By the Time You Read This

30

DEAD MOTHER AND CHILD. The Edvard Munch painting was Frederick Bell’s favourite, and he knew exactly why. The still form of the dead mother, pale, almost transparent, on the bed, and the family members attending to her, ignoring the little girl in the foreground, her hands wavering about her head as though to cover her eyes, or perhaps her ears, to shut out the reality of her mother’s death. The mother had died of consumption, Bell knew, when Munch was still a boy, and it had coloured his whole life. It had made him miserable, and it had made him an artist.

Consumption. Medicine had come a long way in the past hundred years. Consumption, or tuberculosis, with the help of antibiotics, had been virtually erased from the planet. Depression, of course, was flourishing.

Munch had had his deathbed. Bell had known two.

The first had been his father’s, when Bell was eight years old. Every day he would have to sit with his father for an hour, between the time school got out and the time his mother got home from her job as a nurse.

His father had been a dark man: thick moustache, a single lintel of brow above his eyes, and curly black hair. Black Irish, his mother had called him, and the young Bell had wondered if that meant his father had had a background in the Troubles of Northern Ireland. Later, he realized his father had never set foot in that country. Later, he learned all sorts of things.

But back then at Deathbed One, his father’s dark good looks were made even more heroic by the swaths of white bandages wrapped around his head, covering one eye. He looked like a soldier just back from a war, wounded in the defence of his brothers, struck dumb by the horrors he had witnessed.

An accident, his mother had told him. A terrible accident while cleaning his pistol—a Luger liberated from the dead hand of a German soldier in 1945.

The door to his father’s study hung open, as it never had before. His father’s study had always been a place you did not venture into uninvited. The young Frederick had been inside only a few times, once to receive congratulations for having come first in his class, most of the other times to receive punishment.

His father had terrified him—such black moods, such tantrums—and yet he could also be kind. One summer he had taken Frederick out into the fields to catch and classify butterflies, an afternoon that was to become one of his happiest memories. His father taught science at a nearby grammar school, and indeed he always seemed happiest when he was teaching something.

Those evenings when he took it into his head to instruct his son, he was transformed into a different man: patient, good-natured, and knowledgeable about a wide range of subjects (the history of flight, the principles of internal combustion, the intricacies of cellular reproduction, the diatonic scale). He would sit beside the lad for a couple of hours explaining, giving context, analyzing, even suggesting what Frederick might want to write down or draw to help him remember. Every once in a while he would lay a hand on the boy’s shoulder and say, “Don’t roll your shoulders like that, son, it’ll develop into a habit.”

Bell still had the model steam engine his father had given him; it had been a gift to him from his own father. A simple, elegant toy, it consisted of a miniature brass boiler suspended on brass brackets above an oak base. You filled it by unscrewing a tight-fitting brass cap and pouring water from a measuring cup into a tiny hole. A single piston, a driveshaft, a flywheel, and that was it. You placed a tiny lamp filled with methyl hydrate under the boiler. When the water boiled, it moved the piston and the piston drove the shaft that cranked the wheel. The best part was a miniature valve at one end of the boiler that you could open with a lever, causing it to emit a surprisingly throaty whistle.

Those pedagogical afternoons and evenings were infrequent. Mr. Bell was prone to depressions that sent him into his study for days on end. When he was like that, you didn’t want to disturb him. Even if you were lonely and bored and all your friends had gone away somewhere for the holidays, you didn’t dare knock on that door. Sometimes Frederick would sit on the hall chair just outside the study, not doing anything, just sitting, swinging his feet, waiting for his father to emerge.

Sometimes he would hear weeping, papers tearing, a book being thrown, even though there was no one else in there with his father. The sobs tore into Frederick, frightening him. His mother would sometimes tap with a light hand on the door. The sobbing would cease and she would enter, and then Frederick would hear her voice, questioning, soothing, pleading, and his father’s laconic, unintelligible replies.

Nobody called it anything back then, at least no one in his family’s circle. People had moods, some people had severe moods, that was all. This was England, they had come through the war, nothing could be as bad as that. You were supposed to keep your chin up, stiff upper lip, mustn’t grumble, and under no circumstances suggest that you had any complicated emotions. No one uttered the word depression.

