Double Blind

by Edward St. Aubyn

‘Next week?’ said Sebastian, in despair. ‘So, I’m just left with all these thoughts until next week?’

  Martin made a rapid decision.

  ‘Listen, Sebastian, I know how urgent this feels to you and I want to help as much as I can. I normally practise from another office and, as it happens, one of my long-term patients has just completed her analysis and I now have an opening on Friday mornings at eleven forty. If you’d be interested, I would like to offer you that session. We would also have a second session a week so that you come regularly to the same office both times.’

  ‘So, you still had a card up your sleeve,’ said Sebastian, ‘one more ciggie hidden away that you weren’t going to share with me.’

  ‘It’s an opportunity that only arose this week and it only occurred to me just now that you might like to have that session. It would be free of charge, like here. You can think about it if you like.’

  ‘I’ll take it,’ said Sebastian. ‘I don’t want to think about it.’

  ‘Good,’ said Martin, getting up and smiling. ‘I’ll see you on Friday then, at eleven forty. This is the address.’

  He went to his desk, took out a card and gave it to Sebastian.

  Sebastian said goodbye and then paused at the door with his back still turned.

  ‘I think you’re a kind man,’ he mumbled, and then left abruptly, without looking round and without closing the door.

  10

  Now that her book was done, Olivia had the feeling of being on holiday for a while, a period in which she could choose between various research projects without any particular pressure or urgency. She was lying on the bed in her old room in Belsize Park, with a copy of Brainwashed face down on the bedspread beside her. She was already halfway through but had decided to take a break. It had been a long time since she had felt the extravagance of having nothing in particular to do, gazing at the familiar configuration of trees and roofs and windows that she had looked at throughout her life, season after season and year after year. Today, the last autumn leaves were clinging to the damp branches and the lights were already on in many of the windows opposite.

  The house felt peaceful. Partly, no doubt, because it was in a quiet street and had no party wall on one side; also, perhaps, because it was a place where troubled people came to find some peace by talking to one or other of her parents; but mostly, from her perspective, because it was a perfect family house. Ever since she could remember anything, she could remember being there, and when her parents died, she would no longer be there, since neither she nor Charlie could keep it. It was a family house for the precise family that the four of them constituted, giving it a complete continuity and a realistic impermanence. It had neither the financial nor the sentimental burdens of being ancestral, nor the restlessness of being part of an ascent or a separation or a decline. It had the additional stability of hardly ever changing. Until something definitively broke, neither Martin nor Lizzie could ever quite face having things done up. It was a place for work and hospitality, but mostly it was a home for the family she had almost been born into – making Olivia suspect that she was even more attached to it than any of the others.

  Lucy was having an fMRI today to find out if her tumour was operable. When Olivia had spoken to her on the phone yesterday, there had been a pace and compulsiveness to her description of what she was going through that made Olivia sense the traumatic grip of the experience. She had never heard Lucy sound so frightened. It was hardly surprising, but the effect was strong enough to constitute a new layer of personality, entirely devoted to managing fear. Olivia had embarked on reading Brainwashed, at Ash’s recommendation, partly to give more authority to whatever reassurance she could offer Lucy, but also because she had been intrigued by neuroscience for some time, not least because its flamboyant imagery seemed to have usurped DNA’s double helix as the popular emblem of the irresistible power of hard science to penetrate nature’s secrets. And yet, there were crucial differences between the status of these two scientific icons: whereas the actual structure of DNA consisted of two helices running in opposite directions and laterally bonded by base pairs, no brain surgeon, without a high dose of psilocybin, had yet opened a skull and been treated to the multicoloured light show fabricated by neuroimaging, and so often reproduced on magazine covers, and deployed in the slide shows that accompanied lectures on every subject from oncology to impulse shopping. Pop Art brains made talks about violence or advertising, unconscious processing or political preferences, Alzheimer’s or sexual arousal, look thoroughly scientific. The pictures had become so ubiquitous that students might soon demand them at a Jane Austen lecture, just as they might feel entitled to ketchup, mustard and mayonnaise at a hot dog stand. What part of the brain lights up when the reader first encounters Mr Darcy and his odious pride? Can literary criticism afford to ignore what is happening to the reader’s amygdala when Elizabeth Bennet rejects his first proposal? It is a truth universally acknowledged that any topic in search of a reputation for seriousness must be in want of neuroimaging.

