The Quantity Theory of Insanity: Reissued

Ward 9

‘Ha ha ha, ha-ha … Hoo, h’, hoo, far, far and away, a mermaid sings in the silky sunlight.’ An idiot cooed to himself on the park bench that stood at the crest of the hill. Below him the greensward stretched down to the running track. In the middle distance the hospital squatted among the houses, a living ziggurat, thrusting out of a crumbling plain.

The idiot’s hair had been chopped into a ragged tonsure. He wore a blue hooded anorak and bell-bottomed corduroy trousers, and rocked as he sang. As I passed by I looked into his face; it was a face like the bench he sat on, a sad, forlorn piece of municipal furniture — although the morning sun shone bright, this face was steadily being drizzled on.

This particular idiot lay outside my jurisdiction. He was, as it were, un-gazetted. I knew that by ignoring the opportunity to indulge in the sickly bellyburn of self-piteous caring, I was facing up to an occupational challenge. If I was to have any success in my new job I would need to keep myself emotionally inviolate, walled off. For, this morning, I was to begin an indefinite appointment as art therapist, attached to Ward 9. My destination was the squat fifteen-storey building that rose up ahead of me, out of the tangled confluence of Camden Town.

I bounced down the hill, the decrease in altitude matched pace for pace by the mounting density of the air. The freshness of the atmosphere on Parliament Hill gave way to the contaminated cotton wool of ground-floor, summer London. Already, at 8.45 a.m., the roads around Gospel Oak were solidly coagulated with metal while shirtsleeved drivers sat and blatted out fumes.

As I picked my way through the streets the hospital appeared and then disappeared. Its very vastness made its sight seem problematic. In one street the horizon would flukily exclude it in such a convincing way that it might never have existed, but when I rounded the corner there was its flank rearing up — the grey-blue haunch of some massive whale — turning away from me, sending up a terrace of concrete flats with a lazy flip of its giant tail.

I walked and walked and the hospital never seemed to get any closer. Its sloping sides were banded with mighty balconies, jutting concrete shelves the size of aircraft carrier flight decks. The front of the building was hidden behind a series of zigzagging walkways and ramps that rose in crisscross patterns from the lower ground to the third floor. At the hospital’s feet and cuddled in the crook of its great wings-for-arms, were tumbles of auxiliary buildings: nurses’ flatlets; parking fortlets; generator units two storeys high, housed in giant, venetian-blind-slatted boxes; and ghostly incinerators, their concrete walls and chimneys blackened with some awful stain.

I rounded the end of the street and found myself, quite suddenly, at the bottom of a ramp that led straight up to the main entrance. The two previous times I had been to the hospital it was a working wasps’ nest in full diurnal swing. But now, their photoelectric cells disconnected, the main doors to the hospital were wedged open with orange milk crates. I picked my way through the long, low foyer, past the shop, at this hour still clad in its roll-over steel door, and in between miscellaneous islands of freestanding chairs, bolted together in multiples of two, seemingly at random. They were thinly upholstered in the same blue fabric as the floor covering. The room was lit by flickering strips of overhead neon, so that the whole effect was ghostly; the overwhelming impression was that this was a place of transit, an air terminal for the dying. It was impossible to differentiate the ill from the dossers who had leaked in from the streets and piled their old-clothes forms into the plastic chairs. All were reduced and diminished by the hospital’s sterile bulk into untidy parasites. The occasional nurse, doctor or auxiliary walked by briskly. They were uniformed and correct, clearly members of some other, genetically distinct, grouping.

In the glassed-in corridor that led to the lifts there was an exhibition of paintings — not by the patients, but by some pale disciple of a forgotten landscape school. The etiolated blues and greens chosen to take the place of hills and plains were flattened to sheens behind glass, which reflected the dead architectural centre of the hospital: an atrium where a scree of cobblestones supported uncomfortable concrete tubs, which in turn sprouted spindly, spastic trees.

I shared the lift to the ninth floor with a silent young man in green, laced at hip and throat. His sandy, indented temples with their gently pulsing veins aroused in me an attack of itchy squeamishness — I had to touch what repelled me. I scratched the palms of my hands and longed to take off my shoes and scratch the soles of my feet. The itch spread over my body like a hive and still I couldn’t take my eyes off that pulsing tube of blood, so close to both surface and bone.

At the ninth floor the sandy man straightened up, sighed, and disappeared off down a corridor with an entirely human shrug.

I’d been on to the ward before, albeit briefly, when Dr Busner had shown me round after the interview. What had struck me then and what struck me again now was the difference in smell between Ward 9 and the rest of the hospital. Elsewhere the air was a flat filtered brew; superficially odourless and machined, but latent with a remembered compound of dynasties of tea bags — squeezed between thumb and plastic spoon — merging into extended families of bleaching, disinfecting froths and great vanished tribes of plastic bags. But in Ward 9 the air had a real quality, it clamped itself over your face like a pad of cotton wool, soaked through with the sweet chloroform of utter sadness.

A short corridor led from the mouth of the lift to the central association area of the ward. This was a roughly oblong space with the glassed-off cabinet of the nurses’ station on the short lift side; a dining area to the right looking out through a long strip of windows over the city; to the left were the doors to various offices and one-to-one treatment rooms; and straight ahead another short corridor led to the two dormitories.

Every attempt had been made to present Ward 9 as an ordinary sort of place where people were treated for mental illnesses. There were bulletin boards positioned around the association area festooned with notices, small ads, flyers for theatrical performances by groups of hospital staff, clippings from newspapers, drawings and cartoons by the patients. Over in the dining area a few of the tables had rough clay sculptures blobbed on them, left there like psychotic turds. I assumed that they were the products of my predecessor’s last art therapy session. Around the open part of the area there were scattered chairs, the short-legged, upholstered kind you only find in institutions. And everywhere the eye alighted — the dining area, the nurses’ station, dotted in the open area — were ashtrays. Ashtrays on stands, cut-glass ashtrays, lopsided spiral clay ashtrays, ashtrays bearing the names of famous beers; all of them overflowing with butts.

There are two kinds of institution that stand alone on the issue of smoking. Whereas everywhere else you go you encounter barrages of signs enjoining you to desist, slashing your cigarette through with imperious red lines, in psychiatric wards and police stations the whole atmosphere positively cries out to you, ‘Smoke! Smoke! We don’t mind, we understand, we like smoking!’ Ward 9 was no exception to this rule. Empty at this hour (the patients had no reason to get up, they didn’t roll over in their beds at 8.00 sharp and think to themselves, ‘Ooh! I must get up quickly and have my shot of thorazine …’), the whole ward still whirled and eddied with last night’s acrid work.

I walked down the short corridor to the nurses’ station. A young man sat behind the desk completely absorbed in a dogeared paperback. He wore a black sweat shirt and black Levis; his sneakered feet, propped on the cluttered shelf of clipboards and Biros, pushed the rest of him back and up on two wheels of his swivel chair. As I stood and observed him, he rocked gently from side to side, his body unconsciously mirroring the short, tight arcs that his eyes made across the page.

I shuffled my feet a little on the linoleum to warn him that he was no longer alone. ‘Good morning.’

He looked up from his book with a smile. ‘Hi. What can I do you for?’

‘I’m Misha Gurney, the new art therapist, I start on the ward today and Dr Busner asked me to come in early to get a feel for things.’

