by Tom Cutler
Keep Clear
Tom Cutler is a bestselling author of humour books, including the Amazon number-one blockbuster 211 Things a Bright Boy Can Do. His titles have been translated into several languages. In 2016 he was identified as being on the autism spectrum. This, he says, was the happiest day of his life.
Scribe Publications
2 John St, Clerkenwell, London, WC1N 2ES, United Kingdom
18–20 Edward St, Brunswick, Victoria 3056, Australia
Published by Scribe in 2019
Copyright © Tom Cutler 2019
All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the publishers of this book.
For the protection of the persons and organisations involved, some names and identifying details have been changed.
The moral rights of the author have been asserted.
The Autism-Spectrum Quotient and empathising–systemising (E–S) theory scatter plot have been reproduced in this book by kind permission of the Autism Research Centre.
9781911617563 (UK edition)
9781925713770 (Australian edition)
9781925693157 (e-book)
Catalogue records for this book are available from the National Library of Australia and the British Library.
scribepublications.co.uk
scribepublications.com.au
For Marianne
Then said they unto him, Say now Shibboleth:
and he said Sibboleth: for he could not
frame to pronounce it right.
JUDGES 12:6
Contents
Prologue
Chapter 1: Falling rocks
Chapter 2: Signals not in use
Chapter 3: Loose chippings
Chapter 4: Steep hill upwards
Chapter 5: Road narrows
Chapter 6: Changed priorities ahead
Acknowledgements
Prologue
On the desk in front of me, bearing the crown and shield of the royal coat of arms of Her Majesty’s Stationery Office, is Statutory Instrument Number 1857, The Traffic Signs Regulations and General Directions 1964. This document sets out the now familiar system of signage devised for use on British roads after 1 January 1965. The floppy 112-page compendium contains specimen signs set in the attractive and superbly efficient Transport typeface — Ring road, Picnic area, Cattle grid — alongside rules for the deployment of Britain’s classic pictographic road signs — red circles and triangles containing a cow, falling rocks, a walking man, each pared down to its quintessential silhouette.
The booklet gives off a musty, friendly smell. It is the smell of years on an antiquarian bookseller’s shelf, the smell of 1964. Circling the government shield, a heraldic garter bears the motto, Honi soit qui mal y pense, ‘Shame be on him that evil thinks’, the maxim of a more polite, more trusting dominion now vanished. I love this little book and come back to it often.
On the shelf beyond are some of the other books that I return to time and again: The Secrets of Conjuring and Magic, 1877, by Jean Eugène Robert-Houdin; An Essay on Typography by Eric Gill; Metro Maps of the World; The Oxford Medical Dictionary. Non-fiction reference books all, these volumes highlight something of my eccentric and peculiar nature, which until lately had mystified and grieved me.
Why these weird interests? Why my strange tastes in music, food, and clothes, my persistent routines and loathing of variation? Why the hypersensitivity to sounds and smells, the mind-scrambling overload when in a supermarket or using a ticket machine? Why the crippling anguish when meeting people — and why had someone just told me, yet again, ‘You are the rudest man I have ever met’?
For half a century, all this had been a painful puzzle, causing me frustration, bemusement, and deep loneliness. For decades, the real me had been hidden behind a façade of facile wit and practised social formulas. I was going through the motions.
That was until one night, not so long ago, when, the pressure inside me having built to an uncontainable degree, the floodgates burst in a brief episode of craziness.
Since that mini collapse, I have begun, little by little, and with the help of some expert people, to understand what’s been going on for so long, to put a name to the shadows in the cave, to reconcile myself with myself.
The things that happen in this book are true, though various people and places have been disguised. But to understand how it all unfolded we must go back to the chilly autumn of 2015.
Chapter 1:
Falling rocks
Even in our sleep, pain, which cannot forget,
falls drop by drop upon the heart.
AESCHYLUS
It was four thirty on a dark September morning and I was suddenly awake. I knew straight away that something was wrong.
The house was quiet and I could hear the steady breathing of my wife Lea in bed beside me, but I was feeling extremely strange. My pulse was pounding fast and hard, and with each beat my heart seemed to strike my ribcage an abnormally hefty thump. I felt hot and cold all over, my skin was prickling, and I was sweating like a runner.
Outside, the street was dark and still, the hush disturbed only by the mewing of an early gull. The streetlamp opposite cast an eerie glow through the blinds and across my hands as I turned them over and over, closely examining the veins, which appeared black against the orange skin. Somehow they didn’t seem to belong to me. Were they really different in some way or was the streetlight playing tricks? I took a hard look at my palms, crisscrossed as they are with the fine creases of middle age. Extending my arms in the semi-darkness I detected a growing tremor in my fingers. I was feeling very strange and very unwell. What the hell was this?
Sitting up, I swung my legs gingerly over the edge of the bed and planted my feet on the rug. Immediately below my ribcage my abdomen felt bloated. Did it look abnormal? By the green glimmer of the clock on the bedside table it was hard to say. One funny thing — my feet seemed to be more distant than they ought to be, as if seen through novelty glasses.
