‘A mercy, then,’ said Franz, resettling his glasses. ‘How will Dr Rebière proceed?’
‘He was thinking of returning to Paris for the funeral, but I dissuaded him. Jacques’s work has its own momentum now. He read a paper in Vienna last winter which was a development of one he read to us here in the spring. It was well received. There are a number of people inVienna who are thinking in the same way, but they do not all have his authority as a clinical neurologist. That is why people respect him, not as a psychologist, where it is so hard to establish a position, but because he can explain in detail the love life of the eel. And because he is so eloquent, damn it!’
Franz laughed. ‘And German is not even his native language. Imagine what he must be like in French.’
‘Not nearly so persuasive, oddly enough,’ said Thomas. ‘I think he feels that French was the language of his restricted childhood, English for romance and happiness – but German for science and intellectual freedom.’
‘Do you have misgivings about his ideas?’
‘Misgivings, yes. I would put it no more strongly than that. I would not wish to see him develop a complete psychological theory on the basis of what he learned from one neurological illness – a mysterious and not fully understood one, at that. And I think he would find it extremely difficult to move outward from that base into psychiatry, where the different illnesses may have their own singular organic nature. I think what he has done is wonderful, and I do see why he wants to learn from it and extend it. It looks like a cure and a breakthrough and it is so philanthropic in its application. A cure! Happiness! And yet . . .’
‘You have doubts?’
‘Yes. I do not believe you will ever cure severe psychiatric illness by the application of psychological theory and what at the Salpêtrière they now call “psychotherapy” – talking to the patient – however complete your model and whatever your gifts of understanding. He has not yet established the physiology of this process either – how an idea becomes a seizure. He cannot say in exact terms how it works.’
Franz smiled. ‘When I was in Frankfurt, a visiting professor told me the story of a man he knew whose wife had endured an agonising labour. The husband was present throughout, greatly anguished by what his wife went through. At the end she was delivered of a healthy boy and suffered no after-effects. After two days at the hospital, the father went home elated. Two days later, when his wife and child had returned home, he went to open his bowels, something he had done every day of his life after breakfast. On this occasion, however, something went wrong. The matter he was trying to evacuate got stuck. His sphincter kept contracting, but what it was trying to expel was too big. It was enormous. He began to cry out in pain. “I can’t bear it, I can’t bear it.” His wife heard him and came to help. Somewhat shamefaced, he explained the problem. He was in agony, pouring sweat. She went to fetch him a suppository her doctor had given her for the likelihood of constipation in late pregnancy. He inserted it, the contractions increased and eventually this enormous thing was expelled. He expected there to be damage and bleeding to the rectum, but in fact, as soon as it was done, he felt completely normal. He inspected this freak of nature in the water, shook his head in wonder, then disposed of it. It was only a week or so later when he heard his wife describing her childbirth to her sister that he suddenly remembered the words of hers that had so upset him at the time. “I can’t bear it,” she had screamed. “I can’t bear it.” But now it appeared that he had taken over a part of her pain, he had done the proper thing and experienced a version of it for himself.’
Thomas laughed. ‘Did he weigh it?’
‘I think he was pleased to see it go! But although there is a practice in certain primitive tribes – it is called couvade, I believe – when the men go through rituals of shutting themselves away in sympathy or strapping weights to their bellies, that is all a conscious performance. They feel no pain. But this man . . . Something happened. The idea of sympathy was converted by his brain, through the operation of his nervous system into a somatic offering.’
‘Unarguably somatic by the sound of it,’ said Thomas. ‘But you might suggest a quite prosaic explanation. He had late nights at the hospital, he did not have his normal diet. In his care to bring water to his wife he probably neglected to drink enough himself. All available energy was diverted into remaining alert; little was left over for the normal process of digestion.’
‘Is that what you think?’ said Franz.
‘It seems probable. At any rate, it provides a plausible account of how the body worked, even if there was also an emotional motivation.’
