Stranger Than Kindness

by Mark A Radcliffe

  But the absent son, the lack of lovers, the quiet she tended to surround herself with when she was not working, felt more telling than any change in her hormones. And her approaching fiftieth birthday felt even more symbolic than irregular periods and a slightly achy hip.

  Anna Newton was now a health researcher. She still wanted to giggle when she had to tell people that. In her head, research was done by boffins in white coats, fiddling with Bunsen burners and looking earnestly at ‘data’, and they never smiled. But she enjoyed being a researcher, she liked going to work and she believed that what she was doing in the world had some form of usefulness, which remained important to her.

  Anna had stopped working in practice just before the end of the last millennium. Career progression was limited for experienced nurses. Teaching looked dull, management looked corrupt. In 1999 everyone seemed to be re-training as a landscape gardener or a shiatsu practitioner, or starting their own internet business. When she was asked to be part of a research team looking into what had happened to the patients she had helped move into the community more than a decade earlier, she had become fascinated not just in how they had flourished, or not, but in the process of enquiry itself. She did a part time degree in Social Sciences and when she got the opportunity to turn half of her ‘Community Team Leader’ post into a Research Nurse, the perk was that they paid for her to do a Masters Degree in Research Methods. She had been working in research full time for more than ten years. She had seen several projects through to completion and was confident in her ability to do what she was paid to do. Her current project was the biggest and most important she had ever been close to, let alone worked on.

  On the face of it, the subject of her research, ‘Context and Cognition Therapy,’ was perhaps an inevitable response to the alleged failures of Community Care. It was essentially soft and close to whimsical, and if the health service had not been still riding the wave of post-1997 relief it might not have seen the light of day. As it was, it was not only being taken seriously but it had even attracted money, proper money from Leichter and Wallace Pharmaceuticals, one of the largest drug companies in the world and ironically one of the largest producers of anti-psychotics in the UK. Ironic because ‘Context and Cognition Therapy’ or CCT, was a treatment that eschewed all drugs. Unlike the fashionable therapies of the time like Cognitive Behavioural Therapy, it was not offered alongside drugs but functioned instead of them.

  The idea of CCT was twofold. The first was that context at best contributes to suffering and at worst constructs it. If we take people out of whatever situation their psychosis or depression has developed in, then change becomes inevitable or at least available. Traditionally, over the course of the previous one hundred and fifty years or so, psychiatry has taken people out of their situations and placed them into somewhere often worse. Asylums were at best rule-laden, depersonalizing institutions of containment. At worst they were torturous and abusive. Whenever the idea of hospital as sanctuary reared its head in history someone came and redesigned it, bringing back the chains, the degradation and eventually the electricity and the very sharp knives. CCT happened on small quiet farms with gardens and an obligatory orchard. The farms had music rooms and a library full of books and films. There was fresh food and cookery lessons; woodwork classes; swimming; bread-making and of course more yoga then any body could ever realistically tolerate. When the first CCT centre was established and financed by a Rock Star who had too much money and a diagnosis of depression, and made available for free to fifteen lucky if bemused NHS patients, one of the eager-to-hate tabloids had done an exposé on it, describing it as an ‘out-of-time hippie commune for nutters’. Said tabloid had since revised its editorial position.

  The second part of CCT involved a talking therapy. However, unlike all the more popular and prescribed therapies available, CCT didn’t have a theory of human understanding that defined or branded it. Therapists in CCT essentially chatted; asking questions about random things like enjoyable holidays or favourite shoes and taking note of the fact that sometimes, often even, the ‘patient’ was increasingly cogent when reflecting on life outside of their alleged madness. Theories were applied to this process and words given to the nature of change that befell some of the patients. However, the small group of people being paid by the Rock Star to do what they did had the good sense to avoid the labelling of what they were doing and instead just did it. Unofficially the recovery rates were rather remarkable and the Rock Star, this time aided by a PR savvy Film Star recovering from the mental health problem that was punching a co-star for not using mouth wash before kissing her on set, opened another CCT centre. By the time the slowly growing collective of OBE-hunting celebrities opened centre number three the NHS felt compelled, mostly for PR reasons, to join in.

  The problem for the government was, how should they become involved? On the one hand, the CCT centres were currently not costing them anything and were thus something of a flagship for their ‘public/private partnership’ motif. On the other, if they weren’t involved with them they couldn’t really take any credit for them. Beyond having their photograph taken with the Rock Star and friends.

  It was also the case that CCT had recently successfully treated the England football captain who had come to believe—perhaps in part due to too many pain killing injections—that one football, somewhere in the UK, would destroy him and had thus become unable to go outside, let alone play for his country, as well as several ‘ordinary’ but insane patients. People were beginning to wonder if three CCT centres were perhaps insufficient for the mental health needs of the country.

  The people in charge, the government people, ‘knew’ that CCT was a passing fad, a whim with no more evidence underpinning it than crystal healing. However, it was popular, people talked about it and when they did they talked about the mad in a different way—as helpable rather than dangerous—which was a good thing, because the government had been running an anti-stigma campaign for about fifteen years and nobody had noticed. Anyway, the government liked popular things, regardless of the fact that those things might be rubbish; hence the many celebrity photo opportunities.

