All in Her Head: The gripping debut thriller that readers are going crazy for in 2020

by Nikki Smith

  She leans back on the chair. ‘Alison, we have to take things slowly. A lot of things have changed.’ She speaks carefully. ‘You’ve been at this unit for a year. I only started working on your case six months ago when your condition hadn’t improved as much as we’d hoped.’

  I look around the room, as if seeing it for the first time. Two cupboards on the wall above a counter next to a stainless-steel sink. A microwave. A small sofa. My plastic cups. A drawer of plastic cutlery. None of it actually mine. I put my hand on the table to steady myself.

  ‘Are you OK?’ Sarah asks.

  ‘It’s all plastic, isn’t it?’ I say. ‘My knives and forks and cups. So I can’t—’

  Sarah interrupts. ‘It’s the same in every unit. It’s not just yours.’ She smiles. ‘I’m so glad you’re finally talking about this, Alison. Until a few weeks ago we all thought you were making good progress, but then I showed you something Jack had asked me to give to you. A silver bracelet. Do you remember?’

  I shake my head, my thoughts fluttering, not able to

  settle.

  ‘I think he’d hoped it would jog your memory, but I never would have shown it to you if I’d known it would provoke such an extreme reaction. We’d tried a similar approach before with a couple of things your father had brought in when you were first admitted. We’d asked him for anything you had a particular emotional attachment to. He gave us a postcard of Weston-super-Mare where he used to take you on holiday and a glove that he said you carried around with you when you were little. You didn’t show any reaction to them, but when you saw the bracelet you became quite

  hysterical and shut down completely.’

  I remember Jack fastening it round my wrist after we’d found out I was pregnant. The one tiny heart charm dangling from the chain.

  ‘You refused to talk and wouldn’t even acknowledge me anymore,’ Sarah continues. ‘The team agreed to suspend your therapy sessions until we considered you were in a fit state to resume them. I’ve been meeting you informally during your lunchtime over the last couple of weeks as the canteen seemed to be somewhere you felt safe. You began to talk to me when we were in there. The only other time you’d leave your room was to visit the library, so Mrs Painter agreed to take you under her wing and get you to do some jobs for her. You seem to enjoy it.’

  ‘Why didn’t you tell me you were a doctor?’ I ask.

  ‘When I first met you, I did tell you who I was, but in these last few weeks you’ve treated me like a stranger. It’s as though we’d never met and I was concerned if I mentioned it again it would affect your recovery. All those involved with your treatment agreed you needed to remember things in your own time.’

  ‘Now I have,’ I say, ‘it means I’m getting better, right?’

  ‘It’s a very positive sign, yes,’ Sarah replies. ‘But there’s a way to go yet and we don’t want to rush things.’ She looks at me. ‘I … I don’t think you quite realise … how much has changed. Tilly’s over a year old now. She’s not a baby anymore.’

  I know that. Of course, I know that. She isn’t the same tiny bundle I … I start to hyperventilate.

  ‘Take deep breaths,’ Sarah says. ‘In and out slowly. Out for a count of five.’ Sarah holds my hands whilst she talks. ‘Focus on me. Nothing else.’

  I breathe with her and block out all thoughts of Tilly.

  ‘Let’s go back to my office,’ she says. ‘Do you want me to see if we’re allowed outside for some fresh air?’

  I shake my head. I don’t want to go out. Not yet. I run my finger over my eyebrow and pull out a stray hair. I walk slowly with her to reception and look out through the glass doors to the car-park. It doesn’t feel safe. I ignore the glances in my direction from the staff at the desk as Sarah summons the lift. She holds her pass up to the control panel as she presses the button for the fourth floor.

  Now I understand why the lift wouldn’t take me upstairs to her office. My pass doesn’t allow me access. I don’t tell her I went up the stairs at the back of the library and looked through the glass panels down the corridor but couldn’t get in.

  She sees me staring at the control panel.

  ‘There are cameras on every floor,’ she says. ‘For security reasons.’

  ‘You’ve been watching me?’ My voice rises.

  ‘We have to monitor all our patients.’ She stares straight ahead. ‘You’ve always been quite safe. We’ve kept a close eye on you.’

