Double Blind

by Edward St. Aubyn

  ‘So, what are you writing your paper on, Olivia?’ asked Hunter.

  ‘Oh, I’m working on a paper about schizophrenia, with my father, Martin Carr. He’s a psychoanalyst. I’m looking into the genetics, while he’s writing up some case studies. And we’re also trying to get a neuroscientist on board.’

  ‘What’s the lowdown?’ said Hunter.

  ‘Well,’ said Olivia, ‘briefly, there’s an impressive list of environmental stresses correlated with schizophrenia: war, bullying, the early death of a parent, physical and sexual abuse, migration, deracination, racism, and so on. They’re strongly associated with schizophrenia on their own, or possibly in combination with a multitude of marginally implicated genes, but there’s no evidence that the genes on their own can cause schizophrenia. Also, even if genetic expressions are switched on or off by stresses, the results would still shed only a hazy light on the question of inheritability since many of the mutations in schizophrenics are “de novo”, occurring for the first time in that person and, therefore, by definition, not inherited.’

  ‘What about twin studies?’ said Hunter. ‘Aren’t they the gold standard for a lot of this genetic analysis?’

  ‘They’re often treated that way,’ said Olivia, ‘but lots of clinical psychologists, like my brother Charlie, question the Equal Environment Assumption on which they rest. They attribute outcomes to purely genetic causes by ignoring favouritism, scapegoating, imposed narratives and, in the case of identical twins, the effects of often being dressed in the same clothes, being in the same class at school, having the same friends, being mistaken for each other and experiencing “ego fusion”. Genetic enthusiasts try to get around these social and psychological facts by saying that the genes of identical twins “create” confounding non-genetic influences, as if two infant twins, lying next to each other in the same pram, cast out a powerful genetic force field that compels their mother to dress them identically, while the rest of the world turns to stone. The mother herself is not, in this persuasive scenario, subject to any environmental, financial, social or psychological forces, or indeed genetic influences of her own, but is just controlled by her monozygotic twins’ genetic “creativity”. It’s the kind of circular argument, assuming what it set out to prove, that appears again and again in twin studies, like a wagon formation protecting a beleaguered dogma.’

  ‘You know,’ said Hunter, with an appreciative smile, ‘now that I’ve bought all of YouGenetics, you’re making me think that we should rename it. It’s up to you, Lucy. Give it some thought over the next few weeks.’

  ‘I already know,’ said Lucy. ‘EpiFutures.’

  ‘To EpiFutures!’ said Hunter, knocking back another shot. ‘I love it. And Francis, I am so sorry about disrupting your experiments and disturbing the denizens of the forest. I had no idea this was a nature reserve. I’m going to send the pilot home before he needs to turn on all the lights and I’ll get a car sent down.’

  Hunter took out his phone.

  ‘I’m afraid there’s no signal here,’ said Francis, ‘but we can go up and tell the pilot and, if you want to find out about the wilding project, you can come for a walk with me.’

  ‘That sounds great,’ said Hunter.

  Francis lent Hunter a pair of heavy boots to replace his suede loafers, took his notebook from the high shelf by the front door and the two men set off. Olivia led Lucy back to the sofa. When they could no longer hear Hunter’s booming enthusiasm, let alone Francis’s quiet answers, the two friends burst out laughing, sprawled next to each other on the cushions.

  ‘What was that?’ said Olivia, clasping Lucy’s forearm and turning around to look at her. ‘He’s a bit mad! But much kinder than I’d imagined.’

  ‘I really didn’t expect him to be so supportive,’ said Lucy.

  ‘He’s obviously in love with you.’

  ‘God, I hope not. I need an affair with Hunter like…’

  ‘A hole in the head?’

  ‘God, no,’ said Lucy, ‘not nearly as much as a hole in the head.’

  Later she climbed slowly to her room and collapsed on the bed. She always had to read something, however briefly, before going to sleep and so she switched on the bedside light and picked up the novel she had been hurtling through until she checked into the hospital. Since then, she seemed stuck on the same page and again today, before she could turn that heavy page, the book slipped from her hands as she tumbled into sleep.

