The Cambridge Theorem

by Tony Cape

  “Oh, I guess not. But as a culture we’re not so hung up about emotion. And Jews are good at suffering. I just didn’t want to be the only one crying in that chapel.”

  They had stopped outside St. Margaret’s, but Lauren Greenwald made no move to get out of the car. She seemed to have gathered herself.

  “So what are your conclusions, detective?”

  “About what, miss?”

  “Simon’s death.”

  “It’s not my job to make conclusions, miss. That’s for the coroner.”

  “You know what I mean.”

  “There seems to be no foul play, I’m sure of that. As for the real reason he took his life, I’ve no idea. Do you, miss?”

  “I don’t think he took his life,” she said softly. “And I don’t think he typed that note.”

  “Ah, well there we’ll have to differ, miss,” said Smailes carefully. “Unless you know something that you haven’t told me.”

  “No, it’s just a hunch. Because I can’t figure it.”

  “You give me a call, miss, if you get anything more than hunches, okay?” He smiled at her and she gave him an awkward smile in return.

  “Okay,” she said, opening the door of the car.

  Chapter Eleven

  THERE WERE TWO distinct halves to Myrtlefields Hospital. The Old Hospital was a fortress-like Victorian asylum built behind a high stone wall on a knoll outside the town. In the Summer ancient elm trees shrouded the grim turrets and barred windows almost completely from view. Now in the early Spring the bare limbs of the trees, capped with the bell-shaped nests of a rookery, formed a gray curtain in front of brown stone of the buildings. At the rear of the hospital a huge chimney rose from the heating plant, like a textile mill. This was the original hospital, where the worst cases, the chronically mentally ill were housed. The modern half of the hospital had been built in the late sixties on flat farmland between the Old Hospital and the main road, and its trim, low buildings, unwalled and unfenced, with expanses of lawn like playing fields on three sides, spoke of the bleak civic optimism of that era. Smailes pulled into the car park outside the new wing. Bowles had been a short stay resident, a month-long rehab job; he had not needed to ask in which wing Dr. Julius Kramer, Bowles’ psychiatrist, had worked.

  Kramer had agreed to see him late Monday afternoon, and Smailes expected to learn nothing to justify keeping the case alive. He was intrigued by the disclosures of Gorham-Leach and Hawken, and felt he now understood better the bile that Hawken had displayed throughout the investigation. But he did not find himself surprised. He had always assumed that the British security services kept a much closer watch on domestic activities than anyone really knew, and it made sense that they would have their men in the breeding grounds of the ruling class. He wondered if Hawken had any academic credentials at all, how his cover worked. He wondered what else the astute Mr. Bowles might have found out, and knew that although the report he would hand up the next day would officially close the file, he personally would not close this case until he had read all Bowles’ Cambridge files, the files Alice Wentworth had allowed him to remove, the files that he had begun ploughing into that weekend.

  Smailes was quite familiar with institutionalized misery, and the smell of disinfectant, urine and overcooked food which greeted him as he entered the double doors of the hospital was the same as in any orphanage or juvenile prison he had visited. He turned to the right down a low corridor, following a sign to Reception, clearing his throat out of uneasiness. A young man appeared at the far end of the corridor and shuffled towards him. He was wearing pajamas and a carelessly tied dressing gown, and scuffed the floor with his slippers as he walked. “Hey, you,” he almost shouted, and Smailes felt his stomach tighten, wondering how he should deal with this encounter. As the man drew closer it was clear he was no more than nineteen or so, with an unnaturally pale, waxy complexion and a dark stubble on his chin and top lip. Smailes checked his step, but the young man stumbled past, not seeing him, absorbed in a delusion in which the detective played no part.

  “That’s what I said, God damn it!” he yelled toward the end of the corridor, and then began laughing softly.

  Smailes rounded the corner towards a counter which seemed to be the staff station. Behind was a glass-walled office in which a group of people were talking. In front of the counter was a low table which held a number of newspapers and magazines. Below the table sat an old woman, also in nightclothes and a dressing gown, seemingly asleep. Smailes leant on the counter and peered into the office. The old woman asleep under the counter smelled awful.