‘That is not how our professor interpreted it,’ said Franz. ‘His view was that either it happened as you describe or as I describe. There can be no mixture. Either it was a simple change of dietary habit and it was an utter coincidence that his cri de coeur used the same words as his wife’s; or – his subconscious mind entirely took over the working of his body for its own ends.’
Thomas smiled. ‘It need not be a choice. Take the phenomenon of temporary impotence. A man is ready to perform, then lacks confidence, and suddenly the blood drains away. The draining mechanism can be activated chemically, by the effects of alcohol, for instance, or simply by an idea: I am not worthy. So, you would say, this collapse might be caused by the chemical content of wine or the mental content of a man’s timidity: either, or. Yet in fact, I would suggest the mechanism is the same. Increased blood flow depends on a degree of relaxation. Both alcohol and fear can affect that degree of relaxation through their own separate accesses to the operation of the central nervous system. A room with two doors, but the same room.’
Franz put his wineglass down beside the microscope. ‘Dr Rebière tells me you are much interested in your fellow-countryman, Mr Darwin. What would he have to say about this mechanism of temporary impotence, do you suppose?’
‘I think he might argue that it is an advantage for the less self-confident male not to reproduce. By revealing his lack of fitness at the vital moment, he demonstrates to the female that he is to some extent an impostor and she had better mate elsewhere. Though I must say I do not personally believe that every embarrassment, every tiny experience in life is the selected best outcome of a billion previous experiments. There is still chance. Asfor the drunkard . . . I am not sure he serves a high purpose in the process of “descent with modification”.’
‘And what about your demented patients? What would he say about them?’
Thomas sighed. ‘You may say that they are misfits who should be bred out of the human strain. That is the dominant view of European psychiatry, that they are degenerate and part of a doomed process. Yet I cannot accept that. My instincts tell me it cannot be so, partly because they are so numerous. I believe as many as one man in a hundred may have this disease – Dr Rebière’s own brother, for instance. My feeling is that the root of this illness lies very close to the mental faculty that first made us human. It is a relatively new ability, and as a wonderful doctor called Hughlings Jackson – the English Charcot, you might call him – has pointed out, those neural circuits which have most recently evolved are those which are most likely to go wrong. I do not see men like Olivier as degenerates, as simple idiots but with more florid symptoms. I think what they suffer from is a problem in awareness and making connections in the brain. Mr Darwin’s great collaborator Alfred Russel Wallace believes that God has been present at various moments in human development, principally the one at which we gained this consciousness of being alive. I strongly sense that at that crucial chemical moment, when one mutation was “selected” and the first Homo sapiens was born, a certain instability came into the neuronal circuits of the brain. If God was present, you might argue that He was also for a moment absent. Homer nods. One day, this instability may regulate itself through successful transmutation. Until then, I do not see men like Olivier as being degenerate or retarded; I see them rather as at the forefront, in the vanguard of what it means to be a human.’
‘But they suffer,’ said Franz.
‘My God, they suffer. I think they suffer for all of us. It is almost as though they bear the burden of our sins. It is scarcely too much to say that they pay the price for the rest of us to be human.’
‘And how do you treat them?’
‘I talk to them,’ said Thomas. ‘I listen and I try to learn. It is how I treat Dr Rebière’s own brother, though I am aware that I probably take more from it than he does. But, frankly, I have little else to offer him.’
Franz smiled. ‘It is an adventure.’
‘Yes,’ said Thomas. ‘One must always see it in that way. Sometimes I feel such a fool. How can I possibly know these things which are of their nature unknowable? What mad arrogance keeps me hitting my skull against the wall? These are mysteries which no man can know. But there is something of Don Quixote in me, I suppose. Where I see a windmill, I will take my lance and saddle up. I dread growing older because one day I will think that I can no longer be bothered.’
Franz took the glasses to the sink to wash.