‘Well, hello Misha Gurney, I’m Tom.’ Tom swung his feet off the ledge and proffered a hand. It was a slim, white hand, prominently bony at the wrist with long, tapering fingers. His handshake was light and dry but firm. His voice had the contrived mellowness of some Hollywood pilgrim paterfamilias. There was something unsettling in the contrast between this and his beautiful face: sandalwood skin and violet eyes. The body, under the stretchy black clothes, moved in an epicene, undulant way. ‘Well, there’s not a lot to see at this time. Zack isn’t even in yet. He’s probably just getting out of bed.’ Tom rolled his lovely eyes back in their soft, scented sockets as if picturing the psychiatrist’s matitudinal routine. ‘How about some tea?’

‘Yeah, great.’

‘How do you take it?’

‘Brown — no sugar.’

I followed Tom down the corridor that led to the staff offices and the consultation rooms. There was a small kitchenette off to one side. Tom hit the lights, which flickered once and then sprang into a hard, flat, neon glare. He squeaked around the lino in his sneakers. I examined the handwritten notices carefully taped to the kitchen cabinets. After a while I said, ‘What do you do here, Tom?’

‘Oh, I’m a patient.’

‘I assume you’re not on a section?’

He laughed. ‘Oh, no. No, of course not, I’m a voluntary committal. A first-class volunteer, exemplary courage, first in line to be called for the mental health wars.’ Again the light mocking irony, but not mad in any way, without the fateful snicker-snack of true schizo-talk.

‘You don’t seem too disturbed.’

‘No, I’m not, that’s why they let me go pretty much where I please and do pretty much what I want, as long as I live on the ward. You see, I’m a rare bird.’ A downward twist of the corner of a sculpted mouth, ‘The medication actually works for me. Zack doesn’t really like it, but it’s true. As long as I take it consistently I’m fine, but every time they’ve discharged me in the past, somehow I’ve managed to forget and then all hell breaks loose.’

‘Meaning …?’

‘Oh, fits, delusions, hypermania, the usual sorts of things. I carry the Bible around with me and try and arrange spontaneous exegetical seminars in the street. You know, you’ve seen plenty of crazies, I’ll bet.’

‘But … but, you’ll forgive me, but I’m not altogether convinced. If you’re on any quantity of medication …’

‘I know, I should be a little more slowed down, a little fuzzier around the edges, un peu absent. Like I say, I’m an exception, a one-off, an abiding proof of the efficacy of Hoffman La Roche’s products. Zack doesn’t like it at all.’

The kettle whistled and Tom poured the water into two styrofoam cups. We mucked around with plastic dipsticks and extracted the distended bags of tea, then wandered back to the association area. Tom led me over to the windows. The lower decks of the hospital poked out below us. Up here on the ninth floor, more than ever, one could appreciate the total shape of the building — a steeply sloping bullion bar, each ascending storey slightly smaller than the one below it. On the wide balcony beneath us figures were wafting about, clad in hospital clothing, green smocks and blue striped nightdresses, all bound on with tapes. The figures moved with infinite diffidence, as if wishing to offer no offence to the atmosphere. They trundled in slow eddies towards the edge of the balcony and stood rocking from heel to toe, or from side to side, and then moved back below us and out of sight again.

‘Chronics,’ said Tom, savouring the word as he slurped his tea. ‘There’s at least sixty of them down there. Quite a different ball game. Not a lot of use for your clay and sticky-backed paper down there. There’s a fat ham of a man down there who went mad one day and drank some bleach. They replaced his oesophagus with a section cut from his intestine. On a quiet night you can hear him farting through his mouth. That’s a strange sound, Misha.’

I remained silent, there was nothing to say. Behind me I could hear the ward beginning to wake up and start the day. There were footsteps and brisk salutations. An auxiliary came into the association area from the lift and began to mop the floor with studious inefficiency, pushing the zinc bucket around with a rubber foot. We stood and drank tea and looked out over the chronics’ balcony to the Heath beyond, which rose up, mounded and green, with the sun shining on it, while the hospital remained in shadow. It was like some separate arcadia glimpsed down a long corridor. I fancied I could see the park bench I’d passed some forty minutes earlier and on it a blue speck: the tonsured idiot, still rocking, still free.

Zack Busner came hurrying in from the lift. He was a plump, fiftyish sort of man, with iron-grey hair brushed back in a widow’s peak. He carried a bulging briefcase, the soft kind fastened with two straps. The straps were undone, because the case contained too many files, too many instruments, too many journals, too many books and a couple of unwrapped, fresh, cream-cheese bagels. Busner affected striped linen or poplin suits and open-necked shirts; his shoes were anomalous — black, steel-capped, policeman’s shit kickers. He spotted me over by the window with Tom and, turning towards his office, gestured to me to follow him, with a quick, flicking kind of movement. I dropped my foam beaker into a bin, smiled at Tom and walked after the consultant.

‘Well Misha, I see you’ve found a friend already.’ Busner smiled at me quizzically and ushered me to the chair that faced his across the desk. We sat. His office was tiny, barely larger than a cubicle, and quite bare apart from a few textbooks and four artworks. Most psychiatrists try to humanise their offices with such pieces. They think that even the most awful rubbish somehow indicates that they have ‘the finer feelings’. Busner’s artworks were unusually dominant, four large clay bas-reliefs, one on each wall. These rectangular slabs of miniature upheaval, earth-coloured and unglazed, seemed to depict imaginary topographies.

‘Yes, he’s personable enough. What’s the matter with him?’

‘Actually, Tom’s quite interesting.’ Busner said this without a trace of irony and began fiddling around on the surface of his desk, as if looking for a tobacco pipe. ‘He’s subject to what I’d call a mimetic psychosis …’

‘Meaning?’

‘Meaning he literally mimics the symptoms of all sorts of other mental illnesses, at least those that have any kind of defined pathology: schizophrenia, chronic depression, hypermania, depressive psychosis. The thing about Tom’s impersonations, or should I say the impersonations of his disease, is that they’re bad performances. Tom carefully reiterates every recorded detail of aberrant behaviour, but with a singular lack of conviction; it’s wooden and unconvincing. Your father would have found it fascinating to watch.’

‘Well, I find it pretty fascinating myself, even if I don’t have quite the same professional involvement. What phase is Tom in now?’

‘You tell me.’

‘Well, he seems to be playing the “Knowing Patient Introduces Naive Art Therapist to Hell of Ward” role.’

‘And how well is he doing it?’

‘Well, now you mention it, not too convincingly.’

Busner had abandoned his search for a pipe, if that’s what it had been. He now turned and presented me with his outline set against the window. In profile I could see that he was in reality rather eroded, and that the impression of barely contained energy which he seemed determined to project was an illusion as well. Busner sat talking to me, rolling and then unrolling the brown tongue of a knitted tie he wore yanked around his neck. Overall, he reminded me of nothing so much as a giant frog.

Behind him light and then shadow moved across the face of the hospital at a jerky, unnatural speed. The clouds were whipping away overhead, out of sight. All I could see was their reflection on the hospital’s rough, grey, barnacle-pitted skin.

The hospital was big. Truly big. With its winking lights, belching vents and tangled antennae, it slid away beneath the cloudscape. Its bulk was such that it suggested to the viewer the possibility of spaceships (or hospitals) larger still, which might engulf it, whole, through some docking port. The hospital was like this. I couldn’t judge whether the rectangles I saw outlined on the protruding corner opposite Dr Busner’s office were glass bricks or windows two storeys high. The street lay too far below to give me a sense of scale. I was left just with the hospital and the scudding shadows of the racing clouds.