  A young man with light brown hair, beard and spectacles was seated at a desk, resting his chin on his hand and watching the antics of another man with an air of bemused tolerance. A young woman sat on the desk watching with similar concentration. They were both dressed casually in jeans and sweaters. The woman had straight blonde hair pulled back into a pony tail and wore no make-up. The other man was seated across the room and was gesticulating wildly. He was older than the other two, perhaps in his forties, with unkempt black hair and beard. He wore glasses fastened at the hinge with tape, an old sweater and corduroys. He seemed quite overweight. Whatever his ailment, it did not seem to trouble the two orderlies, who listened to him with a sort of rapt weariness, as if they had heard whatever was his tale many times. Although the door was closed, Smailes could catch the occasional syllable as the speaker’s cadence swelled. He considered knocking when he heard a door open behind him.

  A small, middle-aged Oriental man emerged from a ward and asked if he could help. He was not dressed like a typical hospital worker either. Smailes mentioned he had a four o’clock appointment with Dr. Kramer.

  “Please wait in here. I’ll tell him you’re here,” he told him in an accent Smailes could not place. He opened another door off the reception area which was clearly some kind of waiting room. The heavy steel door with its vertical panel of reinforced glass swung shut on its spring.

  Smailes chose one of the battered vinyl armchairs and sat down. Cigarette smoke still hung in the air. None of the chairs or sofas matched, and some were in terrible shape, with their plastic torn and folds of dirty batting hanging loose. He supposed the National Health could not quite stretch to regular furniture replacement, but the state of the room enforced a sense of depression and neglect. The walls had not been painted in years and were adorned with graffiti. Across from his chair someone had scrawled “Nutters Rule OK.” The heavy door opened.

  Smailes tried to contain his surprise that Dr. Kramer was in fact the energetic bearded gentleman he had just witnessed regaling his younger colleagues. He had thrown a white coat over the old sweater and trousers. He pushed his long black hair off his forehead and shook Smailes by the hand. In his other hand he held a large file folder.

  “No, don’t get up, officer,” he said as he pulled out a packet of cigarettes and sat down opposite him. “Mind if I smoke?” He tossed the folder down lightly on a small formica table.

  Smailes’ preference was apparently academic, since Kramer lit a cigarette without looking further at him. He inhaled deeply, protruding his tongue as he did so. He was the most unsavory-looking doctor Smailes had ever seen.

  “You want to talk to me about Simon Bowles, I gather.” The psychiatrist had settled back into his chair and was regarding Smailes pleasantly. “We were all very sorry to hear the news. A number of us remember Simon quite well.”

  “How did you hear the news?”

  “Well, one of the orderlies spotted the notice in the paper, and brought it to work next day. Then I had a call from the coroner’s office. I understand I may be called at the inquest. Which is quite understandable. Unfortunately it’s a duty I have had to perform before. Is that why, ah, you need to interview me?”

  “Not entirely. I’m with Cambridge CID. We normally conduct our own investigation in the case of unusual deaths. The coroner’s officer will probably contact you directly about your testimony at the inquest.”
Smailes shifted his weight and the plastic chair gave a sharp squawk.

  “Were you surprised at the news that Simon Bowles had taken his own life?”

  “Yes, yes I was,” the psychiatrist began, prefacing his remark with his unsettling tongue movement. “Simon seemed absolutely fine when he left here, and since we had heard nothing in the interim, one always assumes the best. Of course, he had technically attempted suicide before, and there is an unfortunately high relapse rate among patients who have suffered a major depression.”

  “Why do you say ‘technically’?”

  “As I recall, and I did take the opportunity to review the file after the coroner’s people called, Simon was not trying to harm himself when he jumped out of his window. He was in the grip of a powerful delusion in which snakes were entering by the door of his bedroom. He chose the logical way to escape them, by leaping from the window. He landed on his feet, quite deliberately so, and broke an ankle, I believe. There were also a couple of crushed vertebrae, because we were unable to administer ECT, which would have been the treatment of choice. We had to rely on drugs, which worked quite well, actually.”

  “ECT? What’s that?”

  “Electroconvulsive therapy. More commonly known as electric shock treatment.”