So when his mother told him that his father had suffered a terrible accident with his pistol, Frederick did not question her. Although he was surprised. On one of his more instructive afternoons, Mr. Bell had invited Frederick into his study to show him how to clean and care for a gun. It was a manly sort of endeavour, involving manly smells of oil and metal. His father had explained how you never kept a pistol loaded, and you never stored the ammunition in the same location as the pistol. He admonished him how you never pointed the barrel at anyone, yourself included, not even in jest, not even in the most transient gesture. Instead, you held it pointed toward the floor, toward the corner, in fact, while you removed the various cunning parts and set them out on a cloth.

Much later, after he had become a doctor, Bell realized that the bullet must have entered toward the posterior nasopharynx, crashing through the palate, probably fracturing the eye socket, before exiting through the anterior of the skull. Emergency rooms were not then as skilled as they would later become at dealing with gunshot wounds. Today such a wound would probably send a man home with impaired speech and eyesight. In the fifties, the damage was enough to kill, but not immediately.

His father lingered. A hospital bed was set up in the living room. A VON nurse came every other day to check his condition and change his bandage. Frederick was always ordered out of the room when she did this. Sometimes his father muttered things, irrelevant words and sentence fragments. “Dragon’s foot,” was one phrase. “On the wire,” was another.

Frederick’s mother was so riven with grief, she was little help to her young son. Indeed, it was he who tried to comfort her, bringing her tea and sandwiches that his various aunts had made. She would smile wanly at him, and her eyes would overflow. Frederick felt himself to be invisible during this time. His aunts talked as if he were not there, and more than once he heard one of them—Aunt May, it was—whispering into the phone the phrase “shot himself,” in a way that made it sound, well, not accidental.

The invisible boy would sit in the gloom at the top of the stairs, listening. Whenever anyone came up to use the bathroom, he would scuttle back to his bedroom and pretend to be reading. He heard more phrases, and several times his mother wailing, “Why did he do it? Why!”

“He must have been in terrible pain,” Aunt May answered.

“He was not in his right mind,” said Aunt Josephine.

And so the young Frederick came to understand, with a sick feeling in his stomach, that his father had shot himself on purpose. There was nothing he could do with the information. There were no priests or nuns to consult, not that they would have done any good; he had been brought up without religion. And he couldn’t go to his mother, because she still insisted that it had been an accident. He was like the girl in the Munch painting: bewildered and alone, with nowhere to turn.

The sick feeling stayed in his stomach and hardened into something else. At school, the teacher began to sound very far away, as if talking to him from the edge of a deep well into which he had tumbled. He had no urge to climb out. His fellow pupils no longer interested him with their silliness and their games. During recess he took to sitting under a tree, counting stones or bits of grass, or reading one of his science biographies.

His father sank ever deeper into unconsciousness. According to the nurse, things were taking a grave turn. A doctor came to visit—they still made house calls then—and then another doctor. Both said there was nothing they could do; Frederick’s father would either wake up or he wouldn’t.

Nothing to Be Done.

Dr. Bell often reflected that if Munch had painted a picture of himself as a boy sitting by that deathbed, that’s what he would have titled it. Nothing to Be Done. Nothing to do but mourn and be consumed by all the emotions that were not to be mentioned in a 1950s British household. As a psychiatrist, Bell knew that he must have experienced tremendous rage at his father for abandoning him in this hideous way, for the torment he had inflicted on his mother. But he never felt it, not then, not now.

It was on a Friday afternoon in March 1952 that Frederick Bell’s father died. The boy was not actually in the room with him, nor was his mother. His Aunt May had been on duty at the time. According to her (the eavesdropping boy heard her telling someone sotto voce on the phone), it had been the most terrifying event. Mr. Bell, who had barely moved for the past three weeks, suddenly sat up in his bed, staring straight ahead with his one uncovered eye. Aunt May had been too frightened to move. Her brother sat there, bolt upright, staring for a few moments, perhaps not even a minute.

“Then he spoke,” she said. “It was as if someone had just handed him some bad news. Oh my God, he said. No, not in a way at all religious. I don’t believe he had a revelation of that sort. It was the tone you would use if someone told you a school had burned down, a kind of horrified wonder. Oh my God, he said, and lay back down. I went to his side and tried to speak to him, but he didn’t say anything else, he just made a kind of gasp and that was it. It’s been massively hard on Jane, of course.”

