by Kerry Daynes
*
Maya first started hanging around the GP’s surgery as a teenager, sitting in the waiting room after school even though she didn’t have an appointment. When she was 16 she began to write cards and letters to one of the GPs, Dr King, expressing her undying love for him. It seemed harmless enough at first, but her devotion didn’t stop at teenage infatuation, and she had begun to wait for him outside the surgery and even followed him home a number of times.
Maya’s behaviour gradually escalated to the point where she began threatening to hurt herself and Dr King if he didn’t return her affections. She warned she would slit her wrists if he couldn’t be hers, she would lie down in the road and kill herself.
Then one afternoon she had waited outside his consulting room while he was seeing a patient and, when the door opened at the end of the appointment, pushed her way into the room and locked the door behind her, ensuring she was alone with the doctor. Dr King had reached directly for his desk phone and called through to reception, and fortunately a nurse was able to unlock the door from the outside, but there had been a tussle and raised voices as Maya had tried to block her. As Dr King tried to open the door, Maya pushed him onto the examination couch and tried to climb on top of him. She simply wanted to be close to him, she said. It all sounded clumsy and vaguely farcical, but if you’re the person being climbed on against your will in a locked room, it’s likely to be a while before you can see the funny side.
As psychotherapist Frank Tallis points out in his book The Incurable Romantic: And Other Unsettling Revelations, there is a certain unsavoury pleasure to be found in watching people make fools of themselves in the name of ‘love’. But ‘when we mock the lovelorn, we do so as hypocrites or automatons. Who hasn’t acted foolishly – or at least conspicuously out of character – when in love?’ Who indeed. But Maya’s fixation went far beyond simply making a nuisance of herself. When she began to deliver handwritten threats to kill Dr King’s wife and children to his home, she was arrested and taken into the care of psychiatric services. Maya had put him and his family through a terrifying ordeal.
*
For the next 20 years, Maya had lived in one secure hospital after another, residing in locked psychiatric wards, gradually moving from high to medium and eventually low-security settings.
The reports in her considerable file showed she hadn’t given up on doctors. The reports nearly always mentioned a psychologist, a psychiatrist or maybe a nurse with whom she was beguiled, although she was fickle and her allegiances drifted from professional to professional. One report described her as ‘willing to show up for therapy but non-committal when she does and maintains declarations of love’. It seemed she was keen to be in the same room as the string of psychologists who had been tasked with her treatment over the years, but once there she would say very little apart from telling them repeatedly that she loved them.
For nearly twenty years, Dr King had remained a more consistent passion – she had continued to write letters to him since the episode at the surgery, although of course they were never sent. The letters were kept in her file. Looking through them it was clear from the earlier notes that she was someone in a state of genuine agony, they were long and intense pages of handwriting, spelling out her suffering in exacting and tortured detail and her fury that she and the love of her life, her destiny no less, were being kept apart.
Reports from her earlier years in hospital detailed how she described the voice of Dr King telling her to kill his wife to clear the way for their love. She talked about taking him hostage at knifepoint, if that was what it would take for them to be together at last. In the depths of her despair, when she felt most hopeless or rejected, she starved herself, scratched deep lines across her face and pierced her body with whatever sharp object she could get her hands on.
I noted that as time passed and she moved to lower-security wards, the letters became less and less frequent. They became briefer, less poetic and harrowed. They unravelled into a thin string of repetitive notes, ‘I want you to know that I love you. I would do anything for you.’ The notes read like someone paying lip service to a relationship that has long since lost its spark, as if writing it had been a job on her to-do list that day. The letters eventually stopped and she hadn’t written to Dr King for a number of years by the time I met her.
Now she was the same age as me – 40; when life begins, so the greetings cards say – and the hope was that this would be her last hospital placement before her transition into ‘real’ life.
Things were looking positive for Maya.
*
But when I met her, it quite quickly became clear that she wasn’t so keen on building a life for herself outside the oasis of the hospital walls.
During her very first meeting with her care team (me, the psychiatrist, the occupational therapist and the nurse in charge that day), she sat down and informed us forthrightly that she was a hopeless case. ‘I’ve done it all before,’ she said. ‘Nothing can make me better.’
This seemed like a defeatist way to start proceedings. I took in the sparky, bright-faced woman in front of me. Her impossibly white teeth looked too perfect to be real, and I realized they were false. The straight line of perfect dentures looked just slightly too big for her mouth, which added to the overall impact of her. She had on the chunky yellow jumper that she wore all the time, it swamped her frame, and she tucked her thick dark hair behind her ears with efficiency and purpose as she spoke, her fingernails each painted a different shade. She had intricate swirls of red henna dye on her hands. She was full of colour.
How would you know that you are ‘better’? I asked. What would better look or feel like? She couldn’t answer. She was dangerous, she informed us. She had De Clérambault syndrome and she was ‘treatment resistant’. She had all the jargon, and I was struck by how certain she was of what she saw as her irreversible condition. It seemed she saw it as her identity now. This wasn’t so much a level of self-awareness as an exercise in locking down the situation on her terms.