  Smailes shuddered inwardly at the image of some unfortunate wretch strapped to a table while an orderly wired up his skull to an electrical socket. He could not believe such practices survived in modern hospitals. Lucky Bowles and his crushed vertebrae. It seemed Kramer was able to sense his distaste, for he crushed out his cigarette and continued amiably, “And the most commonly misunderstood and maligned practice in modern psychiatry, I might add.”

  “How so?”

  “Well, I think I detect in your expression the usual impression that ECT is some barbarous and primitive practice, a violation of individual rights, a mistreatment of the mentally ill, that sort of thing.”

  “Perhaps. But I don’t really know anything about it.”

  “Precisely, officer. Precisely. I concede that we don’t quite know how it works ourselves, except that it rapidly alters brain chemistry in a way that alleviates depression almost immediately. It is quite safe, harmless, and has few lasting side effects now that we are able to administer the charge to the nondominant side of the brain. You probably have the image of a struggling patient held down as his body convulses uncontrollably. That is all wrong, all wrong.”

  Kramer’s tone had become more urgent. He lit another cigarette.

  “The patient is given anesthesia and a skeletal muscle relaxant. The voltage that is administered is quite low and usually causes only a slight contraction of the digits. The patient wakes up with little discomfort, and whatever fears he may have had allayed. Most patients will show significant improvement after one or two treatments. The majority will recover completely.”

  Kramer reclined in the chair and made an expansive gesture with the hand that held the cigarette.

  “Fortunately in Simon Bowles’ case, the modern anti-depressants worked quite quickly and well, so there was significant improvement within a few weeks. But I stress, with ECT we would have expected improvement within days.”

  Smailes said nothing for a few moments. “Perhaps we could go back to that time two years ago, when Bowles was admitted. You may be able to help reconstruct the young man’s state of mind the night he killed himself.”

  “Well, it is some time ago, but the case was somewhat unusual, and it was also one of the first I handled after I became a resident here. I’ve also been looking at the file, as I mentioned. One of the most vivid dietary defaults I’ve ever seen.” Kramer reached down for the manila file, removing his glasses by the taped hinge as he did so.

  “I’m sorry?”

  “Oh, I thought you would have known that. Simon Bowles’ psychotic episode, you know, the delusional thinking, was caused by violation of the dietary restrictions of the medication he was taking. He had been put on one of the older generation of drugs—they are generally slower-acting, and have more potential side effects. He obviously did not understand the seriousness of not strictly following the dietary constraints that applied.

  “The snake hallucination was really quite powerful at first. He was brought here from the Royal Cambridge after the emergency room set his ankle and then realized that he should be in a, well, more appropriate environment. By the time he was admitted here he could not move his limbs—you see, he thought he had become a snake himself.”

  “Really?”

  “Yes, poor chap.”

  “Excuse me, doctor, I’m not trying to be clever, but he must have seemed really crazy when you first saw him.”

  “Quite. With such severely disturbed individuals, our policy is to administer a major tranquillizer to encourage any delusions to subside. Then we proceed with discussions with the patient and his clinicians to try and arrive at a diagnosis, and a course of treatment. Of course, we would not have considered administering ECT as a treatment until we discovered that Simon was depressed, which became clear quite quickly.”

  “It sounds a lot worse than that.”

  “Not really. Through his family we quickly found out which doctor had been treating him, and with which medications. One does not like to criticize a professional colleague, but it really was surprising to find that Simon had been prescribed an MAO inhibitor as an anti-depressant. A little old-fashioned, one might say. Although not entirely surprising that a practitioner of family medicine might be a little behind the psychotropic times, so to speak.

  “Simon’s hallucinations subsided quite quickly, and he was able to describe them quite candidly, although with considerable embarrassment, the file notes.”

  Kramer had become quite animated and was about to quote further from the file when the detective held up his hand. He kept his eyes on his notepad.

  “I’m sorry, doctor, you’ve lost me with some of these technical terms. You’d better try and explain them to me, if you can. Just tell me in layman’s terms what happened to Simon Bowles two years ago.”

  Kramer studied the file for a few moments, flicking through its pages impatiently. Smailes suspected he actually enjoyed this appeal to his professional abilities.