  When she woke, she saw the light of her lamp smeared across the glassy blackness of the window. She had no idea whether it was late afternoon or the middle of the night. Opening her bedroom door, she heard a brief interchange from downstairs and embarked again on the slow descent to the sitting room, guessing that it must still be quite early and that she would wake in the middle of the night if she rested any longer. She found Olivia on the sofa with her laptop on her raised knees, and Francis reading at the other end, his legs entangled with hers.

  ‘Has Hunter left?’ she asked, sitting down in the armchair nearest the fire.

  ‘Yes, about an hour ago,’ said Olivia, closing her computer. ‘He said to say goodbye and sent his love and said you should take as much paid leave as you need.’

  ‘Well, that’s amazing for me, but I’m sorry he burst in on you like that.’

  ‘He’s welcome to bring lunch every day,’ said Francis, ‘by bicycle. Normally, I’m against fast food, but I thought Hunter’s hamper was an excellent solution for “people on the move”.’

  ‘Was he fun to take round?’ asked Lucy.

  ‘He was,’ said Francis. ‘He really seemed to get it. We talked about soil a lot. I told him what Roosevelt said: “The Nation that destroys its soil destroys itself.” He loved that. And then we were away with Darwin and earthworms and artificial fertilisers and declining nutritional values in foods. I also told him the annual global cost of soil degradation: 10.3 trillion dollars a year.’

  ‘Your idea of heaven,’ said Olivia, ‘terrifying people with soil stats.’

  ‘It’s true,’ grinned Francis, ‘it was pretty great. I think he had a little eco awakening. Howorth has a strange effect on people. Walking around a place that isn’t being exploited gives them a holiday from wondering how to exploit everything themselves.’

  ‘Capitalism and nature need couples counselling,’ said Olivia.

  ‘Yes,’ said Lucy, again exploring the edges of the dent hidden under the bandage on her head, ‘there’s a price to pay for out-of-control growth. Anyhow,’ she said, moving on quickly, ‘it sounds as if it was worthwhile all round. He certainly took a lot of pressure off me.’

  ‘Oh, and we’re all invited to his house in the South of France in May,’ said Olivia.

  ‘We are?’ said Lucy, astonished.

  ‘Yes, Le Plein Soleil,’ said Olivia. ‘Oh, les beaux jours!’

  PART TWO

  13

  Instead of the damp bricks and skeletal branches that until recently had dominated the view through the glass doors of his consulting room, Martin could see salt-white hawthorn and the dark pink cherry blossom screening the walls, a trellis disappearing behind a tangle of honeysuckle shoots and, beyond that, the thick foliage of his neighbour’s chestnut tree, melding separate gardens into a single flourishing scene. Many of his patients commented on the beautiful view, if only as the starting point for a contrast to their inner state, or as a source of envy compared to what they were doomed to contemplate at home. Those with properties that ‘enjoyed’ or ‘commanded’ a magnificent view, without their owners being able to enjoy or command anything much themselves, were not likely to be consoled by Martin’s little pool of greenery when they had already been let down by Hampstead Heath or Westminster Bridge. Others hardly seemed to notice, but Sebastian was the only current patient who was almost certain to attack the burgeoning life of the garden, just as he attacked everything else. He was going through a period (if it was a period, if they were going to get to the other side of it) of psychotic t
ransference, in which Martin was an amalgamated bad object: the person on whom Sebastian could project his deepest disturbance, paranoia and despair. This apparent deterioration was a cause for optimism: it showed that Martin’s consulting room was a safe place for Sebastian to bring more and more troubling material which, until now, had always driven people away from him and deepened his loneliness and terror. They had built up to three times a week – Wednesday, Thursday and Friday – in Martin’s home and not in the more institutional clinic where they had started out.