  The problem was one of money. Government cannot throw research money at anything that takes its fancy. It has people in quangoes that do that sort of thing for them and they, by their very nature, take a long time to do anything. They also have people who fix things for them and those sorts of people come in all shapes and sizes and bring all sorts of talents. One such man was was Black Portier.

  For Black, CCT was PR heaven. Black had had an unfortunate brush with psychiatric services in the late Eighties. He had smoked too much dope, got a bit paranoid, stopped when he was told to, got bored and started again. As a result he spent 36 hours in an acute psychiatric ward in London and was scared so utterly shitless that he gave up dope, tobacco, beer and, just to be on the safe side, cheese. In what might have felt like a random act of penance, he volunteered to work on the ad campaign for the original anti-stigma campaign, coming up with the slogan ‘If you caught madness would it make you less of a person’ which was rubbish but somehow encouraged the commissioning Department Of Health official to sleep with him. Black noticed that, in career terms at least, one difficult weekend was the making of him and he was, bizarrely, the obvious candidate when the government was hiring spin-doctors by the dozen to sell various messages to a still-relieved population.

  By 2004, however, government valued solutions to problems a tiny bit more than slogans. Fortunately, Black Portier had moved with the times and, buoyed by the commitment to public–private partnership, had approached a sceptical Leichter and Wallace Pharmaceuticals with a proposition.

  Leichter and Wallace had their own problems. Profits had fallen to £1.48 billion from £1.6 billion the the previous year, and shareholder confidence was not being helped by two lawsuits being taken out against the company: one claiming that its preferred anti-psychotic had caused or contributed to the
suicide of fifty-two patients from 1996 to 2000; the other suggesting that a side effect of its popular anticoagulant caused hair to grow inside the mouths of some patients.

  Leichter and Wallace, who were represented in their meeting with Black Portier by Nina Sykes, a no-nonsense lawyer from Seattle, had research money to burn. However, who they let burn it was always a distinctly strategic decision. Research funding was speculation money: at worst it was money not wasted on taxes, and at its best it was good public relations that might just lead to a new revenue stream.

  ‘So tell me, Mr Portier, and I must say I have been looking forward to hearing the answer to this all day, why would a drug company put up research money for a project that requires no drugs?’

  ‘Good PR.’ Black was trying not to look at her breasts. ‘You demonstrate yourself as being committed to patient well-being regardless of where it comes from.’

  ‘And in so doing we concede the possibility that there might be a better way of providing treatment for psychosis than ours? Isn’t that rather like a tobacco company assisting in the development of green tea? We have spent the best part of fifty years convincing the world that drugs are good for everything. The merest sign of doubt in that truth would be awful PR.’

  Portier smiled. ‘But that assumes this CCT nonsense is anything other then hippie drivel that requires something like a proper research base to laugh it out of the water and file it alongside astrology.’

  ‘Spoken like a true Gemini,’ she said. ‘We’re not interested. Unless you are prepared to run a comparison programme. We establish a fourth CCT centre, call it a control group if you like. We do everything they do but we also use drugs. If there is anything good in CCT we’ll show it gets better with drugs.’ Black had fully expected to offer the control group as part of his pitch: the fact that she had suggested it, and he could make his acquiescence look like her good negotiation skills, was a gift.

  ‘Not that you are presuming the research outcomes or anything…’

  ‘Of course not. And we get to recruit.’

  ‘No,’ said Portier. ‘You don’t. Independent recruitment of all staff, particularly the research team.’

  ‘You can recruit the research team however you wish, Mr Portier, but we recruit the staff to our CCT centre.’

  ‘OK.’ Portier shrugged and stood up to offer his hand.

  ‘You haven’t said how much?’

  Portier shrugged again. ‘£2 million? Four year project.’

  Nina Sykes stared at him for a moment. ‘Fine.’

  Anna knew she was lucky to get one of the jobs. Not lucky beyond her ability or experience, but lucky in the sense that when 256 people want a job and you get it you have to be a particular sort of idiot not to be grateful. Initially the project was for four years, but it became clear that nobody was sure what recovery was, nor what meaningful results might look like. Was it a measurable reduction of symptoms? Was it to appear less mad to people in the street? Or was it something to do with work, or study, or whatever meaningful activity people valued being as available to patients as it is to non-patients? They also hadn’t factored in people getting well, leaving, getting ill again and coming back. How do you measure recurrence? And when do you decide that CCT has failed and another, more conventional treatment should have a go?

  The length of the project was also complicated by the Rock Star and his growing band of rich do-gooders—which now included the Film Star, the Former England Football Captain, two comedians, a very well known guitarist and a news reader—who had insisted on opening three more CCT centres. More data became available, more challenges to the research process emerged. And while all this happened CCT passed into the nation’s consciousness, regardless of its evidence base. Nina Sykes was concerned. By 2011 she had written to Black Portier to insist that results were released, results that she was sure proved that CCT was little more than a holiday camp that waited for madness to pass of its own accord, whereas medication offered salvation. The problem was, as Portier said in an email he sent to Ms Sykes, there was no evidence to suggest that that was the case.