Busner had given up his tie-rolling and taken up with an ashtray on his desk. This was crudely fashioned out of a spiralled snake of clay, varnished and painted with a bilious yellow glaze. Busner ran his fleshy digit around and around the rim as he said, ‘I’d like you to stick close to me this morning, Misha. If you are to have any real impact on what we’re trying to do here you need to be properly acquainted with the whole process of the ward: how we assess patients, how we book them in, how we decide on treatment. If you shadow me this morning, you can then get to know some of the patients informally this afternoon.’

‘That sounds OK.’

‘We’ve also got a ward meeting at noon which will give you an opportunity to get to know all your fellow workers and appreciate how they fit into the scheme of things.’

Busner set down the turd of clay on his desk with a clack and stood up. I stepped back to allow him to get round the desk and to the door. Despite being the senior consultant in the psychiatric department, Busner had about as much office space as a postroom boy. I followed him back down the short corridor to the association area. By now the sun had risen up behind the clouds and the bank of windows on the far side of the dining area shone brightly. Silhouetted against them was a slow line of patients, shuffling towards the nurses’ station where they were picking up their morning medication.

The patients were like piles of empty clothes, held upright by some static charge. Behind the double sliding panes of glass which fronted the nurses’ station sat two young people. One consulted a chart, the other selected pills and capsules from compartments in a moulded plastic tray. They then handed these over to the patient at the head of the queue, together with a paper beaker of water, which had a pointed base, rendering it unputdownable, like a best seller.

‘Not ideal, but necessary.’ Busner cupped his right hand as if to encapsulate the queue. ‘We have to give medication. Why? Because without it we couldn’t calm down our patients enough to actually talk to them and find out what the matter is. However, once we’ve medicated them they’re often too displaced to be able to tell us anything useful. Catch-22.’

Busner cut through the queue to the dining area, muttering a few good mornings as he gently pushed aside his flock. We sat down at a table where a young woman in a frayed white coat was sipping a muddy Nescafe. Busner introduced us.

‘Jane, this is Misha Gurney, Misha, Jane Bowen — Jane is the senior registrar here. Misha is joining us to manage art therapy — quite a coup, I think. His father, you know, was a friend of mine, a close contemporary.’

Jane Bowen extended her hand with an overarm gesture that told me she couldn’t have cared less about me, or my antecedents, but because she thought of herself as an essentially open-minded and kind person she was going to show me a welcoming smile. I clasped her hand briefly and looked at her. She was slight, with one of those bodies that seemed to be all concavities — her cheeks were hollowed, her eyes scooped, her neck centrally cratered. Under her loose coat I sensed her body as an absence, her breasts as inversions. Her hair was tied back in one long plait, held by an ethnic leather clasp. Her top lip quested towards her styrofoam beaker. The unrolled, frayed ends of her stretchy pullover protruded beyond the frayed cuffs of her cotton coat. Her pockets were stuffed full. They overflowed with pens, thermometers, syringes, watches, stethoscopes, packets of tobacco and boxes of matches. The lapels of the coat were festooned with name badges, homemade badges, political badges and badges of cutout cartoon characters: Roadrunner, Tweetypie, Bugs Bunny and Scooby Doo.

‘Well, Misha, any ideas on how your participation in the ward’s creative life will help to break the mould?’ She gestured towards an adjacent table, where several misshapen clay vessels leant against one another like drunken Rotarians.

‘Well, if the patients want to make clay ashtrays, let them make clay ashtrays.’ I lit a cigarette and squinted at her through the smoke.

‘Of course they could always try and solve The Riddle.’

I hadn’t noticed as I sat down, but now I saw that she was shifting the four pieces of a portable version of The Riddle around on the melamine surface in front of her. Her fingers were bitten to the quick and beyond. Busner flushed and shifted uneasily in his chair.

‘Erumph! Well… bankrupt stock and all that. We have rather a lot of The Riddle sets around the ward. I err … bought them up for a pittance, you know. At any rate, I still have some faith in them and the patients seem to like them.’

Busner had been responsible for designing, or ‘posing’, The Riddle in the early Seventies. It was one of those pop psychological devices that had had a brief vogue. Busner himself had been forging a modest career as a kind of media psychologist with a neat line in attacking the mores of conventional society. The Riddle tied in with this and with the work that Busner was doing at his revolutionary Concept House in Willesden. His involvement with the early development of the Quantity Theory also dated from that period.

Busner was a frequent trespasser on the telly screens of my childhood. Always interviewing, being interviewed, discussing an interview that had just been re-screened, or appearing in those discussion programmes where paunchy people sat on uncomfortable steel rack-type chairs in front of a woven backdrop. Busner’s media activities had dropped away as he grew paunchier. He was now remembered, if at all, as the poser of The Riddle — and that chiefly because the short-lived popularity of this ‘enquire-within tool’ had spawned millions of square acrylic slabs of just the right size to get lost and turn up in idiosyncratic places around the house, along with spillikins, Lego blocks and hairpins. In fact it had become something of a catch-phrase to cry as you dug a tile out from between the carpet and the underlay, or from behind a radiator, ‘I’m solving The Riddle!’ Eventually The Riddle itself — what you were actually meant to do with the four square slabs in bright pastel shades, which you got with The Riddle set — was entirely forgotten.

‘I’m sorry Zack, I didn’t mean to sound caustic.’ Jane Bowen placed a surprisingly tender hand on Busner’s poplin sleeve.

‘That’s all right, I think I still deserve it, even after all these years. The funny thing is that I did believe in The Riddle. I suppose a cynic would say that anyone would believe in something that brought in enough income to buy a four-bedroom house in Redington Road.’

‘Even shrinks have to have somewhere to live,’ said Jane Bowen. The two of them smiled wryly over this comment — a little more wryly than it strictly merited.

‘Well, we’re not helping anybody sitting here, are we?’ said Busner. Once again this was a key motif. It had been his catchphrase on all those discussion and interview programmes — always delivered with falsetto emphasis on the ‘helping’. The catch-phrase, like The Riddle, outlived Busner’s own popularity. I remember seeing him towards the very end of his TV sojourn, when he was reduced to going on one of those ‘celebrity’ gameshows where the celebrities sit in a rack of cubicles. Zack trotted out his obligatory line and the contestant dutifully pushed the button on the tape machine — as I recall, she ended up winning a suite of patio furniture. It was really quite a long way from the spirit of radical psychology. Now Busner was using the phrase again, clearly with a sense of irony — but somehow not altogether; there was also something else there, a strange kind of pride almost.

‘I want you to shadow me while I do the ward round.’ Busner guided me by placing his palm on my shoulder. We both nodded to Jane Bowen, who had forgotten us already and fallen into conversation with a nurse. Busner stashed his bursting briefcase behind the nurses’ station, after extracting from it with difficulty a clipboard and some sheets of blank paper. We walked side by side down the short corridor that led to the entrance to the two wards. For some reason Busner and I were unwilling to precede one another, and as a result people coming in the other direction had to crush up against the walls to get around us. We were like a teenage couple — desperate to avoid any break in contact that might let in indifference.

The dormitories were laid out in a series of bays, four beds in each bay and four bays to the dormitory. Each bay was about the size of an average room, the beds laid out so as to provide the maximum surrounding space for each occupant to turn into their own private space. Some of the patients had stuck photographs and posters up on the walls with masking tape, some had placed knick-knacks on the shelves, and others had done nothing and lay on their beds, motionless, like ascetics or prisoners.

Busner kept up a commentary for my benefit as we stopped and consulted with each patient. The first one we came to was a pop-eyed man in his mid-thirties. He was wearing a decrepit Burton suit which was worn to a shine at knee and elbow. He was sitting on the easy chair by his bed and staring straight ahead. His shoulder-length hair was scraped down from a severe central parting. His eyes weren’t just popping, they were half out of their sockets, resembling ping-pong balls with the pupils painted on to them like black spots.