  I’m silent. I’m not sure I believe her. We walk out of the lift and sit back down in her office.

  She gets out a file in which I can see pages of illegible writing. ‘These are your medical notes,’ she says.

  A whole book written about me. People have been studying me and I’ve had no idea. Everything I’ve thought for the past year has been a lie. I can’t trust myself. I could be imagining this, too. I have to grip the arms of the chair to steady myself.

  Sarah stares at me. ‘You were given an antipsychotic drug called Haloperidol,’ she says.

  I see her nails round a syringe as it digs into my skin. Some things I do remember. I swallow.

  ‘But I’d been reducing the dosage over the past couple of months until your recent episode as I wasn’t sure if it was actually helping you and the side effects can be unpleasant.’ She pauses. ‘Things like weight gain, nausea and hallucinations can all be a result of the medication.’

  She’s been filling me full of something alien, turning my body into something unrecognisable. I don’t know who I am anymore.

  ‘It’s been used successfully to treat post-partum psychosis in the past,’ she says, ‘but in my opinion, you were in a state of shock after what happened and this drug wasn’t helping to treat your condition, so we’ve tried some sessions of hypnosis.’

  Why is she skirting around the issue using words like condition? I wish she’d just come out and say it. I’m insane. I don’t understand what’s real and what’s not and I tried to kill my child.

  ‘Have you heard of post-partum psychosis, Alison?’ I shake my head. ‘It’s a severe episode of mental illness following childbirth. In your case, we think having Tilly made you hear voices and see things that weren’t real. Unfortunately, it wasn’t picked up quickly enough. It’s not as uncommon as you might think and if you’re treated, patients can make a full

  recovery.’

  Remember? I block out the small voice that rises from the ashes in my head. I don’t know if I believe her.

  ‘Why me?’ I ask.

  Sarah looks at me. ‘The short answer to that is we don’t know. Statistically, around one in a thousand women will suffer from this type of illness, but if there’s a family history of the condition it can increase your risk of experiencing it.’

  I stay very quiet. I remember touching my mother’s face in the car in our garage. I’d never seen her so peaceful. She’d either been silent, refusing to leave her room, or full of an energy I couldn’t keep up with, even as a child. I’d wondered why she’d seemed so still. I hadn’t realised it was because she wasn’t breathing. Now I wonder if she was suffering with something similar. Maybe no one even realised she was ill. The thought makes me swallow hard to stop myself from crying. I wish I could go back and tell her I understood. I’m aware Sarah’s watching me and I don’t want to talk about it. It would feel like a betrayal.

  I look at the notes Sarah is holding. Pages of scribbled black writing. They seem familiar.

  ‘Do you remember what you thought,’ Sarah asks, ‘after you had Tilly?’

  I close my eyes and try searching back through the fog and then I hear it.

  ‘There was a voice. I can’t remember exactly what it said, but I had to do what it wanted.’ I take a deep breath and wait for the memories to sharpen. ‘It told me I had to get out of the flat. That Jack was going to hurt Tilly. He’d hurt me and he wanted to hurt Tilly.’ I stop talking and put my hand up to my

  cheek.

  ‘You haven’t asked me about Jack,’ S
arah says.

  I open my eyes.

  ‘I don’t need to,’ I tell her. ‘I know he’s been here. I’ve seen him.’

  ‘Jack hasn’t been here, Alison.’

  I smile. ‘He has. He’s been leaving letters for me in my flat.’

  ‘I’m afraid he hasn’t.’ She clicks the end of her pen.

  ‘I’ve seen him in the library too.’ I put my hand up to twist my hair, then put it down again as Sarah looks at me. She’s lying.

  ‘You think you’ve seen him, but he hasn’t been in here.’ She hesitates. ‘Actually, that’s not quite true. He did come here a few months ago. But he didn’t see you. When you arrived, you insisted that you didn’t want any contact with him. You told us he’d been violent towards you. I’m still not sure if that’s true, but my primary duty is to ensure your safety, so I had to respect your wishes. Jack hasn’t seen you. It’s a secure unit here. You’ve seen the control panels on all the doors. No one comes in or out without the staff knowing about it.’

  My heart begins to thump.