  Today, Sebastian was late again, but Martin suspected that he would turn up eventually. Pure absence was too stark to express his current turmoil and, even if being late was the beginning of the attack, he would probably need to attack Martin in more detail. He had missed sessions before, but then a routine kicked in: Martin rang the halfway house where Sebastian lived and told the staff that he hadn’t turned up; he was either informed that Sebastian refused to come or, when he returned from his wanderings, told that he was back safely. If he didn’t come in person, the projection of his sense of abandonment, privation and unreliability found no real home, whereas when he did turn up, it found a resting place of sorts. Not that Sebastian wanted to have his symptoms removed, any more than he wanted an amputation, but he was tempted by being able to express them in a more targeted way: punching the doctor who was proposing to cut off his arm. Nobody came to such a painful and distorted state of mind unless clarity was the more terrifying alternative. Even the most collaborative and well-informed neurotic patient had some resistance, but in those cases the price of abandoning an archaic defence was a wave of anxiety, or the renunciation of a cherished self-image; for the schizophrenic patient, it felt as if the price of abandoning psychosis would be annihilation. Sebastian had tried undermining the therapy again and again. In the early days, he would come in, after taking extra anti-psychotics, claiming to be cured. Now, six months later, he came in to act out.

  The session had already started and so Martin sat in his usual chair, holding his patient in mind, giving him the security of a dependable concern, even when there was no obvious way for Sebastian to appreciate it. If he did show up, Sebastian would find his therapist imperturbably keeping their session going. To Sebastian, at some level, Martin’s dependability was like discovering that a torturer was still waiting for him in his prison cell, and yet, at another level, one of the things infiltrating Sebastian’s mind was the regular rhythm, the rocking cradle of their three weekly sessions. Just because there was an eruption of unconscious material constantly bursting into Sebastian’s consciousness didn’t mean that he was able to understand its meaning; his mind was more like the ‘darkness visible’ of Milton’s hell. Sebastian had encrypted his secrets, using a system he had taken the further precaution of not knowing how to decipher. That way, if he were tortured, he could honestly say that he had no idea what the secret was. Patience was paramount; if too many delusions were removed too rapidly, he might feel too threatened to continue the work and Martin might lose him. How delusional he was being was sometimes hard to tell. When Sebastian had come in claiming that Satan had followed him from the bus stop, Martin treated the news at face value, saying how worrying that must have felt, and asking if this had ever happened before, but he was clear in his own mind that he was dealing with a fantasy. Outside the most extreme cases, though, it was important to keep an open mind, however strongly his experience pulled him towards one interpretation or another. Quite apart from the issue of data protection, and the reluctance or inefficiency that made it hard to get medical notes and detailed biographies, Martin was a psychoanalyst who preferred not to read prejudicial material about his patients, but to deal immediately and directly with the facts, in so far as they could be established, and the symbolic language that emerged from the sessions themselves. Sebastian had been referred to him at the clinic simply as Sebastian Tanner, a man of thirty-four, who had first been admitted to psychiatric hospital fifteen years before, with a diagnosis of schizophrenia, and had suffered from recurring episodes ever since.

  When the basement doorbell finally rang, Martin buzzed Sebastian in and opened the inner door to his consulting room to welcome his patient. Sebastian often stopped in the bathroom to delay his arrival and only emerged with a few minutes of the session left, but on this occasion, he stormed down the corridor, swept past Martin and marched straight up to the garden door.

  ‘You fucking lied to me!’ he said. ‘The cow jumped over the moon long before Armstrong landed on it. One giant – stepping on mankind.’

  ‘Really?’ said Martin. ‘How did the cow do that?’

  ‘Armstrong probably gave it a huge kick, unless it had a rocket up its arse. Wernher von Braun, Wernher von Braun / What goes up must come down! Animal-tested. The Russians sent a dog, but Armstrong sent a cow. Being a Nazi isn’t rocket science, you just have to invade everything.’

  Sebastian opened the door, went into the garden, took out a cigarette and paced up and down, singing inaudibly while Martin sat in his chair waiting. There were only twenty-three minutes of the session left and there was always the worry that it would be difficult to persuade Sebastian to leave before the next patient arrived. Martin tried to relax and do his work. If Sebastian didn’t come in of his own accord, he would invite him to come in a few minutes before the session ended. Until then, he would wait and work with whatever evidence he had. Every interpretation was a threat to Sebastian’s defences. There was only so much that Martin could hazard about Wernher and Armstrong and the moon, but he could persist in treating them as meaningful communications.

