by Kerry Daynes
Was it being sick? Or just wanting to feel safe? I asked her this because I understood that, to some extent, I was working at that hospital seeking the same thing – a sense of security, a safe harbour. I told her that wanting to feel safe was completely understandable. In fact, I believed that she was entitled to that, but not at the expense of someone else feeling unsafe.
She nodded slightly and then said, ‘I do love doctors, but I would probably run a mile if one ever wanted me. A doctor would never look at me. They are too good for me. I just want them to take care of me.’
After Maya left my office that day, she didn’t cut herself, threaten anybody or mention Dr King again. I was certain then that Maya was better and had been for some time. The all-consuming illusion of love had long-since dissipated to nothing more than a pleasant fantasy to call upon, and a mantra to ensure she remained cared for.
*
Doctors had come to represent much more to Maya than mere healers. In that simple act of tucking her into bed, the doctor who had visited her years ago had given her a glimpse of the love and care she had never received from her father. Dr King had rejected her romantic advances but had rescued her nonetheless: her infatuation with him had led to her detention, removing her from the danger of her family home. And now, with a lifetime spent in institutions behind her, the idea of taking responsibility for herself, leaving the safety and security of the hospital and the doctors was terrifying. Infinitely more terrifying, even, than remaining ‘sick’.
Long after her abusive childhood, a basic need to feel safe drove Maya to maintain her ‘sick’ identity. Like the bobble-hatted man, Maya took tentative steps towards her freedom; coming to see and accept me as human like her had been a huge step forward. And yet she wasn’t quite ready to make it past the gates either, finding reasons to stay in the safety of the hospital and rejecting the help that might propel her outwards into the world. This is the nature of therapy sometimes – one step forward, one step back. You keep on going all the same.
The allure and sanctity of the ‘sick role’, as it is known in psychology, is complex. Mental health professionals have long recognized that there are those in the system for whom the idea of being a patient beats the idea of not. I have seen similar in prison environments too.
To those of us for whom freedom is a given it seems unbelievable that someone wouldn’t want that liberty for themselves. But what is privacy and independence for some can feel like isolation and insecurity for others. When life in the outside world is an unkind and uncertain prospect, the psychiatric set up offers care and sanctuary. And as unlikely a settling-down territory as it may seem, stay somewhere long enough and it can become a home, even a family.
In order for someone to feel strong enough to move on, they need to be able to picture a better life for themselves, one that is achievable, that is better than the one they’re living. As their therapeutic ally, the psychologist can only really show them what that life might look like. You shine the light, and hobble with them to the end of the tunnel, but you can’t make them step out. For some the light is blinding.
CHAPTER 11
THE SUM OF OUR PARTS
The whole is greater than the sum of its parts.
Aristotle
Before its incarnation as a women’s psychiatric hospital, the stuccoed Victorian villa where I worked with Jeane had been a bed and breakfast. From time to time people would still walk down the long tree-lined drive to knock at the door, asking if we had any vacancies. I loved imagining what the TripAdvisor reviews might have said if we’d have welcomed them in.
It was part of the same group of small and friendly recovery centres for women where I had worked with Maya, and I had been with them for some time now. Like the others in the group, it felt more like a home than a hospital. It had old-fashioned Anaglypta wallpaper obscured under layers of old paint, shaggy carpets and dark, musty-smelling floral curtains. World of Interiors it wasn’t, but it helped the residents feel at ease, like living on the inside of a giant knitted tea cosy. Although this exercise in faded grandeur was less pleasant for us staff: the ancient heating system in my office meant that if it wasn’t fridge-like it was tropical, a situation made worse by the fact I couldn’t keep the door open because of fire regulations, or open the window because, like all the windows, there was a bar across it.
There were nine bedrooms here, with the residents ranging in age from nineteen through to sixty. They were all women with complex mental health struggles. It was a diverse group, including women who heard threatening voices, had memory problems caused by addiction, or who’d had high-flying careers until the compulsion to wash or pick at their skin had overwhelmed them. I liked that we appeared to have no rigid admissions criteria; no typical story bound these women, other than our shared belief that we could help them. There was a lot of warmth and compassion in the place. In fact, of all the hospitals I’ve worked in, it remains up there in terms of its aspirations and the standard of genuine care it gave. But I came to realize that even in a homely, caring environment like this, compassion comes with conditions and caveats.
Jeane was referred to us after being found by police when she was about to throw herself off a motorway bridge. She’d been taken to the acute ward of an NHS hospital and I’d been asked to assess her suitability for a place with us. It turned out Jeane had been trying to kill herself one way or another for a few weeks; the reports said ‘ligatured’ (when someone tries to hang or strangle themselves) and gave a series of dates on which she had tried to cause herself harm. On one occasion she’d tied herself to the back of her wardrobe door with a blanket and they’d found her unconscious. Another time, she’d tried to cut her wrists with the jagged edges of a Coke can. In her arm she’d scratched the word ‘bad’ with a piece of glass. She was sending some very clear signals that she needed help.