The periphery of my visual field began to narrow like a closing velvet pouch. I started to salivate. The area postrema, the so-called ‘vomit centre’ of the brain, was going into action. Feeling as if I might pass out, I tilted my torso sharply forward.
After a while, the nausea ebbed and I sat up again. My tremor had become a steady shiver now. I took a draught of water, holding on to the glass with both hands. All at once something very bad happened: I was overtaken by the alarming conviction that I was about to die. The sensation was real and frightening. This was it. I was going to die.
This sense of impending doom was something I remembered reading about. People having heart attacks sometimes report it. My own heart was now jumping spasmodically and my breathing was short and fast.
Was I having a heart attack? I know the symptoms because health is a subject in which I take a special interest. To Lea, it is actually more of an obsession. She says it’s morbid to pore over the medical news every day, but I am fascinated by the mechanics of the body’s processes and systems. I am a natural diagnostician, and perhaps would have made a good doctor. I remember as a boy being distracted by the back copies of Nursing Mirror in the reference library when I was supposed to be revising for my A levels. I would flip compulsively to the photographic quiz that illustrated distempers of every kind in harsh black-and-white, and would try to guess the disease, when I should have been going over my art history notes.
The typical symptoms of a heart attack include these:
Pain, pressure, or tightness in the centre of the chest, possibly travelling to the arm/s, jaw, neck, back, or abdomen
Lightheadedness or dizziness
Sweating
Shortness of breath
Nausea
A sense of imminent catastrophe
Coughing or wheezing
I hadn’t got the main one, which is pain, and neither was I coughing or wheezing, but I did have numbers 2, 3, 4, 5, and 6. I looked at the clock. It said 4:33am. If this was a heart attack, I mustn’t delay: time is muscle.
The first thing to do was call an ambulance. Then I should chew an aspirin to help bust any clots blocking the cardiac vessels.
With a shaky hand I picked up my phone, but with no chest pain this frightening disturbance was probably not a heart attack. If it wasn’t, an ambulance would be superfluous. I put the phone down again. The aspirin was likewise academic. Still, I might as well chew one. It couldn’t do any harm.
This unemotional analysis was being done by the rational bit of my brain, watching me askance, as always, from slightly beside my left temple. Or so it seemed to me in my unhinged condition. Whatever this attack was, my autonomic nervous system was still in the throes of it. My hands were wet, my breathing rapid. I continued to shake.
I don’t express emotion on the whole, but now tears began running down my nose, mingling with the rivulets of sweat. I knew that I was very ill, and I was frightened. I shook my wife’s arm.
‘Lea! Lea!’ I gasped, trying to master my emotions, ‘I think there’s something wrong with me. Something’s seriously wrong.’
Lea woke up and listened to me calmly. She is a positive, cheerful person, unlike me. I am cool, precise, ironic, a watcher in the shadows, prone to low moods and restlessness. Lea continued to look at me. I sat there quivering and gasping.
‘What is it, Tom?’
‘I think there’s something terribly wrong,’ I gulped.
She considered for a moment. Then she said, matter-of-factly, ‘You’re having a panic attack.’
Panic attack? Me? Don’t be ridiculous. I’ve never had a panic attack. A panic attack is something other people have, not me. But in the turmoil the analytical bit of my brain took charge. I knew the symptoms of a panic attack:
Trembling
Rapid breathing
A feeling of impending doom
Racing heart or palpitations
Hot and cold flushes
Pins-and-needles
Lightheadedness
Sweating
Nausea
Tearfulness
Feelings of unreality or detachment
I had the lot, including number 11. Now I understood the strange idea that my hands were not my own. ‘Yes,’ I said to myself. ‘These are the symptoms of a panic attack.’ But my body wasn’t impressed by the diagnosis and went on trembling and sweating.
If you are hiking in the Rocky Mountains and come unexpectedly face to face with a grizzly bear, an aspect of your brain called the limbic system will come into its own. This primitive so-called ‘lizard brain’ is responsible for the ‘four Fs’, which are, in the words of one witty biologist, feeding, fighting, fleeing, and mating.
In the fight-or-flight response to danger, the brain causes the release of hormones that help the body to run away or fight. These hormones include cortisol and most significantly adrenaline. Adrenaline increases the heart rate and blood pressure, makes you sweat and tremble, and gives you a dry mouth. Cortisol puts your blood glucose up. Now your alertness is heightened, and as the body tries to take in more oxygen to feed its muscles your breathing quickens. Because blood is being diverted from the brain to more immediately critical parts, you can become lightheaded and nauseous.
An entirely imaginary or unrealistic threat occasioned by some nameless fear will provoke the same responses as a real bear. If you have ever delivered a speech to an audience you will understand how the fight-or-flight response can make you feel even when you are in no immediate physical danger. You will probably get a dry mouth, become very alert, and experience a strong desire to run away.