Jane was his mother, and it had been just the two of them after that. Eventually she turned his father’s study back to its original function as a parlour, but neither of them ever set foot in the room again. Shortly after that, financial pressures forced them to move to much meaner accommodation, a dark, cold flat where they lived for the next ten years. One day Frederick came home from his part-time job assisting the local pharmacist and found a note in his mother’s handwriting on the door:

Frederick, don’t come in. Please go round to your Aunt May’s and have her call the doctor.

And so, Deathbed Two. This one comparatively brief. His mother had taken an overdose of sleeping pills, but she had thrown up. Consequently, it took her three days to die instead of the hour or two she had no doubt intended. In the end, so much brain function was suppressed that the other organs failed.

Frederick had to move out of the flat and into a basement room at Aunt Josephine’s. While cleaning out his mother’s papers, he found an old envelope with just one word scrawled on it in his father’s handwriting: Jane. This was inside:

No signature, no expression of love, no mention of their son. Frederick Bell, eighteen years old, sat down in his mother’s bedroom, surrounded by the overstuffed bags and boxes, and stared at his father’s handwriting—stared for a long, long time.

Luckily, he was an intelligent young man, and determined to succeed. He put himself through university entirely through scholarships and part-time jobs. Thanks to Aunt Josephine, his living expenses were minimal while he attended Sussex University.

Calm and jocular on the outside, on the inside he was launched on a private crusade. As he put it to himself, he wanted to cure blindness—the blindness of the medical profession to the problem of suicide. He had lost two parents, both of whom had been seeing family doctors, neither of whom had been diagnosed as depressed, let alone suicidal.

He wanted to perfect that treatment himself. He was fascinated both by the prospects of pharmaceutical treatment and also by the various kinds of talking therapy. Except for his occasional foray onto a nearby river in a small rowboat, he had no other interests. Essentially, he entered the university library one September day and emerged years later an MD. Another four years at London University and he was a board-certified psychiatrist, armed for battle with The Entity.

Through his various residencies his supervisors noted the young doctor’s particular affinity for depressed patients; his evaluations were uniformly excellent. His final residency was at the Kensington Clinic, where at the end of six months he was offered a staff position. He was dedicated, sensitive, and up-to-the-minute on the latest medications. His results spoke for themselves.

His first year was all work and success. Somehow along the way he found time to court Dorothy Miller, a nurse at the hospital. She found him a gentle and amusing bundle of nervous tics, what with his shoulder rolling and head shaking, and she admired him. For his part, he found Dorothy attractive, and liked it that she forced him to go to the occasional movie or dinner out, insisting that he live like a human being now and again.

It was during his second year as a full-fledged psychiatrist that he began to experience difficulties. Even thirty years later he remembered the first time the change had really taken hold. For some weeks he had been having more and more trouble listening to his patients. He would suddenly be startled to find they were asking him a question and he hadn’t heard it. Or they had just finished telling him something important and he had not responded. The patient would be sitting there looking at him expectantly and he hadn’t a clue what for.

Then one day a middle-aged man, married twelve years and a father of three, was telling him how deathly depressed he was, how he woke each morning with a groan and a curse because he could not face another day. And Bell felt a surge of anger in his belly. He couldn’t account for it; it seemed quite anomalous. His life was going well, he enjoyed his work and his patient had said nothing in particular to irk him, and yet he had felt anger radiating up from his belly and into his chest—so much so that he had a split-second fantasy of crossing the room and grabbing the man by his collar and shaking him. Hard.

That day the feeling passed quickly, but these surges became more and more frequent. And it wasn’t just this one patient who provoked them; it was all of his patients—at least, all of the depressed ones. It was an alarming development that threatened to become debilitating, and he was afraid to discuss it with any of his colleagues.

It became increasingly uncomfortable for him even to face his patients. He could not bear to hear how they hated themselves. Could not bear to hear them summarize their lives with deep derision. Could not bear to hear how the future held nothing for them, how they were sick of everything, sick of themselves. Especially themselves. It was torture.

And then one day it happened, the anger broke through.

Edgar Vail was a thirty-six-year-old commercial artist, admitted to the clinic after he had tried to kill himself by drowning only to discover that he was a better swimmer than he remembered. There was suicide in his family’s past, and the isolation of life in the present. Contributing factors were the sorrows of a recent divorce and a series of career disappointments. Plenty to be sad about, in other words.