  Anna, not immune to the cynicism that she had gathered around her like an invisible layer of mould, was as surprised as her research colleagues at the collated data. There had been three of them leading the project since its inception eight years before. They had come to like the farms, the workers and the patients. They had become as immune to the on-demand yoga and well stocked libraries as they were to the weekly offers of inducements when visiting the Leichter and Wallace-established farm, which included the overt offer of sexual favours to the research lead, Dr Paul Stern, on more than one occasion. They were not, however, immune to the collated results of eight years’ work. To break it down, patients with a psychotic illness have a 1 in 4 chance of a recovery in normal psychiatric service. People in the Leichter and Wallace CCT showed a 1 in 3.3 chance of recovery. People in the drug free CCT services showed a 1 in 2.5 chance. These results were, unless they could be discredited by the methodology or corruption of the research team, sensational. Indeed, they were so annoying and surprising that Portier’s bosses told him to make the research team collate them all again. That took five months. The results were the same.

  Paul Stern, Anna Newton and the third member of the research team, Meena Ahmed, were taking up a project researching depression management regimes for a large charity. Their work with CCT was done and they simply awaited the call that would tell them when the data would be released and what availability was required from them for the inevitable press rounds. They were satisfied that they had done a good job. They were excited that they had contributed to refining information that might help people. They were happy that their work felt meaningful.

  It is possible that Anna would have waited more attentively for the call telling her to prepare to share her work if it had

  not coincided with the end of Tom’s degree. He got a first in English and Music and she was too embarrassed for him to see her cry. She bought him a handmade Gretsch Resonator guitar though, like the one in the picture on his wall. He cried when she gave it to him, and hugged her like he used to hug her when he was eight and had had a bad dream.

  While Anna lent most of her conscious attention to her work, all of her unconscious world revolved around her son. Was he doing an MA because he couldn’t think of anything else to do? Because he loved his life so much he didn’t want anything to change? Because he didn’t want to come home? Had he met someone and not felt able to tell her? What if the someone was a man? Tom liked clothes and used moisturizer. He was good at sports but didn’t take them seriously. He hadn’t had a proper girlfriend before he left home, not proper in the ‘can she stay over’ sense. And how does Anna make it easy for Tom to tell her he is gay without forcing the issue? Anyway, if he doesn’t want to move back to London it might be because she interfered with his life in some way she had failed to anticipate; asking about his sexuality might simply exacerbate the looming presence she had lived in fear of being. Work was a blessed release for Anna. A world of tangibles, of clear lines and hollow belonging that made the fear go away. She was also self-aware enough to know that spending her working life trying to find better ways of looking after people called mad acted as some kind of penance. Not that she had a clear sense of what the penance was for, but she felt something, somewhere, that she knew required acting upon.

  The team had two weeks off before starting the new job. Anna had gone to Greece for a week and lay in the sun reading. Paul Stern had spent a week fishing with his son in Scotland. Meena, being younger than the others, had spent a lot of it dancing. And sleeping.

  Four days before they were due to start work Paul had called and left a message. ‘It’s 11.35. Call please. Bit concerned.’ Paul was given to economy in his communication but not anxiety, and he had sounded anxious. Anna had been out running when he called and phoned back as soon as she got the message, but it had g
one straight to voicemail. ‘Calling back. What’s up?’ When she hadn’t heard from him by the evening she called again and left another message. ‘What’s going on, Paul?’ He didn’t phone before she went to bed. Tom did though. He sounded distant and sniffed a lot. He said he had a cold but she wondered, is he on drugs? And then ‘how wrong is it to take a urine sample from your son without him knowing?’ She closed her eyes and shook her head. Maybe it was hormones after all. Either that or she was becoming a rubbish old woman.

  Anna listened to the news on regional radio. Mostly they wheeled out press releases dressed up as events and questioned people without letting them answer, but it was better than anything else available. She might have missed the report of a domestic fire were it not for the word Clapton. Meena lived in Clapton. Indeed, when Anna turned on the TV news and waited for the regional bit in the cheap studio she could see the fire was in Meena’s street and eventually her flat. She phoned Meena. No answer. She phoned Paul. No answer. Eventually she phoned the police. Yes, they could confirm there had been a fire: three people were injured, two of them seriously. No, they could not release any names and they could not comment on the cause of the fire until their investigation was complete.

  The problem with living alone was that you never had anyone to test your responses against. Was the fear she was feeling, the near certainty that her friend and colleague had been hurt, an appropriate response to the information available to her or was she jumping to conclusions? She decided to walk down to Clapton.

  It was a fifteen-minute walk from her flat on Cazenove Road down to Clapton. Anna did it in nine. Most of the road was cordoned off: there were still three fire engines there and several police cars. It was Meena’s flat. The house her flat was part of was completely destroyed, as were most of the houses on either side. The building that Meena had lived in was completely gone except for one charred lump of wall and a black smouldering piece of timber. Anna stood and stared at the smoking pile of debris. There was a cluster of people around one of the police cars.