Jeane’s paperwork revealed she’d spent much of her late teens and early adulthood in and out of psychiatric care. But she had also spent long periods of time living an outwardly unremarkable life – long enough to get married and raise two children. She was in her 40s now, but when she’d discovered her husband was having an affair, and he’d cruelly asked her to leave so he could move his mistress in, she had started to flounder.
The first thing I noticed about Jeane was her other-worldly aura; she often looked as if she were drifting, like she had swallowed a big cloud. The effect was made all the more incongruous by her hulking size and build. She was five feet ten, and almost as wide; silver haired, with a ruddy complexion, she looked like she could single-handedly plough a field. Intently squeezing a string of blue beads as she spoke in her slow, light and delicate voice, she explained that she was desperate to understand what was happening to her, and to break out of the pattern of self-destruction she found herself in. She was reaching out for an escape from her situation; from all the confusion and guilt she was feeling and her fear of what might happen next. I felt certain that we could work with Jeane to turn things around.
My enthusiasm in wanting to bring Jeane into our eclectic group wasn’t shared by my colleagues, however. Jeane had been given a diagnostic label that can be interpreted in many different, and often pejorative, ways by mental health staff: ‘borderline personality disorder’ (BPD, also sometimes referred to as ‘emotionally unstable personality disorder’).
For starters, the criteria used to diagnose BPD feel more like a rap sheet than a set of symptoms or difficulties: self-harming and all-round reckless behaviour (unsafe sex, outbursts of rage, drug use and so on) are the big markers, along with violent mood swings and a paranoid mistrust of others. Meanwhile, the characteristics and personality traits associated with a BPD label can read like the definitive list of all the reasons ever invented not to like someone. Such people can be irritable, self-destructive, clingy, wildly unpredictable and generally quite annoying for everyone around them. There’s an unhelpful tendency, even among those caring for them, to see this disproportionately female grou
p as manipulative and attention-seeking. The term ‘drama queen’ was probably coined – unfairly – about someone tagged with BPD.
What’s certain is that whatever a person with this label is doing, they aren’t having a good time, or trying to provoke people merely for the hell of it. Yet the term ‘personality disorder’ is innately accusatory; the diagnostic equivalent of a wagging finger. These people have been bruised; describing them as disordered makes it sound like their character, their innermost core, is somehow wilfully and irretrievably flawed.
When a few days later Jeane arrived to check in at the hospital, I noticed there was something different about her. She was, expectedly, anxious. But she was also uncommunicative with the staff, and when she did speak her voice was even higher-pitched, more nasal and childlike. It didn’t help that she was dressed in pink jeans and a pink top with a pony on it – the kind of outfit a nine-year-old girl might pick out. She planted herself on the sofa in the hospital lounge surrounded by a menagerie of cuddly toys she had brought with her. One of these, a huge cat, became as much a resident of the place as Jeane. It had a patch over one eye and mismatched ears, the kind of loveable stray you see in children’s books. We had to restuff it at one point, because it had nearly been cuddled into extinction.
I clocked a couple of the usually kind-hearted nurses roll their eyes at each other when she arrived, as if to say, Here we go. Even before she had had any professional attention, Jeane’s copybook already had a big fat BPD-shaped blot on it. Beneath the gaze of even these dedicated nurses, she had been labelled as difficult, possibly beyond help, before she had barely got through the door.
That wasn’t the only reason for my unease. As soon as I had encountered this floating woman in the acute ward of the hospital, I felt that her predicament didn’t even correspond to the already broad and unhelpfully loaded category of BPD. If we had to slap a label on Jeane, it should at least offer a more accurate description of her issues. Her difficulties were more consistent with what is known as ‘dissociative identity disorder’ (DID).
Previously known as having multiple personalities, people attracting the DID diagnosis in fact have only one personality, but they experience it as distinct and separate parts. The switch between the different parts of their personality can be very subtle, as simple as a change in mannerisms or tone of voice. Or it can be more obvious: someone can feel physically different, a different gender even, or reveal skills or habits their ‘regular’ self doesn’t seem to share. They can also be entirely unaware of the switch, and experience a kind of amnesia when it happens, travelling to different places and not remembering how they got there. Jeane’s reports showed she did this frequently; she had been picked up in random places on the other side of town, clueless as to how she’d arrived. Understandably, the accompanying lack of control and sense of powerlessness was terrifying, adding another thread to the already complex knot of emotional trauma involved. Most importantly, the symptoms aligned with DID are a consequence of severe physical and sexual abuse in childhood – something I would learn Jeane had endured on an immense scale as a little girl.
As a child, she had learned to cope with the abject horror of her childhood abuse by cutting off from and ‘floating’ outside herself. Her memories of that time had become fragmented, and emerged – usually uninvited – in the form of these alter egos. Hence the pink outfits and the cuddly toys – they were physical props, the cherished possessions of her alternative selves. These personalities were the manifestations of her recollections and emotions stuck in time, ring-fenced and given names of their own.
*
We began twice-weekly therapy sessions and normally she gave it her all. I wanted to help her understand her distress in the context of what had happened to her, and to make her self-harming less frequent and, more importantly, less likely to be lethal. Between us, we started to piece together her story.
