchanged a smile. “Both.”

The cigarette had burned down to its filter and Chris extinguished it in the dregs of the Pot Noodle. She sat back down, facing me.

“She is so small and pale and just a tiny, tiny victim,” I continued. “She is powerful, but she is also just a little girl cuddling her rag doll.”

“A doll?”

“Yes, a rag doll. Apparently her dead sister's doll.”

“Transitional object?”

“Well, she never puts it down, and we can't touch it. It really smells, but she won't let us wash it. At night she sucks—well, sort of suckles on its face. In the daytime it's tucked under her arm, constantly.”

Chris went still. Then she carefully lit another cigarette. “And people would think to want to wash this doll, why?”

“Because it smells.”

A long smoke exhalation. “Listen. I wanted you to be my trainee because I thought you were bright and we could skip the obvious stuff. So, doll equals transitional object, as in link to dead sister. No one touches it. The doll
is
her sister. Smell and all. I thought Winnicott was first year, first week of training, basic lecture shtick?”

Christ, this woman made me feel like an idiot. Of course I knew who Winnicott was—the influential English pediatrician and psychoanalyst who transformed our thinking about the mind with his writings on object relations theory. Of course I understood that the doll represented Imogen's sister!

“OK. No sulking. Carry on with the story.”

Aren't you supposed to start by hating those you'll later credit as being your mentors? With Chris it was too early to call. I took a deep abdominal breath and continued.

“When she was first admitted as an inpatient to the unit, she would skip obsessively whenever she was given monitored access to her skipping rope. Every moment she could, she'd skip and count constantly—and even now that we've taken her rope away after her hanging attempt, we can see her legs twitch up and down and her wrists circling. It was exhausting to watch. She was totally impenetrable—no one could engage with her. She'd stop skipping when any of us tried to talk and then the second we left, giving up on the nonconversation, the total lack of engagement, she would start again.”

“How does this affect the team?”

“She totally splits us. Completely.”

“How?”

“Pretty much the way you'd expect, because you know all the differences and interdisciplinary rivalries—the doctors get biological and diagnostic, and ram the sodding drug charts down our throats, while we sit with the social workers and disappear up ourselves with compassion, understanding and behavior-management programs. And of course, the analysts hover above us all with interpretations that make the team argue and end up disliking them.”

“What, ‘she unconsciously wanted her sister to drown'—that sort of thing?” Chris grinned.

“Yep, the very one.”

“But what's wrong with that thought?”

“What?”

“Maybe she did want her sister not to be around anymore. Maybe she is very anxious and needs to control it all with obsessive and ritualized behavior. Maybe she has got some neurobiological problems that need pharmacological management. Maybe she has a sad little life underpinned by a family in crisis. Perhaps every discipline is on the button. But that's all maybe, and for now what I suggest is that here you have one powerful little girl on your hands who can split the team and stir you up while saying nothing, eating nothing, and trying to die.”

In that moment I didn't know what frightened me most—my supervisor, my patient, or the way I seemed to keep getting this stuff wrong.

*   *   *

Later that day, looking at Imogen in our session, I saw hollow and empty. This tiny girl, one pale arm decorated with neat parallel red cuts, stared at me with large blank eyes and counted under her breath. Thinking over what Chris had said, I struggled to make sense of the word “powerful” in relation to this kid. Yes, small could be powerful, fragile also, but how can bereaved, emaciated, mutilated, anxious, and suicidal be powerful?

Chris had asked me for the story, and maybe that was where I would find clues—the clues to the hidden code that led to the unlocking of the child, of Imogen.

So I began to tell Imogen her story—as much as I understood it.

“Once upon a time there was a girl who lived in a big house in a big city. She lived with her mother and father and a nice lady called Miriam who couldn't really speak English. One day, when the little girl was three years old, her father decided he wanted to live in America in an even bigger house and in another city far away, with his friend Angus. The little girl was sad but stayed at home with her mother, who soon brought home a man with a lovely face who became the little girl's stepfather…”

Imogen had stopped counting, and her eyes were now completely focused on me. I felt my heart leap, my throat tighten. Her brown eyes were huge, framed by her tiny white face.

“The family lived together in the big house, and soon the mother and stepfather got married, not long after the little girl had her fourth birthday. The little girl was a bridesmaid and wore a pink shimmery dress with…”

There was a croak from across the room, and while I couldn't be sure, I thought that the croak was the word “blue.”

“A blue shimmery dress … Is that right, Imogen? A blue bridesmaid dress?”

She started counting again. Shit—how could I have been so stupid? I continued.

“After the wedding the family lived together, and while the mother was traveling and working, the little girl stayed at home with her stepfather and Miriam.”

Feeling my throat constrict, I suddenly realized that I had been mouth-breathing for too long; my throat was dry, and without a glass of water, I knew that I would start coughing uncontrollably and lose the moment, the connection—whatever was going on here.

How to get to the water, however, was beginning to panic me—I felt pinned into my seat by Imogen's wide, staring eyes. And then I started coughing.

The fit came with such force that I was left doubled over. The more I tried to control it, the worse it got.

I was bent over, with my eyes streaming, when I suddenly became aware of someone close by. Sitting up slowly, I found Imogen standing an arm's length away from me and holding out a glass of water. The start shocked me into stopping. I took the water and gulped it gratefully.

Imogen sat back down, the stinky rag doll under one arm, wrists circling and counting under her breath. And then she stopped and said in the tiniest voice, “My dress was blue.”

*   *   *

The next few sessions were uneventful. This was because I pushed her too hard. Buoyed up by the “conversation” about the blue dress, I pressed for more. But Imogen was giving me no more—and why should she? She sat silently with her dead sister's rag doll. Her wrists rotated through half-turns and back, and she counted under her breath. I was going about this all wrong.

Chris and I met for a coffee between her meetings.

“Try to understand Imogen's communication. Stop trying to get her to communicate on your terms.”

“What she's communicating is that she has given up and she wants to hang herself—I understand that, and I think she knows it.”

Chris was shaking her head. “Hanging is not a communication strategy. Hanging is about coping. She feels alone, afraid and misunderstood, so she wants to leave the party. That's all there is to it.”

I think I was shocked by this idea. I'd never thought of suicide as a coping strategy. I could see it as a way out for a desperate adult who has given life a shot but found it unlivable. For someone like that, suicide might be an active choice, something they could control and finally get right after a miserable life of perceived failure. But could a child think like that?

“OK, look at this another way. Stop pathologizing Imogen's behaviors. Stop trying to ‘stop' her when she behaves in ways that seem ‘abnormal.' Join her, get in alongside her, listen to what she is trying to tell you via her behavior.”

“Her behavior is suicidal, pathological—how can I get alongside that? The risks would be—”

“You are not listening to me. Suicide is merely an exit strategy. Look at what else she's doing.”

I ran out of our meeting because I had to get to a lecture, but driving back to the unit the following day, I kept thinking about what Chris had said.

Pathology: a variation in normal or healthy functioning; abnormal, or not typical, behavior or thinking that is caused by mental or physical disease.

A grim concept, and a bleak word to apply to a child. Where was Imogen being pathologized? She had been admitted in a crisis; she was on the highest-level observation; she wasn't allowed to possess anything that she might use to kill herself—her skipping rope, even her shoelaces had been confiscated. All that stuff
had
to be pathologized if she was to be helped, right? So what else was there that I could apply Chris's theory to?