‘Clive is prone to bouts of mania, aren’t you, Clive?’

‘Good morning, Dr Busner.’

‘How are you feeling, Clive?’

‘Fine, thank you, Doctor.’

‘Any problems with your medication? You’ll be leaving us soon, won’t you?’

‘In answer to your first question, no. In answer to your second, yes.’

‘Clive likes everything to be stated clearly, don’t you, Clive?’

At the time I thought Busner was being sarcastic. In fact — as I realised later — this wasn’t the case. If anything, Busner was being solicitous. He knew that Clive liked to expatiate on his attitudes and methods; Busner was providing him with the opportunity.

‘You’re staring very fixedly at the opposite wall, Clive, would you like to tell Misha why this is?’

I followed his line of sight; he was looking at a poster which showed two furry little kittens both dangling by their paws from the handle of a straw basket. The slogan underneath in curly script proclaimed, ‘Faith isn’t Faith until it’s all you’re hanging on to.’

‘The kitten is powerful.’ Clive smiled enigmatically and pointed with a dirt-rimmed nail, ‘That kitten holds in its paws the balance, the egg of creation and more.’ Having pronounced he lapsed back into a rigid silence. Busner and I left him.

Although there were only thirty or so patients on the ward they soon resolved themselves, not into names or individuals, but into distinct groups. Busner’s catchment area for his ward was an L-shaped zone that extended from the hospital in one dog-leg into the very centre of the city. The hospital pulled in its sustenance from every conceivable level of society. But on Ward 9 insanity had proved a great leveller. A refugee sometimes seems to have no class. The English depend on class, to the extent that whenever two English people meet, they spend nano-seconds in high-speed calculation. Every nuance of accent, every detail of apparel, every implication of vocabulary, is analysed to produce the final formula. This in turn provides the coordinates that will locate the individual and determine the Attitude. The patients on Ward 9 had distanced themselves from this. They could not be gauged in such a fashion. Instead, I divided them up mentally into the following groups: thinnie-pukies, junkies, sads, schizes and maniacs. The first four groups were all represented about equally, whilst the fifth group was definitely in the ascendant; there were lots of maniacs on Ward 9 and by maniacs I mean not the culturally popular homicidal maniac, but his distant herbivorous cousin, hyper, rather than homicidal, and manic, rather than maniacal.

As Tom had already characterised himself earlier that morning, hypermanic types are lecturers; extramural, al fresco professors, who, like increasingly undulant or syncopated Wittgensteins, address the world at large on a patchwork syllabus made up of Kabbalah, astrology, tarot, numerology and Bible (specifically Revelation) study. They are sad-mad, they know they are ill, they have periods of conformity, but they are always somehow out of joint.

‘Art therapy is very popular here, Misha.’ Busner detained me in the vestibule between the two wards. ‘We can’t keep the patients sufficiently occupied, they have treatment sessions of various kinds in the mornings, but in the afternoons you’ll be all they have to look forward to. Sometimes we can arrange an outing of some kind, or a friend or relative will be allowed to take them out on the Heath, but otherwise they’re cooped up here in a fuddled daze.’

We went on into the women’s dormitory. Here things seemed, at first, different. On the men’s dormitory Busner and I had spoken with a few isolated individuals, backed off into their individual bays. But here the patients seemed to be associating with one another. They reclined on beds chatting, or sat round the formica-topped tables which formed a central reservation.

A skeleton with long, lush hair rocked on a bed in the bay to our right, an obscenely large catheter protruding out of her lolly-stick arm. Busner took me in under tow and introduced us.

‘Hilary isn’t that keen on eating — or at least she is sometimes, but she doesn’t really like the nutritional side-effects of food. Hilary, this is Misha Gurney, he’s our new art therapist.’ Hilary stopped rocking and gave me a level smile from underneath neatly coiffed chestnut bangs.

‘Hello. I’ll look forward to this afternoon. I like to paint, I like watercolours. These are some of mine.’ She gestured towards the wall at the head of the bed, where an area about a foot square was tiled with tiny watercolours, terribly painfully precise little paintings — all portraits, apparently of young women. Busner wandered off, but I remained and walked to the head of the bed, so that I could examine the pictures thoroughly. They had been executed with a fanatical attention to the detail of make-up and hair which made them almost grotesque. Hilary and I sat sideways to each other. With her neck canted around so that she could face me, Hilary’s greaseproof-paper skin stretched, until I could see the twisted, knotted coils of tendon and artery that lay within.

‘They’re very good. Who are all these people?’

‘They’re my friends. I paint them from photographs.’

‘Your pictures are very detailed. How do you manage it?’

‘Oh, I have special pens and brushes. I’ll show you later.’

I left Hilary and went over to where Busner was sitting at one of the tables in the central area of the dormitory.

‘Has Hilary been telling you about her friends?’

‘Yes …’

‘Hilary doesn’t have any friends, as such. She cuts pictures of models out of advertisements in magazines, then she paints over them. She’s been in and out of this ward for the past three years. Every time she comes in she looks like she does now. She’s so close to death we have to put her on a drip. She’s usually completely demented; the amino acids have been leeched out of her brain. After she’s been on the drip for a while we transfer her to a tight regime of supervised eating based on a punishment/reward system, and at the same time she undergoes an intensive course of psychotherapy with Jane Bowen. Jane is very much the expert on eating disorders. After six weeks to two months Hilary is back to a healthy weight and eating sensibly. She’ll leave and we can predict her return usually to within the day — some four months later.’

‘I thought a lot of anorexics and bulimics grew out of it?’

‘To some extent, but there’s always a hard core and at the moment it seems to be growing. These long-term anorexics are different, they’re placid, resigned and apparently unconscious of any motivation. The temporaries tend to be wilful, obstinate and obviously powerfully neurotic. These hard-cores, like Hilary, could almost be psychologically blameless. Some of them even have fairly stable relationships. They’re at a loss to explain what comes over them, it seems to be somehow external, imposed from elsewhere.’

I should have been paying attention to what Busner was saying, but I couldn’t concentrate. For a start there was the strangeness of the situation — I’d only ever spent isolated periods of a few minutes on psychiatric wards before. I had known what to expect in broad terms, but it was the relentlessness of the ambience that was beginning to get to me. There was something cloacal about the atmosphere in the women’s ward. None of the patients seemed to have bothered to dress, they sat here and there talking, wearing combinations of night and day clothes. There was a preponderance of brushed cotton. I sensed damp, and smelt oatmeal, porridge, canteen; indefinable, closed-in odours.

I could walk away from the tonsured idiot on the Heath, but inside Ward 9 I was trapped. And these people weren’t pretending. They weren’t closet neurotics or posing eccentrics, Bohemians. They were the real thing. Real loss of equilibrium, real confusion, real sadness, that wells up from inside like an unstaunchable flow of blood from a severed artery. I felt my gorge rising. I felt my forehead, it was sandpaper-dry. Busner was neglecting me and talking to a pneumatic nurse. The nurses on Ward 9 didn’t wear a uniform as such, rather they affected various items of medical garb: tunics, coats and smocks, nameplates and watches pinned at the breast. This nurse had a man’s Ingersoll attached by a safety-pin to her jacket lapel. She had blonde baby curls, bee-stung lips and the creamy, slightly spongy complexion that invariably goes with acrid coital sweats. I forced myself to listen to what they were saying, and fought down nausea with concentration.

‘Take her out to the optician then, Mimi, if she has to go.’