Most often she talked to me as Jeane, and other times she talked to me as one of her alters. She experienced intensely physical flashbacks; sometimes she would choke and even vomit. The sex offenders I’d worked with tended not to mention certain details, like how their victim threw up during the abuse or how they had gagged so much that they couldn’t breathe. It’s only when you work directly with victims that the full, unsanitized horror of abuse becomes clear.
Jeane hadn’t told anyone the candid story of her life and it felt like an enormous privilege to be entrusted with it, to be a witness for her and to guide her gently back to the here and now when a flashback engulfed her. I wanted to help her understand that what was happening to her was an understandable response to what she had been through, and to reassure the different parts of herself that she wasn’t in danger any more.
Jeane was the only patient who I’ve ever allowed to see me cry. For an unsentimental and usually hard-nosed forensic psychologist tears in front of a client would usually be a big no-no, but I felt it was unavoidable with Jeane. After all, it was my genuine, human response to her story. She needed to know that what had happened to her was wrong and someone was genuinely sorry that it was allowed to happen.
Ten-year-old Claire was the most frequent of Jeane’s identities to appear. Claire co-existed with her, and acted as her trusted helper and friend. Claire told me how her earliest memories were of watching her brother being abused by her father and his friends. Over the course of our time together, it became apparent that Jeane’s father had been part of an organized paedophile ring, who Jeane and her brother had been trafficked by.
If Claire was Jeane’s ally, someone she could call when she felt scared, her other alter Drew was the troublemaker. It was Drew who drove much of Jeane’s destructive behaviour, the suicide attempts and the self-harming. It was Drew who was often the most difficult part of Jeane for the hospital staff to accept.
Interestingly, Drew was also the name of Jeane’s older brother. At 16 he had run away from home and she never saw him again. He had gone on to take his own life, something Jeane only heard about years later. The thought that her brother had died and then been buried alone was unbearable for Jeane. Drew then was the part of her who carried the most intense loss, anger and guilt she felt about her brother. After dissociating into Drew, when she was consciously Jeane again, she would deny all knowledge of Drew’s behaviour. To the staff at the hospital, already sceptical, this seemed like an all-too-convenient and suspicious loss of memory. They found Drew’s antics unacceptable.
Jeane’s third alter, Belle, didn’t speak at all. Perhaps she was trapped in a time when she was too young for speech, or maybe there just weren’t the words. But she drew pictures.
Faceless men holding children’s hands. Belle was left-handed, while Jeane was right-handed. I sometimes sat and watched as Belle quietly drew with her left hand while Jeane wrote with her right, both hands working at the same time. It was, admittedly, an eerie thing to see. Staff began to whisper that Jeane seemed possessed.
It struck me, not for the first (or last) time, that here were otherwise highly competent mental health professionals who were more comfortable talking in terms of demonic possession, or insisting their patient was a devious manipulator, than accepting the logical, psychological formulation of Jeane’s behaviour: that she had broken her sense of self down into disparate parts in what was an elaborate and creative survival strategy. Jeane was not possessed. Just divided. That, and ambidextrous.
But maybe, in their own way, the staff were also dissociating. Perhaps their empathy and disgust for what Jeane had been put through was too much for them to make sense of. Or maybe the reality of Jeane’s experience and of those like her is too alien for anyone from the comfort of a relatively normal background to fully comprehend. But I was unfortunate enough to have been a witness to the murky world of paedophilia through my work with offenders, and understood what she had been through without the need for much imagination. Perhaps I was more able to accept what had happened to her. Jeane’s ‘disorder’ had in fact been an effectiv
e and essential strategy for her during the years she was being abused, but dissociating was far less helpful to her in adulthood. Having used this strategy for practically her whole life, I knew it was unlikely she was going to be able to stop altogether – to be able to fully accept all her thoughts, feelings, experiences and memories as her own and become a single ‘I’ rather than a multiple ‘we’. (Although, if we are honest, do any of us really fully embrace every aspect of ourselves?) Besides, giving up Claire, who she thought of as a reassuring friend, would have been a grave loss to her. So through our sessions we worked towards a point where she wasn’t putting herself in danger any more, where if she felt she was drifting off into unsafe corners of her mind – into Drew – she could pull herself back with simple grounding techniques. This could be something as easy as making herself aware of her feet on the ground or using her worry beads to bring her awareness back to her body, focusing on objects in her environment and naming them out loud.
On the anniversary of her brother’s death we planted an apple tree for him in the grounds of the hospital and talked about, and celebrated, his life. By these small acts of validation, we were taking steps towards healing her trauma.
*
Therapeutically, I felt our sessions were a success. But outside of the psychology sessions, things weren’t so rosy. Jeane wasn’t toeing the line. As a hospital resident she was expected to get up by a certain time, eat the meals provided at the set time, take part in a scheduled programme of activities, be observed bathing and – most difficult for Jeane – drop her trousers at the required time to be injected with medication.
This wasn’t in a prison or a secure hospital, Jeane didn’t have any forensic history or criminal convictions, and yet here again were the ways in which institutions insist upon taking away autonomy and dignity, controlling the individual.