  But what was the real status of those vibrant snapshots? Apart from valuable information about its fixed anatomy, much of the excitement that came from making the brain visible had led to exaggerated inferences about what was going on in the mind, and indeed about what was going on in the brain beyond a certain level of complexity. Dynamically, they measured the blood-oxygen-level-dependent response (BOLD). The scans represented local activation based on statistical differences in BOLD signals. That was it; and the level of resolution of these computational artefacts depended on voxels – the 3-D equivalent of pixels. A voxel was minuscule from a human perspective, but from a neuron’s point of view, it was a vast forest in which to remain undetected, nowhere near the level at which synapses, dendrites, axons and electro-chemical activity could be represented, let alone proved to be the cause of complex psychological states. In Lucy’s situation, it was clearly beneficial to see the location and size of a tumour. Images of the brain revealed something about the brain, that much was clear, but to what extent they could reveal anything about the mind and the personality was much less clear. Not only was the brain not the mind, but an image of the brain was not the brain.

  At the same time as her concern about neuroimaging had been stirred up by the way it had suddenly crashed into Lucy’s life, Olivia was also hearing about it from her father, who had remained obsessed with the inadequacy of the Very Short Introduction to schizophrenia that he had been reading from on the day that Lucy told the Carrs about her tumour.

  ‘It’s full of claims about brain scans,’ he complained, ‘showing that the areas “associated” with hallucination light up when people are hallucinating or concluding that patients with schizophrenia “tend” to have a hippocampus and an amygdala that is “slightly” smaller than normal. People who believe this sort of high-tech phrenology are truly mad, but unlike the patients whose brains they scan, they don’t seem to want to recover. There may be some justified scepticism about women suffering from Penis Envy, but Physics Envy is all too real: trying to build a machine big enough to remove psychological experience from mental illness. It’s absurd!’

  ‘The genetic correlations with schizophrenia are not convincing either,’ said Olivia.

  ‘It’s open season when it comes to correlations,’ said Martin. ‘There’s a parasite carried by cats, Toxoplasma gondii, which is more prevalent in people with bipolar disorder and schizophrenia than in control groups. Some people even think that Blake may have written “The Tyger” under the influence of his cat’s toxoplasma.’

  ‘Really?’ said Olivia. ‘It’s amazing there isn’t more visionary poetry, given the number of people who own cats.’

  ‘Maybe we should write a joint paper about the role of cats and genes and scans and psychotherapy in the diagnosis and treatment of schizophrenia,’ said Martin. ‘I could write up some case studies and you could look into the genetics and neuroimaging.’

  ‘Hang on,’ said Olivia. ‘I’
m on holiday. Anyway, I’m not qualified to make the neuroimaging case. You could ask Ash, Lucy’s friend; he’s a neuroscientist as well as a medical doctor.’

  ‘Excellent,’ said Martin. ‘A project! Schizophrenics are a hundred times more likely to kill themselves than ordinary people. If genes were the culprits, why has the scythe of natural selection not eliminated something so disabling?’

  ‘Well, the true believers have an answer for that: the reason why there are so many feeble and widely dispersed correlations is that the big culprits have been eliminated by our hero Natural Selection.’

  ‘So, in that story,’ said Martin, ‘schizophrenia used to be a much more genetic disease than it is now, but although it’s becoming more common, it remains genetic – amazing, truly amazing.’