‘Oh, she does, Zack, she can barely see a yard in front of herself. She can’t be expected to deal with reality if she can’t see it.’ The voluptuous Mimi was squidged on to the corner of the table. Behind her stood a short woman in her thirties with the hydrocephalic brow and oblique domed crop of an intelligent child. She stared at me with sightless eyes.

‘Rachel shouldn’t really be off the ward, considering the medication she’s on.’

‘But Zack, it’s a walk down to the parade, ten minutes at most. Give her a break.’

‘Oh, all right.’

‘Come on then, Rachel, get your coat on.’ Rachel bounced away into one of the bays. Mimi lifted herself off the edge of the table and winked at me in a languid way.

‘Come on, Misha, we’ve got an admission for you to see. I’ll leave you at the front desk. Anthony Valuam will pick you up and take you down to casualty.’ We walked out of the women’s dormitory and back to the association area. Tom, my friend from the earlier part of the morning, was back behind the nurses’ station, reading his dog-eared Penguin. Busner despatched me to wait with him by giving me a gentle shove in the small of my back, then he crooked his finger at a scrofulous youth in a tattered sharkskin suit who sat smoking and disappeared with him towards his office. Tom put down his book and treated me to another little conspiratorial exchange.

‘Has the good doctor given you a little tour?’

‘We’ve been round the ward, yes.’

‘Beginning to catch on yet?’

‘What do you mean?’

‘Well, who did you get introduced to? No, don’t tell me. Let me guess. You talked to Clive and then you saw a lot of other male patients quite quickly until you ended up scrutinising Hilary’s watercolours.’

‘Err … yes.’

‘And did Zack come out with his catch-phrase?’

‘Yes, when we were talking to Jane Bowen.’

‘Thought so. He’s so predictable. That’s one of the truly therapeutic aspects of this place, the unfailing regularity of Dr Busner. What are you doing now?’

‘I’m meant to be going down to casualty to sit in on an admission with a Dr Valuam.’

‘Tony, yeah. Well, he’s my kind of a shrink, not like Dr B; more practical like, more chemical.’

A door opened to the right of the nurses’ station which I hadn’t noticed before. A very short man came out of it and with neat movements locked it behind him, using a key that was on an extremely large gaoler’s bunch. He turned to face me. He was a funny little specimen. He had wispy fair hair teased ineffectually around his bare scalp. It wasn’t as if he was going bald, it was more as if he’d never grown any hair to begin with. This impression was supported by the watery blue eyes, and the nose and chin which were soft and seemingly boneless. He wore a stiff blue synthetic suit of Seventies cut and vinyl shoes.

‘You must be Misha Gurney. I’m Anthony Valuam.’ His handshake was twisted and rubberised, like holding a retort clamp in a laboratory, but his voice was absurdly mellow and basso. A voice-over rather than a real voice. His foetal face registered and then dismissed my surprise; he must have been used to it. Tom was stifling an obvious giggle behind his paperback. Valuam ignored him and I followed suit. We walked off down the short corridor to the lift. Valuam launched into an introduction.

‘It’s very unusual to have an admission through casualty at this time of day. On this ward we deal almost exclusively with referrals, but we know this particular young man and there are very good reasons why he should be treated on Ward 9.’

‘And they are …?’

‘I don’t wish to be enigmatic, but you’ll see.’

Valuam fell silent. We waited for the lift, which arrived and slid open and closed and then dropped us down through the hospital to casualty, which was situated in the first sub-basement. The lift stopped on every floor, to take on and drop passengers.

The architects, interior designers and colour consultants who had made the hospital were not insensitive to the difficulties posed by such a project, they had earnestly striven to make this vast, labyrinthine structure seem habitable and human in scale. To this end each floor had been given slightly different wall and floor coverings, slightly different-shaped neon strip-light covers, slightly different concrete cornicing, slightly different steel ventilation-unit housings and slightly different colourings: virology an emphatic pale blue, urology a teasing (but tasteful) green, surgery and cardiology a resilient pink and so on. At each floor the patients and their orderlies were also different colours. The faces and hands of the patients as they were transferred from ward to ward, on steel trolleys, in wheelchairs as heavy as siege engines, were stained with disease, as vividly as a pickled specimen injected with dye.

The orderlies were violently offhand; they manhandled the patients into the lifts like awkward, fifty-kilo bags of Spanish onions. Then they stood menacingly in the corners, lowering over their livid charges, their temples pulsing with insulting health. Occasionally a patient would be wheeled into the lift who was clearly the wrong colour for the direction we were headed in (this was evident as soon as the lift reached the next floor) and the orderly would back the chair or table out of the lift again, the faces of both porter and cargo registering careful weariness at the prospect of another purgatorial wait.

We reached the sub-basement. Valuam turned to the left outside of the lift and led me along the corridor. Down here the colour scheme was a muted beige. The persistent susurration of the air-conditioning was louder than on the ninth floor and was backed up by a deeper throb of generators. The industrial ambience was further underscored by the pieces of equipment which stood at intervals along the corridor, their steel rods, rubber wheels, plastic cylinders and dependent ganglia of electric wiring betrayed no utility.

The beige-tiled floor was scarred with dirty wheel tracks. We whipped past doors with cryptic signs on them: ‘Hal-G Cupboard’, ‘Ex-Offex.Con’, ‘Broom Station’. The corridor now petered out into a series of partitioned walkways which Valuam picked his way through with complete assurance. We entered a wide area, although the ceiling here was no higher than in the corridor. On either side were soft-sided booths, curtained off with beige plastic sheeting. The beige lights overhead subsonically wittered. We passed stooped personnel — health miners who laboured here with heavy equipment to extract the diseased seam. They were directed by taller foremen, recognisable by their white coats, worn like flapping parodies. Valuam turned to the right, to the left, to the left again. In the unnatural light I felt terribly sensitive as we passed booths where figures lay humped in pain. I felt the tearing, cutting and mashing of tissue and bone like an electrified cottonwool pad clamped across my mouth and nose.

At length Valuam reached the right booth. He swept aside the curtain. A youth of twenty or twenty-one cowered in a plastic scoop chair at the back of the oblong curtained area. On the left a fiercely preserved woman leant against the edge of the examination couch. On the right stood a wheeled aluminium table. Laid out on it were tissues, a kidney dish of tongue depressors, and a strip of disposable hypodermics wound out of a dispenser box.

Valuam pushed a sickly yellow sharps disposal bin to one side with his blue foot and pulled out another plastic chair. He stretched and shook hands with the woman, who murmured ‘Anthony’. Valuam sat down facing the youth and untucked his clipboard from the crook of his arm. It was left for me to lean awkwardly in the opening, looming over the gathering like a malevolent interloper. I was conspicuously ignored.

‘Good morning, Simon,’ said Valuam. Simon drew a frond of wool out from the cuff of his pullover and let it ping inaudibly back into a tight spiral. Simon was wearing a very handsome pullover, made up of twenty or so irregular wool panels in shades of beige, grey and black. He pinged the thread again and fell to worrying a bloody stalk of cuticle that had detached itself from his gnawed paw.

‘Simon and I felt it would be a good idea if he came to stay on the ward with you for a while, Anthony.’ The woman uncrossed her ankles and hopped up on to the examination table. Her steely hair was sharply bobbed, one bang pointed at the youth who was her indigent son. She took a shiny clutch bag from under her arm, popped it open and withdrew a tube of mints which she aimed at me.

‘Polo?’

‘Err … thanks.’ I took one. She smiled faintly and took one herself.

‘How do you feel about that, Simon?’ Valuam held his foetal face on one side, his basso voice sounding concerned.

