The Skeleton Cupboard (8 page)

What were we missing?

The unit was located on the grounds of a large, mostly derelict asylum, which was once a Victorian manor house. Apart from the more modern health-care center where we worked, one other wing of the old complex still housed long-stay institutionalized residents who were unlikely ever to leave. I drove in torrential rain through the vast hospital grounds and the detached infirmary, which had been built away from the villas as lodging for those with infectious diseases or terminal illnesses and those considered so insane they were locked away until they gave up and died. This building was in the rear of the asylum, north of the other buildings, so that the prevailing winds, which blow southwest, would not carry its influence down into the city; in those days, pathology was believed to be contagious, a belief dating back to the Victorian era.

The Victorians thought it was possible to “catch” immorality and insanity. In Victorian London, the dominating wind was a westerly one, and so the slums, in the poor end of town, were in the east—spatial order dictated social order. The insane were housed even farther outside the east of the city, so no one—not even the most poor—would be exposed to their influence.

Driving up the central road of the asylum, I knew that on my left were those villas that once housed the women, on the right those for the men. Every building had been a microcommunity of individuals considered unfit to live in civilized society.

Morally defective women—usually those who had been “in service” or had been raped by the squire or his son and had given birth out of wedlock—would be dumped here after their children were taken away. They would cohabit with epileptics who were considered “degenerates, lunatics and idiots” and others with depression, anxiety, learning difficulties and psychosis.

The “defectives” had to be gender-segregated. God forbid they fornicate and produce a new generation. The large bushes lining the long track, however, told the real stories: tales of furtive couplings, a need for contact and connection. There were awful stories about those villas: of the rape and sexual exploitation of residents by the people charged to care for them.

Considering the history of the place I was working in, I began to resent the word “pathology.” Taken from medicine, in the mental health setting it nailed a boundary between “normal” and “abnormal” as if such a division existed. The language itself seemed to suggest it was right to segregate those with mental health difficulties from the rest of the “healthy” world. So much for our believing we're so enlightened nowadays. We might not still think mental illness is contagious, but the environment in which we treated the mentally ill hadn't changed a bit. Here we were trying to help these kids on the grounds of an early-twentieth-century asylum.

I thought about Imogen's skipping, her counting and those deep, parallel cuts into the soft skin of her left arm and both thighs—behaviors that had been labeled as pathological anxiety-management strategies, maladaptive coping techniques. The “wrong” sort of coping.

Which of course they were—excessive obsessional and ritualized behaviors do not make for an effective way of managing anxiety in the long term. Anxious thoughts may be managed in the short term by elaborate counting and other behavioral rituals, but long term, that kind of compulsive behavior would not enable Imogen to get to the root of her anxiety, her need to control.

This kid, unbelievably controlling in the external world, was, I began to realize, internally in complete turmoil. She felt out of control and afraid. Skipping was a way to keep it all together.

By pathologizing those behaviors, all we had done was see them as symptoms of an underlying condition. We'd responded with anxiolytic medications and behavioral boundaries—no skipping, no counting out loud and definitely no cutting while in the unit—and by doing that, we had effectively removed Imogen's only way to manage herself. We had left her with no way of coping with her painful and overwhelming inner world. We couldn't bear what she was doing and what we were seeing and so we had taken it on ourselves to put a stop to it. No wonder the poor kid wanted to kill herself.

Imogen is anxious, I thought. Why? That was easy:

1. Emotionally uncontained by an absent mother.

2. No connection to an absent father.

3. Nurtured by a woman, Miriam, who could be kind in a task-oriented way but did not have the language skills to enable her charge to learn to verbalize feelings.

4. The loss of Miriam when she was fired after Maisie's drowning.

5. Nurtured by a stepfather who was so able to emote that he was too consumed in his own grief to attend to that of his stepdaughter.

6. Guilt at finding her little half sister, Maisie, drowned but not being able to save her.

7. Perhaps even frightened by her own unconscious desire to get rid of Maisie, who had come into her life and so taken away everything that was once only Imogen's.

I was out of new ideas. Imogen needed help and I needed to find a way to give it to her. Maybe I would have to talk to the analyst after all.

These were real anxieties, understandable and obviously overwhelming for one so young. Imogen had no emotional constant to help her make sense of it all. No ability to verbalize what she felt tormented by. No one to help her understand that this wasn't her fault; she wasn't to blame; she didn't cause or will her sister to die.

But that didn't answer Chris's suggestion about getting into Imogen's painful world. I still didn't know how to do that. She still wasn't speaking. If she can't do words, what can she do?

And then, just as I parked outside the unit and turned off the engine, I got it.

She can skip.

I scrambled to grab my bags and climb out of the car. I needed to find the analyst, get my head straight. Turning to open my door, I jumped out of my skin. The naked buttocks of one of the long-stay residents were pressed firmly against my window. I crawled across to the passenger door to get out.

*   *   *

The meeting with the analyst that followed was full of clichés. Woody Allen meets Almodóvar.

I entered a small, dark room with the requisite couch against one wall. Abstract prints alongside postcards from Anna Freud's house in Hampstead, all dominated by a huge reproduction of a self-portrait by Frida Kahlo, with her complicated and untended eyebrows. Endless books stacked up (very few with the spine broken) on a faded kilim on the floor. It smelled dusty.

I told him that I needed to skip with Imogen. I asked him how I could persuade the team, especially the nurses who ran the health and safety of the unit, to give Imogen back her skipping rope.

“Why would they? Won't she hang herself?”

“Not with the skipping rope. It means too much to her. It's her voice.”

Then silence. Interminable silence.

Just talk to me, tell me what you think.

“Are you asking me for permission?” he asked.

Oh, so bloody, fucking frustrating.