He wanted to paint serious art. In fact, he did paint serious pictures, he just couldn’t get a gallery to handle his work or a single soul outside his immediate circle of friends to buy anything. He was going on about it, staring at the floor and shaking his head, and mumbling how he didn’t know why he bothered painting at all, how he should just throw away his brushes and give up entirely. It was a perfect mirror of his romantic life, he went on, all this effort, all this struggle, and nothing to show for it.

“Why don’t you just kill yourself?” Bell burst out. “Why not just do yourself in, and make a thorough job of it this time?”

Vail looked up sharply. The shock in his usually haunted eyes frightened Bell.

He had tried to recover, saying, “Well, I mean, I certainly didn’t intend it to sound so harsh. I just meant, there you were, you had a bottleful of Seconal at home, and yet you jump into water knowing perfectly well you can swim. My point being that you could have ended all this pain, this terrible pain you suffer from, right there with a few pills, and yet you chose not to. Why don’t we concentrate on what was behind that choice?”

The shock had dwindled in Vail’s eyes.

“I thought for a second there you were actually attacking me.”

“Good heavens, no. Last thing on earth I want to do. Please continue.”

The reassurance seemed to work. Vail sank back into the couch, and into the comfortable assumption that his psychiatrist was trying to help him.

Over the next few months, Bell set himself the task of learning to hide the anger. He tried reminding himself of happy events just before he had a scheduled session. That didn’t work; he simply forgot them in the face of his patients’ misery. He tried exercise, taking up rowing again. It made his muscles ache so much that his temper actually became worse—with everybody, not just patients.

But eventually he mastered his anger by training himself to not even feel it. And the way he did this was to behave just like any other psychiatrist. It came to him one afternoon when he was about to go out rowing. He stopped, with the oars in his hand, and sat down heavily on a bench beside the water.

The Thames shimmered, silver fringed with fire in the last of the afternoon light. He heard the lapping water, the breeze through the leaves, and all the million individual traffic noises. For some moments he had the sense that he was hearing a conversation taking place blocks away. A moment of hideous confusion, one might think, but Bell recognized it as absolute, razor-sharp clarity.

What he had realized in that instant was that you could use the tools of therapy in a brand new way, just as a surgeon might choose to employ his blade. You could ask the same questions, raise your eyebrows in just the same way, show great empathy, positive regard, all the rest of it. And yet you could skew it all just slightly, change the angle by a few degrees, and you could steer your patient in quite a different direction.

The next time Edgar Vail left his office, with a prescription for yet more sedatives, Bell spoke aloud to his book-lined walls.

“Kill yourself and get it over with, you pathetic waste of space.”

The words seemed to echo in the empty room, and Bell felt giddy. He began to laugh. It was all so simple; why hadn’t he seen it before? He laughed with surprise, with shock, with recognition, but also with the sheer hilarity of relief.

It was amazing how easy it was. Pick a patient who is desperately unhappy, take a few sessions to establish trust and empathy, then prescribe a month’s supply of sleeping pills. Barbiturates, they were, back then. Handled correctly, absolutely lethal.

In certain cases, like Edgar Vail’s, where the patient was consumed with self-loathing and yet still fully functional, you had to be sure they were aware of the right dosage. Too much—as Bell knew from his mother’s experience—and they throw up, possibly surviving. Too little, and they just end up with a bad hangover.

In other cases, where a patient was prostrate with the inarticulate grief that had eaten his father alive, Bell had to be a little more artful. In these cases what he did was schedule them for a Monday or Tuesday and send them home with a scrip for one of the tricyclics, something fast-acting. Come the weekend, the patient has the energy to pick up the gun, to climb to the roof, to tie the noose. It was like lighting a fuse. Of the first twenty suicides under his care, probably half came to their end this way. Another twenty-five percent (including Edgar Vail) chose sedatives. The rest had been so far gone they no doubt would have killed themselves anyway. Bell didn’t take credit for those.

But there were problems with the pharmaceutical approach. The simple fact was that it was too easy. Really, the drugs did all the work; any psychiatrist could have managed it. Also, it was risky. A large prescription for sedatives does not look good in the medical history of a suicidal patient, as the “wake-up-and-die” effect of tricyclics is well known. He had got into a spot of trouble in Swindon over this. Later on, too, in Manchester, there had been rumours of an inquiry, but that was about his mortality rate, not about over-prescribing per se. In any case, Bell had thought it prudent to move to Canada. He had long ago eased up on the chemicals, and now relied solely on his skills as a therapist.