  “Yes. Okay. Well, Bowles had sought treatment from a family doctor for anxiety and depression. This was in March, two years ago, about six weeks before his Finals, I think. This alone is significant. We regularly see an increase in undergraduate admissions here around exam time. The stress, you know.

  “According to the file, he was put on an anti-depressant, one of the monoamine oxidase inhibitors, as I mentioned.”

  “What’s that?”

  “Well, how technical do you want me to get?”

  “Not very,” said Smailes, evenly. “I just want to get a sense of what happened to him two years ago, and whether what happened was some kind of repeat performance.”

  “Okay. When Simon saw his doctor, and described his symptoms, which I gather were sleeplessness, loss of appetite, anxiety, and ah, gloomy ruminations, he was diagnosed, I believe correctly, as suffering from depression. What was incorrect perhaps was the prescription of Parnate.”

  “Why so?”

  “This family of drugs—the MAO inhibitors—works to counteract a chemical deficiency in the brain which we are now sure plays a significant role in depression. Unfortunately, it can have serious side effects on the cardiovascular system and the liver. It can also have most unpleasant consequences when ingested in combination with certain common foods—notably fish and cheese. So its use needs to be carefully monitored. Since a much safer and more effective drug family—the tricyclics—has been discovered, most physicians would only turn to the earlier drugs if other methods had failed. One of these drugs helped Simon recover quite nicely, we found.

  “What we found out was that the night of his admission, Simon had eaten a cheese sandwich, the only thing he had eaten that day. So he was either unaware of the restrictions that applied, or
did not take them sufficiently seriously. The psychotic episode, I am convinced, was obviously a direct response to this, although Simon, poor fellow, was convinced that he had gone quite mad. Naturally, we took him off this medication and substituted one of the more sophisticated drugs, as I mentioned.”

  Smailes was silent for a moment as he caught up with his note-taking, and then studied the psychiatrist’s face. He was obviously an oddball, but then he supposed you would have to be to choose this kind of work. Despite his appearance, he obviously knew his stuff. The detective was aware that he was laboring under a strong prejudice, a severe distrust of this man’s profession and its efficacy in the treatment of simple human unhappiness. Look at young Bowles and the muck they had pumped into him. His next question emerged somewhat involuntarily.

  “How are you defining depression, in Mr. Bowles’ case?”

  “Well, depression is an organic condition whose symptoms include profound feelings of sadness and worthlessness, inability to sleep or eat properly, loss of interest in sex, and, intense feelings of guilt and self-blame.”

  Smailes shifted uncomfortably in his chair. There had been times in his life when that description pretty well summed up his own state of mind, particularly after his divorce. Uncannily, the doctor seemed to sense his discomfort.

  “This should not be confused with normal feelings of sadness or despondency, which everyone experiences. Depression in the psychiatric sense is a disease, which can be treated as a disease quite successfully, thank goodness. But clinical depression should not be confused with simple loss of spirits. Depression is a loss of all perspective, where the sufferer cannot conceive that life will ever improve. He cannot recall ever having felt contentment or joy, and will revive all manner of ancient memories to confirm his sense of worthlessness and inadequacy. For the depressed person, suicide becomes a real threat, which is such a tragedy since depression is one of the simplest psychiatric disorders to treat.”

  “We classify depression as an affective disorder, that is, a disorder of mood, but since as humans we are biopsychological organisms, as it were, there are changes in brain chemistry that accompany such severe mood alterations. They may not have caused the depression initially, but they reinforce its tenacity. Studies tell us that untreated, ah, depression will lift organically in say, six to eight months. What our modern drugs do is to accelerate the recovery process, by restoring the chemical balance in the brain so that our natural resilience, the tendency of our organism to heal itself, can take over. The first indication is often the restoration of sense of humor. Incidents that previously confirmed a patient’s sense of shame or worthlessness can be seen as funny or absurd. I remember in Simon’s case this was the first indication of recovery. One morning in group he said that if he were not allowed to speak first, he would jump out of the window again. He had a big smile on his face, and most people appreciated the joke, if only because we only have the ground floor here.”