‘S’alright.’ Simon was rotating the cuticle stalk with the tip of a finger. He was also starting to rock back and forth.

Valuam consulted the papers attached to his clipboard. ‘Mmm … mm …’ He snuffled and ruffled the case notes while the steely-haired woman and I regarded one another peripherally. She really was pretty chic. At neck and wrist she was encircled with linked silver platelets cut into shapes; her clothes were made out of varieties of vicuna and rabbit; her stockings were so pure you could see the mulberry in them. I couldn’t quite get the measure of why she was so blase about Simon’s voluntary committal. Genuine lack of caring? A defence mechanism? Something more sinister?

‘You were discharged last October, Simon,’ Valuam had found the right place, ‘and went to the Galston Work Scheme. How did that go?’

‘Oh, OK, I guess. I did some good things; worked on some of my constructions. I enjoyed it.’ Simon had given up on the cuticle, he looked up at Valuam and spoke with some animation. His face was quite green in hue and distorted by weeping infections. It was like watching a colour screen where the tube has started to pack up.

‘But now you’re in pretty bad shape again, aren’t you?’

‘Yeah, I guess. I’m fed up with living with the bitch.’ Simon’s mother winced. ‘She puts me under pressure the whole time. Do this, do that. It’s no wonder I start to freak out.’

‘I see. And freaking out means stopping your medication and stopping going to the Galston and stopping your therapy and ending up looking like this.’

Simon had relapsed into torpor before Valuam had finished speaking. The cuticle had claimed his whole attention again. We were left regarding the top of his unruly head.

Valuam sighed. He ticked some boxes on the sheet uppermost on the clipboard and twisted sideways on his plastic chair to face the woman. ‘Well, I suppose he’d better come in for a few weeks then.’

‘I’m glad you see it that way, Anthony.’ She eased herself off the examination couch with a whoosh of wool and silk and patted herself down. ‘Well, goodbye then, Simon. I’ll come and see you at the weekend.’

‘Bye, Mum, take it easy.’ Simon didn’t look up, he’d found some antiseptic and fell to swabbing his bleeding finger with tight little arcs. His mother smiled absently at Valuam as if acknowledging his sartorial failure. I stood to one side and she nodded at me as she swished out of the cubicle and away.

Valuam got up and scraped the chair back against the wall.

‘I have someone to see here, Misha, would you mind taking Simon up to the ward?’

‘I’m, er, not sure I’ll be able to find my way back.’

‘Oh, that’s OK, Simon knows the layout of the hospital far better than he knows his own mind.’

I wasn’t sure whether I was meant to share in this sick irony — but looking at Valuam’s miscarried countenance I could see that he wasn’t joking. Simon seemed not to have noticed.

I followed the abstraction of Simon’s pullover back through the twisting lanes of the casualty examination area. Even before we’d gained the corridor I found that I’d completely lost my bearings. Simon, however, didn’t hesitate, he plunged on unswervingly, walking with long fluid strides. We travelled like a couple arguing; he would make gains on me of some twenty yards and then I’d have to put on a spurt to catch up with him. To begin with I feared that he was actually trying to lose me, but whenever there was a choice of directions and he was some way ahead he waited until I was close enough to see which way he went.

The nature of the corridors we bowled along was perceptibly changing. The machines that stood at intervals against the corridor walls were becoming more obviously utilitarian — parts were now painted black rather than chromed or rubberised — they had petrol engines rather than electric pumps. The walls themselves were changing, they were losing their therapeutic hue and reverting to concrete colour, as was the floor. Lights were becoming exposed, first the odd neon tube was naked and then all of them.

This part of the hospital was beyond the world of work, it was a secret underworld. From time to time we would pass workers clad in strange suits of protective clothing: wearing rubberised aprons, or plastic face masks, or Wellington boots, or leather shoulder pads. They looked at us inscrutably. It was clear that they were intent on their jobs; maintaining the whine, stoking the hum, directing the howl. It was also clear the Simon wasn’t taking me back to the ward, he had business here. I caught him on a corner.

‘Where are we going, Simon?’

‘To see something, something worth seeing. I promise you won’t be angry.’

‘Can you tell me what it is?’

‘No.’ He wheeled away, calling over his shoulder, ‘Come on, it’s not much further.’

The corridor walls gave way to sections of masonry. Embedded in them were the filled-in remains of long-dead windows. I realised that we had reached the place where the new hospital had been grafted on to its predecessor. There were the marks of cast-iron railings, pressed and faint, like fossilised grass stems. More than ever I sensed the great weight of the hospital crouching overhead. A dankness entered the air; at intervals trickling pools of water seeped up on to the floor. Eventually Simon stopped by a set of double doors, old doors belonging to the former hospital, the top halves glassed with many small panes. He pushed them apart on failing rails.

We were in some sort of conservatory. Round, twenty-five feet across, fifteen feet up the walls gave way to a dirty glass dome, which arched overhead, almost out of sight in the gloom. There was daylight here, filtering down weakly through the tarnished panes. Water dripped audibly. In the centre of the room stood a giant machine for doing things to people. This much was clear from the canted couch positioned halfway up its flank. Otherwise it resembled a giant microscope, the barrel obliquely filling the uncertain volume of the room, the lens pointing directly at the couch. The whole thing was festooned with hydraulic cabling. It had originally been painted a kitchen-cream colour but now it was corroded, atrophied.

Simon and I stood and looked.

‘Good, isn’t it.’ His voice was full and resonant. He’d lost his sullen edge.

‘Yes, very striking. What was it for?’

‘Oh, I’ve no idea. I got left alone one night in casualty and just started wandering about, I found this. I don’t think anyone’s been here for years. Funny, really, because it’s right in back of the MDR.’

‘MDR?’

Simon beckoned me over to the grey-filmed window opposite the door we’d entered by. I circled the giant machine, stepping over the edge of the vast plate that riveted it to the floor. Bits had fallen off the machine — bolts, braces, other small components — but given the scale of the thing, they were large enough to bruise your shins if you knocked against them. Simon was vigorously rubbing the windowpane.

‘Look, can you see?’ There was no sense of sky, or the outside, but light came from somewhere. Outlining a squat blockhouse, clapboarded with massive concrete slabs. It was like some defence installation. ‘That’s the Mass Disaster Room. If there’s ever a nuclear attack, or an earthquake, or something like that, that’s where all the equipment is kept to deal with it.’

‘Well, like what?’

‘I don’t know, no one will tell me. I only found out about it because I came across the door with the notice on it.’

We stood at the window for a while. The conservatorylike room, the giant machine, the blockhouse. All thinly lit by an invisible day. There was something eerie about the atmosphere. The eeriness that washes over when you step obliquely out of a populous area — from a crowded park into a little grey copse — and look behind you at the life that still goes on, children and dogs.

Back up in the ward Busner was hurrying about the place, gathering together all the staff members. A circle of chairs had been roughly arranged in the association area. Anthony Valuam and Jane Bowen were already seated and engaged in earnest discussion when we arrived. Valuam showed no curiosity about where we had been. Simon himself had reverted to sullen, disturbed type as soon as we arrived at the ninth floor. He disappeared into a shifting knot of movers and shakers and was gone from sight.

‘Sit down, Misha, do sit down.’ Busner flapped his poplin-bumped turkey-skin arms. I sat down next to Mimi, the voluptuous nurse, who had been and gone to the optician. The rest of the staff began to trickle into place, auxiliary as well as medical. There were canteen ladies here in nylon, elasticated hair covers, and psychiatric social workers with rolled-up newspaper supplements. They chatted to one another quite informally, swopping cigarettes and gesturing. The patients took no notice of this assembly — which to my mind more than anything else underlined their exclusion from the right-thinking world.