  ‘So how come I’ve got letters from him? He must have delivered them. I found them … they didn’t have any envelopes,’ I say.

  ‘I gave them to you,’ she says. ‘All except the one I kept in my bag that mentioned Tilly. I didn’t want to give you that one until you remembered what had happened and I felt you were ready to read it.’

  ‘You gave them to me?’ I ask. ‘When?’

  ‘A couple of months ago in our therapy sessions. I thought they might prompt you into remembering what happened. Jack found out I was treating you and came here with them, and asked me if I’d give them to you. I couldn’t confirm I knew who you were as that would have been a breach of patient confidentiality, but I read them, and together with your treatment team we made the decision that it might be helpful for you to have them. You refused to look at them, but you took them back to your room afterwards.’

  I frown at her in disbelief. ‘No, I didn’t. Jack left them in my flat for me.’

  Sarah hesitates whilst she looks at me. ‘No one’s been in your room, Alison. It’s always locked and only you and the staff have a key. I think you took Jack’s letters away with you, hid them, and when you had your recent episode you blanked out the fact I’d ever given them to you

  at all.’

  ‘I saw Jack,’ I say insistently, the words coming out louder than I expect. ‘Running down the stairs. And in the library.’

  ‘Hallucinating is one of the common symptoms of your illness as well as a side effect of the drugs you’re taking,’ she replies, clicking her biro. ‘And you think you’re seeing Jack rather than anyone else because there’s so much that’s unresolved between you. There are still so many things you want to say to him.’

  Jack has been here. I know he has. He’d grabbed my arm, tucked my hair behind my ears and held my hand. His touch had been unmistakable.

  He’d told me it wasn’t my fault. But I know it was. I remember now. I remember being in the car with him and being terrified about him taking me to the doctor’s, thinking they’d take Tilly away from me. I’d almost made him crash. I put my hand up to my cheek. I’d thought he was trying to hurt Tilly, to take her away from me when all he’d ever been trying to do was protect her. From me. I just hadn’t been able to see it before. He must hate me. I have to tell him how sorry I am.

  ‘I think …’ Sarah pauses. ‘I think you have to try and see things from Jack’s point of view. He was so angry about what happened. To start with, he refused to see you. Then he changed his mind, but once he realised you’d requested there be no contact, he had a few … difficulties … in dealing with it.’

  ‘What kind of difficulties?’ I ask.

  ‘He couldn’t accept he wasn’t allowed to see you. He was very … persistent.’ She chooses her words carefully.

  ‘What do you mean?’

  ‘We had to send him a letter advising you’d asked not to see him, and that he shouldn’t try to visit or contact you. He ignored it. I think he felt what happened was his fault. That something he’d done made you do what you did. He kept trying to phone me. He came here and tried to get into the building. Then he turned up at my house. Luckily my husband was there … but we had to call the police. I’m afraid Jack ran off as he was … very distressed.’

  I interrupt her. ‘I need to see him … explain … make him understand …’

  ‘You can’t see him, Alison. He’s not here.’

  ‘Can I ask him to come?’

  ‘No,’ Sarah replies.

  ‘Why not?’ I shout in frustration. ‘I’m telling you I want to see him. Why can’t he visit and bring Tilly?’

  ‘Tilly isn’t with Jack.’

  Someone is pouring freezing cold water into my chest. ‘Who’s she with then?’

  ‘She’s safe.’ Sarah doesn’t look at me. ‘She’s with your father.’

  ‘My father?’

  Sarah hesitates. ‘Your father’s dealt with everything. You asked that he be considered your nearest relative. He’s our point of contact in your case. He visited you when you were first admitted, but as you were unresponsive, we advised him to stay away until we could see an improvement. We update him regularly on your condition and he’s the one funding your treatment. Tilly went to live with him after … when Jack wasn’t able to look after her.’

  I stare at her. ‘So … Jack … when did I last see …?’

  ‘The morning you jumped from the bridge. You haven’t seen him since.’ She glances at me, trying to work out what to say next. ‘Alison,’ she says gently, ‘Jack isn’t here anymore.’