  Although Olivia had parted from her father protesting that she wouldn’t take on a project just yet, she was in fact tempted by the idea of working collaboratively after the long haul of writing alone. She thought about where she might start from. There was only a short passage mentioning schizophrenia in her book, but it showed that there were one hundred and twenty-eight genes in one hundred and eight loci associated with ‘enduring psychosis’, and most of the variants were also associated with bipolar disorder, attention deficit and autism. In the extreme case of 22q11.2 deletion syndrome there were one hundred and eighty clinical associations, of which schizophrenia was only one. When this immense scattering of tiny, ambiguous effects was swept together, the resulting pile of dust still only amounted to a meagre genetic difference between schizophrenia patients and control groups. Nevertheless, she wasn’t going to commit to a joint paper today, despite her father’s enthusiasm.

  As she was going to see Lucy in the flat that Hunter had lent her, Olivia made only token preparations for going out. What she needed above all was a strong cup of coffee to ward off the listlessness and creeping headache and faint despair that seized control of her decaffeinated body after four or five hours. Perhaps she should have a scheduled withdrawal in Willow Cottage, with Francis bringing her black and then green and then white tea, while she thrashed and sweated and mumbled, strapped to the bed in a locked room.

  When she came through from the kitchen to the living room carrying a gigantic mug, she found Martin sitting in the comfortable old armchair with crushed springs, where she had been intending to install herself. He was dressed in one of his three mid-grey work suits, a V-necked sweater and a woollen tie. It was a psychological rather than a sartorial outfit, designed to reassure his patients that he was indeed a professional man of a certain age, who dressed respectably without having the slightest interest in expressing himself through his clothes. He was interested in what the patient had to tell him, not in telling them anything about himself. Knowing the range of his wardrobe, Olivia was always impressed by the consummate neutrality of these outfits. She imagined that spies must be taught to dress in a similar way, so that nobody could remember them.

  ‘Hi, Dad,’ she said, settling down on the sofa opposite him.

  ‘How are you, darling?’ said Martin.

  ‘Oh, I’ve just been lolling about,’ said Olivia, ‘and I’m off to see Lucy in a moment.’

  ‘Dear Lucy,’ said Martin. ‘How is she bearing up?’

  ‘I’ll know more after dinner,’ said Olivia. ‘She’s being very brave, but there’s no need to be very brave unless you’re very frightened, which of course she is.’

  ‘Of course,’ said Martin. ‘There’s a limit to the benefits of stoicism. I’m sure it’ll be a great help to her seeing you.’

  ‘I hope so,’ said Olivia, taking her first gulp of coffee. ‘On the upside, she seems to be on better terms with her boss.’

  ‘Oh good,’ said Martin, pausing briefly. ‘I’ve been thinking about our joint paper.’

  ‘I’m on holiday!’ Olivia interrupted him.

  ‘We could write it at a holiday pace,’ said Martin. ‘I still have to see my patients and I would have to research and write up case studies.’

  ‘Ah, yes, the anecdotal end of science,’ Olivia teased him.

  ‘Well,’ said Martin, ‘what is a theory, after all, except an incredibly stable anecdote? And what is a fact, except an incredibly stable theory?’

  ‘Luckily, I’m about to leave for dinner,’ she said, laughing, ‘and I don’t have to answer that question.’

  She got up and kissed her father on the forehead.

  ‘Goodnight, darling,’ he said. ‘Give my love to Lucy.’

  ‘I will.’

  11

  By the time he arrived back in California, Hunter was experiencing peripheral hallucinations, not a full-blown usurpation of the visual field, but the constant flicker of mistaken identities on the edge of his vision. The shadows of camels and axe murderers thrown up by the headlights on the hillsides and the rocks, as Raoul drove him back from Carmel to Apocalypse Now, were less disturbing than the improbable mouse that had just scurried across the empty seat beside him and disappeared when he turned to confront it. He had been to New York, Oxford, London, Assisi, Paris, London and New York again and was now, just ten days later, back on the West Coast. He had powered on because there were so many meetings, decisions, time zones and acquisitions, and so much pressure to be charming or ball-breaking, as the occasion required, that sleep had been sent to the back of the line again and again. Bullying his body with prescription medication made each collapse more brutal than the last. On the flight from New York, he felt as if a mafia enforcer had thrown him out of a helicopter into a rat-infested landfill site, among shards of broken china and twisted metal, cushioned only by illegal hospital waste and bulging diapers. It was a feeling he was prepared to do almost anything to change. He definitely had a problem accepting any form of disappointment, and he had made the stupid decision to pop another pill. Now he was paying the price, not only with hallucinations of scuttling mice, but also with the hordes of barbarian thoughts pouring through the undefended gates of his editorial intelligence and vandalising even the most basic concepts until they looked unintelligible and menacing.