Busner called the meeting to order.

‘Ahm! Hello everyone. We’ve a lot to get through today, so I’d like to get under way. We don’t want to run over, the way we did last month. Before we come to the first item on the agenda I’d like to introduce to you all a new member of staff, Misha Gurney. Some of you will, no doubt, have heard of his father,’ Busner’s face purpled at the edges with sentimentality, ‘who was a contemporary of mine and a dear friend. So it’s an especial pleasure for me that Misha should be joining us on the ward as the new art therapist …’

‘Wait till you hear what happened to the old art therapist …!’ Before I had had time to wheel round in my chair and see who had whispered in my ear, Tom was gone, soft-shoe shuffling down the corridor.

From then on the meeting deteriorated into the usual trivial deliberations that — in my experience — seem to accompany all departmental meetings. There were discussions about the hours at which tea could be made, discussions about shift rostering, discussions about patients’ visitors. My attention began to falter and then died away altogether. I was staring fixedly over the shoulder of a middle-aged woman who liaised with the ward on behalf of the local social services department. Through the two swing-doors, between her and the entrance to the dormitories, I could see Clive. He was staring at me fixedly, or so it seemed; his great globular eyes were incapable of anything but staring. He was rocking from side to side like a human metronome. If I narrowed my eyes it appeared as if his bizarre messianic hair-do was rhythmically pulsing out of the cheek of the middle-aged social worker. This trick hypnotised me.

Mimi jabbed me in the ribs. ‘Misha, pay attention!’

Busner was saying something in my direction. ‘Well Misha?’ he said.

Mimi whispered, ‘He’s asking what you intend to do in the art therapy session this afternoon.’

I started guiltily. ‘Um … well … err. I intend really to, ah, introduce myself to the patients with a series of demonstrations of different techniques and then invite them to show their own work so that we can discuss it.’

This seemed to satisfy Busner. He turned to Jane Bowen and whispered something in her ear, she smiled and nodded, tapping a yellow biro stem on the edge of her clipboard.

Soon after this the meeting broke up. I drew Mimi to one side.

‘Thanks for that, you saved my hide there. I was miles away.’

‘Yeah, absurd isn’t it. Zack’s like most benevolent dictators, he seems to think that by letting us all discuss a load of trivia we’ll feel that we have an important decision-making role in ward policy.’

‘How long have you been working here?’

‘Oh, quite a while. Ever since I qualified, in fact. There’s something about this ward. You might say that it and I were made for one another.’ The middle-aged social worker came over to where we were standing, Mimi introduced us and then they went off together to discuss a patient. The social worker was blushing furiously. It wasn’t until later that I realised she had thought I was staring at her throughout the ward meeting.

I took my sandwiches up on to the Heath for lunch and sat on the bench with the idiot. He went on ranting and rocking in a muted way, inhibited no doubt by my presence. I offered him a sandwich, which he accepted and then did hideous things to.

I looked over the city. The light pattern had been reversed as I was walking over from the hospital and now the vast ziggurat was bathed in bright light, while the bench where the idiot and I scrunged cheese through our teeth was in deep shadow. Tom had told me that he referred to the hospital, privately, as the Ministry of Love; and it was true that the sepulchral ship forging its way through the grid of streets had something of the future, the corporate about it, mixed in with the despotic past.

The wind whipped across the flight deck entrance to the hospital as I re-entered by the main gates. Well-heeled patients and visitors were being landed by taxis and minicabs, while their poorer fellows struggled against the up-draft that roared off the hospital’s oblique walls — air crewmen and women lacking enlarged ping-pong bats with which to semaphore.

On the ninth floor I met Jane Bowen. She was right outside the lift. Her hands fidgeted at her mouth as the doors rolled open.

‘Well, Misha, where have you been?’

‘I took my sandwiches up on the Heath. I like to get a little fresh air during the day.’

‘Well don’t make a habit of it.’

‘Why’s that?’

‘Zack prefers it if all the staff eat in the canteen on the ward …’

‘You can’t be serious …!’

‘Obviously it isn’t imposed on anyone. You’re free to do what you want. But Zack has good reasons for it and you need to witness lunch to understand them.’

The association area was thronged with patients, they eddied round the counter in the eating area — more of an enlarged serving hatch really — and then gravitated from there to the medication queue. Busner stood in the centre of it all, like some Lord of Misrule. He’d donned a shortie white coat which rode up over his rounded hips. The coat pockets were stuffed to overflowing, and because of the way he was standing it looked as if he was wearing a codpiece. Busner waved his arms around his head and turned circles on his heels, his face contorted, with pain? With hilarity? It was impossible to say.

I approached him through swirls of the committed.

‘Ah, Misha, I’ve tangled my spectacles cord up in my tie at the back. Can you see what’s going on?’ He turned his back on me and I fiddled with the two strands where they had become entwined. ‘Ah, that’s better.’ He clamped the spectacles on to the red grooved bridge of his nose. ‘Now I can see. We’d better sort out your materials for you.’ He led me over to a wall cupboard at the far end of the dining area from the serving hatch and opened the ceiling-high doors. Inside there was a mess of materials and half-finished attempts at something or other. ‘Gerry wasn’t great on ordering the materials,’ said Busner, stepping forward into the cupboard and crunching pieces of charcoal sticks beneath his heels, ‘but everything is here that you could need. I should take it easy, let them come to you and show you what they’re up to — try and build up some trust.’

Busner put a cloyingly affectionate arm around my shoulders, he didn’t register my wince. We stood side by side, facing a shelf full of streaked tins of powder paint.

‘Your father would have been proud of you, Misha. He would have understood what you’re doing. You know, in a way I feel as if you’re coming home to us here on the ward, that it’s the right place for you, don’t you agree?’ I muttered something negative. ‘I’m glad you feel the same way, come and see me when the session is over, tell me how it went.’ He wheeled away from me and tracked a series of charcoal arcs across the lino. I was left alone — but not for long.

* * *

Tom materialised. At his shoulder was a thirtyish man of medium height and build, unremarkable in lumberjack shirt and denims, remarkable for his arms and his countenance: arms which struggled to escape his body and pushed forward long, muscular, mechanical arms. His face was stretched tight away and zoomed towards his flaring brown hair. The whole impression was one of contained speed.

‘This is Jim,’ said Tom, ‘he can’t bear to wait, he wants to get started right away.’

‘Yeah. Hi. Jim.’ He thrust a tool at me, I shook it, he retracted it. ‘I really look forward to these sessions. I’d like to work on my thing all the time, but they won’t let me.’ I pulled the double doors open wider.

‘Which one is it?’

‘Here.’ He pulled down a sort of sculpture, made from clay, from one of the higher shelves, his long arms cradling the irregular shape protectively. He turned and set it down on one of the rectangular melamine tables.

It was a large piece, perhaps some three and a half feet long and half that wide. Jim had used a base board and built on it with clay. The work had the kind of naive realism I associated with children’s television programmes featuring animated figures moving around model villages. The work depicted a descending curve of elevated roadway which I immediately recognised as the Marylebone Flyover. Jim had neatly sculpted the point at which the two flyover lanes remerged with the Marylebone Road, there were tiny clay cars coming down off the flyover and one of them had knocked into a small Japanese fruiterer’s van which was coming in from the Edgware Road. Two miniature clay figures were positioned in the road gesticulating. The whole thing cut off at the point where the Lisson Grove intersection would be to the east and where the flyover reaches its apex to the west.

‘It’s nearly finished,’ said Jim. ‘Today I’m going to paint and glaze it and then I’d like you to arrange for it to be fired.’