  THEN

  Jack – 10 Months after Tilly’s birth

  I have the same recurring nightmare every night now, aware I’m asleep but powerless to wake myself up to stop its inevitable conclusion. I’m on the bridge, watching helplessly from inside a car as she climbs over the metal barrier, one end of the blanket wrapped around Tilly, the other fluttering loosely in the wind. I tug at the door handle, but it slides through my fingers, refusing to open. Why is no one trying to stop her?

  More cars pull over and a few people get out, congregating in a huddle near their vehicles, watching from a distance. She ignores their shouts. I pound my fists on the window. Please don’t do it. I rip open the glovebox to see if there’s something, anything, I can use to open the door. There’s nothing.

  She looks out over the river, one hand on the railing. My voice is hoarse and tears run down my face.

  ‘I’m begging you,’ I scream, my hands pounding on the glass. ‘Please don’t do it.’ I catch sight of the golf umbrella on the back shelf of the car and grab it, shoving the pointed metal tip into the passenger window. At first there’s a dull thump, but after slamming it a couple of times with all the force I can muster, the glass fractures, then shatters over my hands and the seat. I roar her name as the breeze hits my face and watch in horror as she lets go of the railing and falls forward, seemingly in slow motion, with Tilly’s blanket trailing like a pair of deformed wings behind her.

  ‘Jack!’ Someone’s calling me.

  I try unsuccessfully to bury myself under the covers as the curtains are drawn back.

  ‘Jack!’

  I don’t want to wake up. I have to get back, to stop her …

  The duvet is thrown off roughly. My face feels puffy as I peer through the slits of half-open eyelids.

  ‘Edward?’ I croak. Ali’s dad stands at the side of my bed.

  ‘Get up.’ He turns and walks out of the room.

  I fight to disentangle myself from the bed linen. My head spins. I blink as I look at the clock. Ten o’clock. Shit. Shit. I grab my dressing gown off the back of the door and stagger into the sitting room. Edward is sitting on the sofa holding Tilly and her shoulders are shaking in the way they do when she’s been crying for some time. He’s rubbing her back.

  ‘You didn’t hear her.’ His voice is cold.

  ‘What the hell are you doing here?’
I shout. ‘How did you …?’ I notice the breeze on my face before I see the pile of glass on the carpet. ‘You broke in?’ I ask, incredulous.

  ‘Yes, I broke in. I had no choice. I’d been buzzing the intercom for ten minutes and no one answered so I came around the back and looked through the window to see her,’ he gestures at Tilly, ‘hysterical in her travel cot. I didn’t even know if you were here.’ He looks at me in disgust. ‘How long has she been in there?’

  I can’t get my thoughts into any kind of order. I’d put her down to sleep next to me in her cot last night. I remember that.

  ‘D’you not know?’ he demands.

  ‘No … I do … I thought I’d put her …’ I trail off. Had I? Or was that the night before? I’m not sure.

  Edward looks at me, speaking deliberately slowly. ‘You can’t remember at all, can you? You don’t know why your daughter’s in a travel cot in your sitting room, in a soaking-wet nappy, crying her eyes out at ten o’clock in the morning. What are you doing, Jack? What if she’d managed to climb out?’

  I rub my face and swallow down the bile that crawls up my throat. I try desperately to think what I did last night, but it’s all a blur.

  ‘I don’t think at the moment you’re fit to be a father.’ He says these last words quietly, but they’re sharp enough to cut through the fog of my hangover.

  I put my head in my hands.

  ‘You’re not coping, Jack. I know what Ali did was unforgiveable,’ Edward says, ‘but she was ill. You’d know that if you went to see her.’

  ‘I can’t face her. You don’t understand.’ His eyes narrow in disbelief. I fight the urge to sit down, my head thumping.

  ‘I do understand, actually, Jack,’ he says. ‘Ali was ill. What she did wasn’t a deliberate decision. I should know, I speak from experience.’ He lets the words sink in slowly through the haze in my head. Tilly turns her face out of Edward’s shoulder to look at me.

  ‘What are you talking about?’ I ask. ‘Did you know she wasn’t well?’

  He shakes his head. ‘No. I’m talking about Ali’s mother.’

  I look at him holding Tilly and feel a stab of pity. He’d lost his wife in a car accident and now he’s lost his daughter. I’d seen the tiny star Ali had got tattooed on her ankle to remember her.