‘We must all try to keep the quixotic element,’ said Thomas. ‘Throw the old knight a pie. Give oats to Rosinante.’
Later that year Thomas read the new edition of Emil Kraepelin’s Handbook of Psychiatry. Kraepelin had suffered a frustrating exile in Estonia, where his inability to speak the language had prevented him from making progress; on his return to Germany, however, he had gone to Heidelberg, where he continued to study the long-term course of severe illness. With the help of an enormous card-index, he had begun to identify two repeating patterns of psychosis. The first had been baptised ‘circular insanity’ by doctors at the Salpêtrière, because periods of high elation and mania alternated with passages of profound depression; Kraepelin developed the idea and went on to call it‘manic-depressive illness’. The second category of psychosis he called ‘premature dementia’ or dementia praecox.
Reading the definition in Kraepelin, Thomas recognised it immediately as Olivier’s disease. Its basis, Kraepelin stated, was a ‘psychopathic predisposition’; in other words, it was a biological brain disease. Thomas was moved by the intentions that lay behind the monumental industry of Kraepelin’s research: he wanted to be able, as a doctor, to help the woman who asked, ‘Will my husband recover from his illness? What will happen to him now?’ About three quarters of those suffering from dementia praecox grew steadily worse, Kraepelin concluded; but the remainder might grow well again.
Thomas enthusiastically pointed out the passage in Kraepelin to Jacques, thinking he would be encouraged to know that his brother’s illness finally had a name; but Jacques said the term had been coined by a Frenchman called Morel some years before, and did not seem able to share Thomas’s enthusiasm. To Thomas, it did look like progress. He remembered the ledgers in the asylum, and the multiplicity of colourful and unscientific diagnoses: old maid’s insanity, honeymoon psychosis, moon madness. In the older books, causes of insanity were divided into moral and physical, the former including ‘loss of several cows’ and ‘overexcitement at the Great Exhibition’. He saw the faces, grey and dirty, of the urban poor who came to stand in front of his trestle table in the hall, waiting to be assigned a ward number, waiting for an instant name for their distress, then set to vanish down the shrinking corridor.
Kraepelin had divided psychoses into those with violent swings of mood, and those without. Fromthe former, patients tended to emerge, from the latter they were unlikely to. He had established patterns, something close to a nosology, and surely this progress at least gave grounds for hope?
What he described to Franz as the ‘quixotic’ element survived in Thomas because he found there were still enough things for him to despise or rebel against. In the summer of the following year, his father died and he returned to Torrington with Sonia for the funeral. His brother Edgar told him he would be moving into the house with Lucy and their five children; he asked if Thomas would like to join him in the family grain business and promised him a farmhouse. Edgar seemed bemused when Thomas explained that he had a profession and a life in Carinthia; it was, as though, Thomas thought, Edgar believed that he was in some obscure way joking. ‘Write and let me know if you change your mind,’ Edgar said, his hand on Thomas’s shoulder when the time came to say goodbye. ‘I will always try to keep a place open for you.’ Thomas wondered if it was just that Edgar felt he had taken Sonia away from England and that if he returned, she might follow. It was certainly true that without her Torrington was not the same. His mother was bewildered by her husband’s death, was herself growing old and had lost some of the self-belief necessary to make such a household seem worthwhile; Lucy was a kind enough girl, he thought, but overwhelmed by children. At least their noise made the old house feel inhabited, and Sonia could not be in two places at once.
Back at the schloss, he learned that Olivier had been found one night in the city, hiding naked in an alleyway. No one was certain how he had got into town in the first place – presumably he had gone with one of the tradesmen who came to deliver each day – but it had been difficult to reassure the police who took him into a cell that he posed no danger to the public or to himself. Jacques enlisted colleagues from the hospital, where he and Thomas still had a clinic, to vouch for their qualifications and good standing. He undertook to make certain there would be no recurrence of the incident, and Olivier was released into his care. The policeman’s major concern, it appeared to them, had been that Olivier’s nakedness might have affronted people who happened to be walking by.