‘Would you like a cup of tea?’ asked Lea.
I nodded and she went downstairs to make one.
I wiped my hand over my face then put it to my chest. The old heart was banging away but there was still no pain and my sixth sense was telling me that, yes, this was a head problem not a heart problem.
Shortly I heard the stair creak as Lea returned with the tea. It was pale and weak-looking. Why must I always be so critical?
‘Thanks,’ I whispered.
My breathing was slowing, the vagus nerve cranking the parasympathetic nervous system into gear, gradually bringing things back into balance.
I went and splashed water on my face. There was a lot more salt than pepper in that stubble these days. I looked tired, too.
As I padded back into the bedroom, Lea peered at me expectantly: ‘Okay?’
I couldn’t decide. Was this really a panic attack? If so, what had caused it and how could I find out? I needed some answers because I didn’t ever want another one of those, thank you very much.
*
The roots of mental distress are, of course, not always obvious. Our subconscious mind seems able to go to great lengths to hide such origins from us. For some time, I had been troubled by bad nightmares, which woke me up or made me shout out in my sleep. In the most recent one, I had thought Lea was creeping in to strangle me with the cord of her dressing gown as I slept. I cried out, and so vivid was the picture that, as she tried to calm me down, I thought the dream was coming true. Five thirty in the morning is no time to be wrestling with a thrashing husband when you’ve got a busy day ahead of you.
I had been waking at an ungodly hour for quite a while, lying there, staring at the ceiling, turning things over in my mind. I recognised early waking as a classic symptom of depression, and it was true that my mood had been low for ages. From a golden sunset to a good meal, I found life unrewarding. My hobbies had lapsed: typography, sleight-of-hand magic, and British road signage had been the focus of my interest for a long time, but now they disgusted me a bit.
I remembered F. Scott Fitzgerald’s account of his own troubles in ‘The Crack-Up’:
I had weaned myself from all the things I used to love … every act of life from the morning toothbrush to the friend at dinner had become an effort. I saw that for a long time I had not liked people and things, but only followed the rickety old pretense of liking.
I was touchy and irritable, unable to read the papers or listen to the news without shouting at the radio. After dinner, I would pace the room, driving Lea to distraction. Family friends found me hard work. During one pub lunch, after I’d wolfed a sandwich and a lemonade as the other three laughed and chatted over their roast beef and beer, one of them asked me sharply, ‘Why do you never savour a meal?’ My distant social disposition was damaging friendships.
Yet I was happily married, I was fairly healthy, and some of my books had spent time on bestseller lists around the world. So why the constant knot in my stomach?
I stopped ruminating and had a last mouthful of tea. It was tepid. Lea told me to try to sleep. She was probably more concerned than she let on. I managed to doze unsteadily till dawn.
In the morning I made an appointment to see the duty doctor at the walk-in clinic. I got an early slot, so the waiting room was not full. On the board was an announcement about blood pressure. I noticed that the heading, which was in capitals, had not been letterspaced. This irritated me beyond endurance and I had to move to a chair where I couldn’t see the offending paper. As Jan Tschichold, the great typographer, famously pointed out, ‘Words in capitals must always be letterspaced. The spacing of the capitals in line
s of importance should be very carefully optically equalized.’ Surely people knew this? Or maybe they didn’t. What other people think or know has long been a puzzle to me.
My deliberation was interrupted by a crackly command from the wall-speaker calling me in to see Dr Sam.
I sat down perpendicular to the doctor.
‘So how are you, Tom?’
Sir William Osler, the so-called ‘father of modern medicine’, coined a useful adage for student doctors: ‘Just listen to your patient, he is telling you the diagnosis.’ Taking a leaf from his book, Dr Sam was using the classic open question designed to get the patient to spill the beans.
‘Well,’ I said, ‘I’m worried there might be something seriously wrong with me. My stomach seems bloated — I just don’t feel right.’
After examining me, Dr Sam gave me a searching look. ‘I can’t find anything physically wrong. There’s no swelling that I can feel, but we’ll run some tests, just to be sure. If I might say so, you do seem rather tense …’
I didn’t know it, but I’d struck lucky; Dr Sam had trained at the Maudsley psychiatric hospital.
‘I’ve been feeling bad for some time,’ I confessed. ‘I can’t seem to enjoy things any more.’
The doctor nodded. ‘What you’re describing is called “anhedonia”. It’s a kind of depression in which you are unable to take an interest in or get pleasure from normally enjoyable activities.’
She observed me ambiguously. Was it my turn to say something?
‘I don’t really know how I feel,’ I said. ‘Sort of “empty”. I’m finding social situations increasingly hard.’
‘We think the zestlessness you’ve described has something to do with the brain’s reward system. Something might be wrong with your dopamine levels. But first we need to find out what’s causing the depression and do something about that.’
Now seemed the right time to tell her about the other thing.