  Driving along Route One was reminding him of the sense of crisis about motion he had first felt when he was fourteen, sitting in the back of his father’s car, returning to London on a Sunday afternoon. He had been half-listening to his ridiculous, embarrassing parents as they analysed the social currents of their deadly weekend in a draughty English house, with most of its rooms closed and the rest packed with the pompous caricatures who had stood between him and a cool weekend cruising around Camden Lock with his school friends from Westminster. British motorways in those days were usually down to one lane, making it marginally quicker to walk back to London, but on this occasion, due to some miscalculation at the Ministry of Transport, all three lanes were fully operational, and the family car was hurtling through the rain well above the speed limit. Like someone concentrating on a single instrument in the orchestra, Hunter tuned out from his parents’ tedious post-mortem and focused on the sticky sound of the tyres clinging to the wet road. In the midst of this self-imposed soundtrack, he found himself suddenly overwhelmed by the paradox that his body was immobile in the back seat and at the same time rushing along at ninety miles an hour. What was really going on? He moved his hand away from the direction of travel and wondered whether he was slowing down its journey but decided that it didn’t have a journey separate from the rest of his body or, more precisely, separate from itself. Everything was at rest relative to itself: his body, the car, the Earth, the Sun; they only achieved motion from their relation to something else: his body to the car, the car to the Earth, the Earth to the Sun, and, of course, the other way around and in relation to all other objects. His body, isolated from any other reference point, was simply always where it was, whether he was diving off a cliff, sitting on a plane or dead. On the one hand, everything was moving: waves undulating, blood circulating, particles thrown or pulled by one force or another, planets spinning, stars erupting, the Andromeda galax
y racing towards the Milky Way at a quarter of a million miles an hour; but on the other hand, everything was at rest relative to itself, just being where it was. The two rival pictures seemed to be throttling him, with both their thumbs pressing on his windpipe.

  ‘Stop the car!’ he shouted.

  ‘Excuse me, Mr Sterling, you need to stop here?’ asked Raoul.

  ‘No, no, sorry Raoul, I was just remembering a story.’

  ‘No problem, Mr Sterling,’ said Raoul, relieved not to have to stop on the cliff edge of a hairpin bend.

  After a lot of protests from his parents and a lot of screaming from him, his father had drawn over to the side of the road, letting Hunter lurch outside and pace along the hard shoulder, with the traffic rushing by dangerously close, trying to see if he could make any difference to his confusion by penetrating space with his own motive force, but although he eventually calmed down and got back resentfully into the car, he knew that it was futile and that there was something unresolved lurking at the root of his panic, something he simply tried to ignore from then on. Hunter could feel it again right now; the memory was so vivid that it had managed to replicate that old British motorway angst from thirty-four years ago. If anything, it had gotten worse. He had learnt more about science since then, especially from Saul and his other advisers during the two years they had been collaborating on Digitas acquisitions, but there was still no way of escaping his root confusion; in fact it had grown worse as he became more knowledgeable. The tension could only be resolved if he could conceptualise absolute motion, motion relative to nothing else. That, however, could only exist in absolute space, a vacuum containing an immaterial grid of mathematical coordinates. And how would that be measured, except by the very thing he was trying to measure in the first place: the motion of a solitary particle, not subject to any forces – since gravity, for instance, would require another massive object – from one coordinate to another, along a grid that itself could only be measured by motion, since it needed to stretch in at least two directions in order to exist? Jesus, he really needed some rest.