  Before long, Sebastian threw his cigarette on the grass, ground it underfoot, and came hurtling back into the room.

  ‘“You say Sigi/ I say Ciggie,”’ he sang at the top of his voice, ‘“I say Ziggie/ you say Sigi. Sigi/Ciggie/ Ziggie/Sigi/ Let’s call the whole thing off!” Seriously, seriously, let’s call the whole thing off. Please. Seriously. Please, let’s call the whole thing off.’

  Sebastian hid behind the armchair he was meant to be sitting in and continued to whisper ‘seriously’ again and again.

  Martin could only see the edge of his arm. He let him whisper to himself for a while, and then said, ‘I take what you have to tell me very seriously, Sebastian,’ in a soothing and conciliatory voice, not much louder than Sebastian’s whisper. Sebastian reappeared around the edge of the armchair, not far from the ground.

  ‘I wasn’t always called Sebastian,’ he said, like a child telling a secret.

  ‘Really?’ said Martin. ‘What did you used to be called?’

  ‘They won’t tell me. They said I had to get used to my new name when they adopted me. I was only two. Two for the price of one. If they had told me my real name, my real parents might find me again, but they were Nazis who would stop at nothing.’

  ‘Like Wernher von Braun?’ asked Martin.

  ‘Raining down rockets, V1s and V2s on innocent men, women and children. Ripping people apart.’

  Sebastian made a high-pitched whistling noise, but instead of ending with an explosion, it went on and on. An adoption fantasy (if it was a fantasy; he must of course keep an open mind, but it almost certainly was) represented a kind of progress. So many patients, at all levels of disorder, played with the idea of adoption, to escape their fate or to embellish the rejection of their families. Martin had treated borderline patients with convincing and elaborate adoption stories which turned out to be fake, but in the case of a schizophrenic patient, the story was even more likely to be the displacement of forbidden, life-threatening feelings of terror towards a real source of harm.

  ‘My granny,’ said Sebastian, ‘during the war’ (high-pitched whistle) ‘was sitting on the floor of her bedroom, playing with her favourite doll’ (high-pitched whistle) ‘when a bomb came through the roof and snatched her doll away and went down’ (high-pitched whistle) ‘through all the other floors of the house and lodged in the basement.’

  The whistling stopped
.

  ‘Did the lodger explode?’ asked Martin.

  ‘No, of course it didn’t explode! Did it sound like it exploded?’ shouted Sebastian.

  ‘No, it didn’t, that’s why I asked,’ said Martin sympathetically.

  Sebastian stood up and walked out furiously from behind the armchair.

  ‘She spent the whole of her miserable life sitting on an unexploded bomb. Can you imagine what that feels like, you heartless bastard?’

  Sebastian rampaged around the room, tearing books from the shelves and flinging them to the floor. Oh, no, thought Martin, not this again. Perhaps he was getting too old to take on psychotic patients.

  ‘Is this what would have happened if the bomb had exploded?’ asked Martin.

  ‘This?’ shouted Sebastian. ‘A few books on the floor? Are you fucking joking? We’re talking about innocent men, women and children being ripped apart. The smell of burning human flesh. We’re talking about my granny, when she was just a little girl, having her life ruined for ever.’

  Sebastian sank to the floor, lay on the carpet and started to run, lying down, making his body turn in agitated circles.

  ‘You can’t even tell the difference between what’s alive and dead!’ he screamed. ‘You’re nothing but a monster.’

  Martin stayed silent for a while, aware that they only had five minutes left.

  ‘So, your new parents called you Sebastian to help protect you,’ said Martin.

  ‘You’d have to ask William Tell,’ said Sebastian.

  ‘Well, maybe he’ll come to our next session and tell us his side of the story,’ said Martin.

  ‘Time’s running out, time’s running out,’ said Sebastian, spinning more frantically than ever around the floor. Then, he suddenly stopped, got up and knelt with his hands clasped behind his back, tilting his head and twisting his body in a perfect impersonation of a Renaissance painting of St Sebastian tied to a post with his body full of arrows.

  ‘What kind of monster would force his son to stand there with an apple on his head, in front of everybody, waiting for a cigarette to go through his body?’