Plus, she still heard the voice of Dr King telling her to kill his wife, she said. ‘So that we can be together, that’s all he ever says.’
I asked if she found the voice upsetting, and she was very matter of fact as she replied, Yes, it was awful, all-consuming and excruciating. This could have been what’s known as a ‘blunted affect’, the emotion-flattening result of long-term mental ill-health and, often, the medication prescribed as a result. She looked at me as she shrugged and I wondered if Maya was really in as difficult a place as she wanted us to believe.
After that meeting, we each received the same short note from Maya, written in an elegant looped script. She wanted us to know that we were ‘perfect and God-like’ to her. She loved us and she would do anything for us.
*
One of the many worthwhile aspects of working with patients in a small environment like this hospital was being able to practise a more free-flow kind of psychology. With such a small number of patients it was far less structured and procedure driven, unbound by the conventions and routines of more densely populated places I’d worked. Alleluia. I found myself with the time, resources and autonomy to practise psychology as I saw fit. I wasn’t chained slavishly to any particular treatment style, manualized programme or group timetable. I could spend time with the women there based on what level of support they needed, rather than the preordained hour once a week, no more, no less. The therapy we practised was tailored to be meaningful for each individual. I believe that psychology should be embedded into day-to-day life, in everything that we do. So I kept an open-door policy and patients came to me when they were struggling, as did the staff. There was still an element of form filling and auditing of course, but it didn’t overtake the care of the patients.
Although there was one person who didn’t make use of my open door. Or in fact anything else on offer in the hospital. Maya turned down invitations to join the local Hearing Voices Group – a small support group that
might have helped her manage what she said were Dr King’s instructions to kill his wife. She often didn’t show up for her scheduled one-to-one appointments with me. We had started trialling a new form of therapy for people who were distressed by voices and it was getting some great results. When I asked Maya if she wanted to try it, she said no – if she lost Dr King’s voice she would miss it. I’ve heard this before from people who hear voices, but given what she had said previously about the distress it caused her it didn’t seem to make any logical sense. There was no rhyme nor reason to it (and that part of it at least sounded the most like love to me).
Maya turned down all my invitations to work with me, remarking ‘you are a psychologist so you are up here’ – she pointed to the sky – ‘and I am down there’ – and she pointed to the floor. She once told me that she liked to think that I spent all my time studying books and probably didn’t even need to sleep, and certainly didn’t use the toilet. Maya wanted me to know that, although she didn’t want to do any work with me, she loved me nonetheless. In fact, she repeatedly said she would do anything for the staff at the hospital, and yet she did her level best to avoid any kind of actual treatment. She would do anything for love, but she wouldn’t do that.
I decided not to ask Maya to keep her appointments with me in the way the other patients did, but instead to ‘bump into’ her around the hospital. This wasn’t difficult as the place was so small. I became a psychologist in stealth mode. My hope was that by doing away with the formal trappings of my role – the quiet room and the notepad, the open-yet-concerned gaze across a coffee table – she might begin to see me as a human being on her level, rather than revere me as a deity.
On one occasion I quite genuinely bumped into her as I was coming out of the toilet, and in a moment of flippancy I said, ‘I’d give it a few minutes if I were you.’ This is not a technique you will find in any psychology textbook, but I was rather pleased with my own maverick genius – I’d used the chance to show her that I was a mere mortal, with bodily functions, and bring myself down off the pedestal she had me on. If her nose wrinkled as her psychologist made a terrible toilet gag, that was exactly what I wanted. I was determined to break down this ideal of health professionals.
Most of the other patients would go out during the day on walks and trips, attending work and appointments alone or with staff, but Maya never wanted to go. She stayed in the communal lounge watching TV. There was always some American sitcom on. She liked the ones about families, with canned laughter and wisecracking kids. Sitcoms, schmaltzy made-for-TV films and anything with Tom Hanks in. She loved Tom Hanks. Kind, non-threatening, smiley-faced Tom Hanks.
One morning I found her in the communal lounge, where she was again watching TV. She wasn’t expecting me, and I sat down beside her, and we both half-watched the programme and half-talked. A big St Bernard dog came on in the show she was watching and she said she loved dogs so I showed her a picture of my two. This is what’s called ‘appropriate self-disclosure’. Psychologists don’t, as a rule, share personal information with patients, but if it is safe and you think it will be helpful, sharing a little part of yourself can be a useful tool. I never tell anyone anything about my family or relationships, and with Maya’s history in particular I wouldn’t let any personal details of that nature slip. But I had discovered that my dogs were a safe go-to subject, the perfect leveller. Who doesn’t love dogs after all? I showed Maya one of Fozzchops where she had got a cream cheese triangle stuck to her ear and she really laughed at it – lost herself for a few seconds and just snorted with glee. A small glimpse into my perfectly imperfect life.
We sat and chatted like this whenever the opportunity presented itself. I started to understand her in those moments. Slowly we were lifting the veil of her diagnosis to see what lay beneath it. Those chats with Maya remain among some of my favourite experiences as a psychologist, building trust, doing it the way I felt it should be done, one old maid to another.