“No. I am asking you for your opinion.”

More silence. And then, finally: “My opinion is that you should begin to value yours.”

Sod him. I left and marched to the nurses' office. To my amazement, they said yes and handed me Imogen's skipping rope, although I did wonder whether it was done with an “OK, then—put your money where your mouth is, girl” attitude. And so I did.

I found Imogen sitting on the window ledge in the rec room with half-closed eyes, silently counting and twirling her small wrists.

This was her regular place. She could look out the window at the pond recently dug by the other inpatients and staff. It was a great activity, but one we couldn't encourage her to join in on. Water was way too dangerous for Imogen, and for us as her caregivers.

“Imogen, it's time for our session.”

No response.

“Imogen, I've come for you. It's our time together.”

Nothing.

“Imogen, I believe this is yours.”

I placed the skipping rope on the window ledge next to her and after a beat she turned to look at it.

“C'mon, Imogen, let's go outside.”

Jelly in the dish,

Jelly in the dish.

Wiggle, waggle, wiggle, waggle,

Jelly in the dish.

Imogen stared as I sang the next rhyme and continued skipping with her rope:

Lady, lady, touch the ground.

Lady, lady, turn around.

Turn to the east, and turn to the west,

And choose the one you like the best.

No response.

I'm a little Dutch girl dressed in blue.

Here are the things I like to do:

Salute to the captain,

Curtsy to the queen,

Turn my back on the submarine.

I can do the tap dance;

I can do the split;

I can do the holka polka just like this.

No response.

A sailor went to sea, sea, sea

To see what he could see, see, see,

And all that he could see, see, see

Was the bottom of the deep blue sea, sea, sea.

I had never skipped so hard in my life. In fact, I hadn't skipped since elementary school, more than a decade ago. Sweat was pouring off me, and my calves and arms ached.

“I'm sorry, Imogen. I have to stop.”

“I was at the bottom of the sea, sea, sea.”

That was the longest sentence I'd ever heard from this most serious little person with a fading red welt around her neck and her dead sister's stinky rag doll tightly clamped under her arm.

“Were you at the bottom of the sea, sea, sea, Imogen?”

“I was at the bottom of the sea, sea, sea. In my blue dress.”

We looked at each other. My heart was racing.

“I didn't want to.”

“You didn't want to do what, Imogen?”

“I'm hungry.”

“OK, Imogen. Let's go and eat.”

I told myself I was getting somewhere. I was sweating, building a picture of what had happened to Imogen in my mind. I was feeling good about myself. I thought I was on my way to understanding.

I would turn out to be very wrong.

*   *   *

Sitting behind the one-way mirror in the family therapy suite and watching the family session was, frankly, exciting. I could see them, but they couldn't see me.

It was also uncomfortable—who thought up this therapeutic strategy? The family knew they were being viewed but were expected to “act normal.” I felt guilty.

Imogen sat still and pale-faced between her mother, Mary, and stepfather, Jake. Jake cried; Mary didn't. They were reliving the moment of discovering Maisie dead. My soft-moccasined colleague was with them in the room, steering the event.

“Tell me about that day.”

It was a normal day, they said: The girls were playing outside. Mary was working in her office in the house, on a call to LA, speaking with a celebrity's assistant. Jake was conferencing with his agent, publicist and manager about an upcoming photo shoot for designer swimwear. Yep, an ordinary day in an ordinary household.

“Where were you, Imogen?”

She said that she was at the bottom of the sea, sea, sea. And then she asked for me to come into the room and pull her out.

I am ashamed when I think back. When I entered the therapy session from that room behind the one-way mirror, there was a
moment
with Jake. A look we exchanged. I had seen him on billboards around London and in the pages of glossy magazines. And now I was in the room with him, for real, joining a family meeting as Imogen's individual therapist, and his eyes were the same, his slight smile the same, as they were in all the ads I had seen. He saw me recognize him, take in his striking features, and he knew exactly what I was feeling; worse still, he realized I knew that he knew. It was a split second, but Imogen
saw
it—saw that “moment” between her stepfather and me. I had let her down by being pathetically and predictably human. I snapped back into the room just as Imogen jumped up, lifted her chair, threw it at the one-way mirror and, with her dead sister's stinky rag doll under her arm, ran out of the room.

In the chaos, I leaped up and chased after her. As I left the unit, I heard the alarms going off; my heart pounding in my chest, I told myself not to panic.

Outside, it was raining, the type of dense, light rain that drenches in seconds and leaves everything looking oily. I could feel myself slipping, so I kicked off my shoes, immediately regretting it as the loose gravel bit the soles of my feet. No time to stop. I had to keep running—besides, the pain was my punishment for being rubbish.

I could hear colleagues behind me shouting and dispersing in tag teams to try to close down our little quarry. My name was being called, but I didn't dare stop or slow down because I still had Imogen in my sights. I was responsible for her running, so I needed to catch her.

As I got to the end of the central road that divided the asylum and rounded the corner toward the exit, my heart skipped. I had forgotten that leaving this closed community, I would enter the real world and the busy road that met the highway. I looked frantically left and right, and spotted a tiny figure sprinting toward the overpass.

I was panting and feeling leaden-leg heavy. It occurred to me to wonder—not for the last time—why the fuck we were housing suicidal children so close to a major road. These were big roads, ribbed with overpasses—perfect platforms for the suicidal. Thinking this, still running, I started to cry.

We were heading toward the highway, toward civilization and the big city. She was slowing down; I wasn't.

I was wet and cold and, I assumed, running for Imogen's life. I kept her in my sights as I watched her climb up onto the barrier of the overpass; I didn't blink or look away. My magical thinking told me that if I didn't take my eyes off her, she wouldn't jump.