The next morning, Olivier came down to Thomas’s consulting room as usual. He had been at the schloss for four years, and they had grown close to one another. The warmth was manifest in an exasperated affection onThomas’s side, a sort of habitual and frustrated brotherly love, and, on Olivier’s, by a manifest anxiety and bizarre behaviour if ever Thomas went away.
Thomas always spoke gently, but he had learned that he could also be direct and that, provided he was not alarmed, Olivier often responded well to a kind of bluntness.
‘Would you like some of the drink that makes you feel drowsy?’
Olivier did not answer. He touched each arm of the chair, then put his fingers soundlessly together, then each hand back to the chair arm, back together and so on without interruption. This was a sequence of movements he seemed frightened to abandon at any time.
‘How do you feel, Olivier? Do you feel better today? Do you feel better now that we are all back?’
Olivier glanced up over his left shoulder. His lips moved, though as far as Thomas was aware he did not speak, at least not to him. It would be one of those days on which it was going to be difficult to engage his attention, but this was often the case.
‘Olivier, do you remember what happened? Do you remember being taken into a cell by the police?’
Still there was no answer, though Thomas was not surprised, since this was not something Olivier would wish to confront.
‘Who told you to take your clothes off?’
‘What did you say?’
‘Who told you to take your clothes off?’
‘The Sovereign.’
Thomas leaned forward; at last he had Olivier’s attention.
‘The Sovereign? You’ve told me about him before, haven’t you? But he doesn’t speak to you often himself, does he?’
Olivier shrugged. ‘Sometimes. There are a number of people. The Carver comes. Or the Seamstress. Sometimes there are more.’
‘What determines if there is to be more than one?’
Olivier shrugged, not really interested by the question. ‘It depends if the message is important.’
‘And are they here now? Is the Seamstress here now?’
Olivier looked up over his left shoulder. ‘Yes, she’s here now. I won’t go to market, I won’t go back there. They are all foreigners and they have read the books. So why should I lend them to—’
‘Olivier.’ Thomas regretted mentioning the Seamstres
s, because now Olivier was talking to her instead of him. He stood up. ‘Talk to me.’
He felt himself appraised by Olivier’s gaze; it was clearly a reasonable choice for him – which one to address.
‘Last time we met,’ said Thomas, ‘you told me something of your thoughts, how they are shared with other people. Do you remember?’
‘Yes, of course. What I think can be seen by the Sovereign and by the President of the Republic. I have no need to write to him.’
‘Which Republic?’
‘The Republic of France.’
‘What is the President’s name?’
‘The President.’
‘Do you live in France?’
‘Of course.’ Olivier was unruffled by the question. ‘There are five or six people who have a list of traitors. They have a list of all the illnesses in the world and they have the cures. It is a very well kept secret.’
‘How do you know about it?’
‘I just know. I receive messages. Sometimes the Carver tells me. Or I can read it in books, you see. It is not in the lines, not in the printed lines. No, no, you would not open the book and just see it there. It is between the lines, that is where I can see it. The Monarchy will return. I have been informed.’
‘But how?’
Olivier gave him a curious look. Thomas was sometimes reminded of one of the fellows of his old college at Cambridge, a man so secure in his superior knowledge that he seemed reluctant to impart it to anyone of lesser intellectual standing; he responded to questions with the same slightly pitying expression that Olivier now directed at him.
Then Olivier spoke quite calmly, something which Thomas always took to be a good sign. He liked watching him, this handsome man of thirty-eight; his greying hair was trimmer these days, as was his beard. There was something oddly cogent in his understanding of the world; the scheme had a completeness, almost a beauty, and in his better moments Olivier achieved a measure of serenity. His voice was gentle and explanatory, and at such moments Thomas felt overcome by love for him.
Human Traces Page 35