With no pressure from me she began to confide in me more and more. She was revealing herself in many ways, not least as being good company. Just as she was beginning to engage with me, I was also warming to her. The stalker I had feared I would struggle to work with was turning out to be quite funny and smart. She told me once that she liked Dr King’s eyes. When I asked why, she said he had ‘footballer’s eyes’. I said I didn’t understand what she meant and she replied, well, they pointed in different directions, one was ‘playing at home and the other was playing away’. I never pushed her on the subject of Dr King but I did enjoy this description of him. We used to make up funny book titles together: Back Problems by Eileen Bent or The Art of Bull Fighting by Matt Adore. She had heard Terry Wogan on the radio in the morning doing something similar and she loved the silliness. In between she talked to me about her past and her family, and told me all about her dad. I found that I liked her. She was bright and had a lot to offer the world.
The time I spent with her also helped me soften mildly – and only mildly – towards the man who had stalked me. I was finding my balance again. The patient– therapist relationship is a two-way street. The benefits to the psychologist of a therapeutic alliance are rarely discussed, but they do occasionally happen.
But all the feelings of hope and optimism I had about Maya’s recovery were most often quashed. She stalled. She didn’t want to leave the hospital alone or even go on any of the accompanied outings with the hospital staff that the other patients did. Just at the point when I felt she might take tentative steps into the outside world and begin to imagine a new life for herself, at the hint of an excursion into reality she would always pull back. And always the same response: No, no, I am ill, I am sick. And if we pushed her: No. I am dangerous. Dr King is telling me to kill his wife. On one or two occasions she scratched herself, and once drew a shallow but decisive line onto her face with a CD.
One day I asked Maya to describe to me her idea of a perfect place, somewhere she would go if she couldn’t be here. She told me it would be a long hospital corridor, entirely bare but with doors leading off it on either side. She could walk up and down this corridor and open any door she liked, and inside every room would be a doctor who she could stay with for as long as she wanted to. They would make sure that she was fed and taken care of. At night, they would tuck her into bed.
This sorry vision of a hospital-based utopia made me think of my Uncle John’s canary, who had spent a lifetime in a cage and preferred to stay there, even when the doors were open.
I’d witnessed something similar a few years before, when visiting a medium-secure unit in the north-east to give evidence at a Mental Health Review Tribunal. It was a grand old sanatorium-style place, shiny pale bricks and long, tall windows, with a winding tree-lined drive that felt like a portal into a Brontë novel.
I had been asked to wait in one of the admin offices with the mental health administrator and two secretaries. The room had a window overlooking an ugly gravelled courtyard with a smoking area and a set of huge iron gates.
As we waited, the pale grey sky in the window turned all of a sudden to a menacing shade of ash and there was a huge crack of thunder. An enormous storm was coming in. We all gathered around the window to watch the blackening sky and saw that, below us, a few patients were huddled together in the smoking area like penguins, sucking rapidly on their cigarettes, their hands cupped around them, trying to keep them dry.
Then there was another almighty crack and instinctively we all looked up to the sky, expecting to see lightning. But there was no lightning and we realized the noise had been the wind blowing one of the big iron gates into the courtyard with such force that it had snapped the chain lock and come loose from the other gate. Suddenly the gates were open and the smokers beneath us were only a few feet away from a tantalizingly easy exit.
One of the patients ran towards it – he was skinny and tall, with a long stride. I couldn’t see his face from where I was, but he was wearing a blue woolly bobble hat, and I wat
ched as the hat travelled at speed towards the entrance, expecting to see him zoom out into the middle distance. But he stopped just short of the gates. He took a couple of steps backwards and one tentative step forward, flapping his arms around indecisively. Just like Uncle John’s canary.
The other patients had all run inside and a nurse was standing at the doorway calling the potential escapee to come back in. He stood looking at the gates for a few more seconds, the heavens now fully opened above him, then he turned around and scurried inside.
As the patients trooped past the office we were waiting in, we made the obligatory comments about the Armageddon-like squall outside. The man in the hat was soaked through to the skin.
‘Look at me! It’s raining bloody cats and bloody dogs out there.’ He stretched his arms out. ‘I’m not running off. Not today, not in that weather.’
I shook my head and said, ‘Nooo, you’ll catch your death in this!’
‘I know,’ he said. ‘I’d rather stay here. It’s a shithole but at least I can get a decent brew.’
How very British, I thought to myself.
*
A locum psychiatrist came to work at the hospital for a week, and before Maya had even met him she sent him a love note, declaring, ‘I love you I would do anything for you.’ Unlike the rest of us, he was furious about this note. He considered it a boundary violation and sent it back to her with a clear message that he would not accept it.
Maya came to my office – at last – and threw herself down in the chair. She said, ‘But he is my doctor, it is his job to take care of me.’ There was that sense of entitlement written in the sulk on her face.
I explained that yes it was his job to take care of safely prescribing her medication, but that it was just that, a job, and he was clearly very personally offended by her note. She thought about it for a moment and declared, ‘Being sick makes you selfish.’