‘Well, I can’t see any problem with that. Tell me, what’s the story behind this sculpture?’

‘It’s not a sculpture.’ He sucked in air through teeth, the weary sigh of a child. ‘It’s an altarpiece.’ He picked up the model flyover and went over to a table by the window with it. Tom giggled.

‘Jim’s got a messianic complex. He thinks that the Apocalypse isn’t coming.’

‘What does that mean?’

‘It’s a bit complicated. The Apocalypse will come when enough people have accepted that it isn’t coming.’

‘That just sounds stupid.’

‘Well it isn’t fucking stupid, it’s you who are fucking stupid, Mister Squeaky, get it!’ Tom’s voice switched from light mockery to the hair-trigger aggression of the subnormal thug. It was a startling transformation, as if he’d been possessed by a weird demon. He stalked away and joined his friend. I dismissed the insult. Busner had told me about him; it was clear that this was another act.

Over the next half-hour or so, most of the other patients on the ward trickled into the association area and came over to where their peers were already at work, mixing powder paint, working clay with fingers, cutting and pasting pictures from magazines. I was astonished by their quiet industry as a group. There seemed hardly anyone on the ward who was genuinely disruptive. Two or three of the patients stood like metronomes around the working area, swaying and rocking, marking the beat of the others’ labour.

Hilary sat at the window and worked on one of her tiny watercolours with hairline brushes. She had propped up the scrap of artboard on a little easel made from lolly sticks and she worked with deft strokes, each one pulling the mobile stand attached to the catheter in her arm, back and forth. The plastic bag that dangled from it contained a clear fluid and a particular sediment. As the stand moved back and forth this sediment puffed up in the bag, the motes occasionally catching and then gleaming in the afternoon sun that washed in through the huge windows.

Simon came over and asked me for scissors, glue and stiff paper. He took a half-finished collage from one of the cupboard shelves and sat down near me. It depicted the machine he’d taken me to see that morning, but recreated out of pictures of domestic appliances cut from colour magazines. I went over and stood by him for a moment. He smiled up at me, cracking the pusy rime at the corners of his mouth.

‘Unfinished work, left it when I last went out …’ He bent his dirty carrot head to the task again.

I confined myself to handing out materials. I sensed that now was not the time to comment on the work that the patients were doing. When they began to trust me they would volunteer their own comments. There was a still atmosphere of concentration over the bent heads. I went and stood by the window, listening to the faint sounds of the hospital as it worked on through the afternoon. The distant thrum of generators, clack of feet, shingled slam of gates and trolleys. On the balcony below, two chronics in blue shifts struggled clumsily with one another, one of them bent back by the other against the parapet. I stared at their ill-coordinated aggression for a while, blankly, sightlessly. The ‘O’ I was looking at resolved itself into the stretched mouth of a geriatric. At the point where I snapped out of my reverie and realised I ought to do something an orderly appeared on the balcony and separated them, dragging the younger one away, out of sight beneath my feet.

Eventually I went and sat down at a table occupied only by a curly-haired man who had lain his head in the crook of his arm like a bored schoolboy. He was doing something with his other arm, but I couldn’t see what. We sat opposite one another for ten minutes or so. Nothing happened. Around us the workers relit cigarettes and built up the fug.

‘Psst …!’ It was Tom. ‘Come here.’ He gestured to me to join him and Jim. I went over. They were working diligently on the altarpiece. Jim was doing the painting, it was Tom’s job to wash the brushes and mix the colours. Jim had finished on the blue-brown surface of the road and was starting on the white lines. Tom was pirouetting lazily, a pathetic string lasso dangling in one hand, his voice modulated to a crazy Californian dude’s whine; he had the part down pat. But wrong.

‘That man there.’ He pointed at the curly-haired man.

‘Yes.’

‘He’s a real coup for Dr B.’

‘How so?’

‘Cocaine psychosis, authentic, full-blown. Used to be an accountant. Not just some scumball junkie. A real coup. Dr B diagnosed him, all the other units around here are real sore. Go and see what he’s doing, it’ll crack you up. And on your way back bring us another beaker of water, OK, fella.’

I did as I was told. Passing by Lionel, the drug addict, I bent down to pick up an invisible object and looked back to see what it was he was hiding in the crook of his arm. It was nothing. He was deftly picking up and ranging his own collection of invisible objects on the tiny patch of table. As I bent and looked he turned his face to me and smiled conspiratorially. His eyes stayed too long on my hand which was half closed, fingers shaping the indents and projections of my own invisible object. I hurriedly straightened and walked off down the short corridor to the staff kitchenette.

Halfway down on the left I noticed a door I hadn’t seen before. It had a square of glass set into it at eye level, which cried out to be looked through. I stepped up to it. The scene I witnessed was rendered graphical, exemplary, by the wire-thread grid imprisoned in the glass. It was a silent scene played out in a brightly lit yellow room. A man in his early forties, who was somehow familiar, sat in one of the ubiquitous plastic chairs. He wore loose black clothes and his black hair was brushed back from high temples. He was sitting in profile. His legs were crossed and he was writing on a clipboard which he had balanced on his thigh. His lip and chin had the exposed, boiled look of a frequent shaver. The room was clearly given over to treatment. It had that unused corner-of-the-lobby feel of all such rooms. A reproduction of a reproduction hung on the wall, an empty wire magazine rack was adrift on the lino floor — the poor lino floor, its flesh scarified with cigarette burns. In the far corner of the room, diagonally opposite the man in black, a figure crouched, balled up face averted. I could tell by the lapel laden with badges, flapping in the emotional draught, that it was Jane Bowen.

The rest of the afternoon passed in silence and concentration. At 5.40 I gathered in the art materials and stacked all the patients’ work in the cupboard in as orderly a fashion as I could manage. It took some time to tidy up the art materials properly. The patients for the most part stayed where they were, hunched over the tables, seemingly unwilling to leave. Tom and Jim muttered to one another by the window. They had the pantomime conspiratorial air of six year olds, still half convinced that if they didn’t look they couldn’t be seen.

I found Busner in his office. He sat staring out of his window at the lack of scale. On the far corner of the hospital a steel chimney which I hadn’t noticed that morning belched out a solid column of white smoke. Busner noticed the direction of my gaze.

‘A train going nowhere, eh, Misha?’

‘Why do you say that?’

‘Because it’s true. We’re a holding pen, a state-funded purgatory. People come in here and they wait. Nothing much else ever happens; they certainly don’t get appreciably better. It’s as if, once classified, they’re pinned to some giant card. The same could be said of us as well, eh?’ He shivered, as if he were witnessing a patient being pierced with a giant pin. ‘But I’m forgetting myself, don’t pay any attention, Misha, it’s the end of a long day.’

‘No, I’m interested in what you say. The patients here do seem to be different to those I’ve met at Halliwick or St Mary’s.’

‘Oh, you think so, do you? How’s that?’ Busner swivelled round to look at me over his glasses.

‘Well, the art work they do. It’s different … it’s … how shall I put it … rather contrived, as if they were acting out something. Like Tom’s behaviour.’

‘An involution?’

‘That’s it. It’s a secondary reference. Their condition is itself a form of comment and the art work that they do is a further exegesis.’

‘Interesting, interesting. I can’t pretend that it isn’t something we haven’t noticed before. Your predecessor had very strong views about it. He was a psychologist, you know, very gifted, took on the art therapy job in order to develop functional relationships with the patients, freed as far as possible from the dialectics of orthodox treatment. A very intense young man. The direction the patients have taken with their work could well have something to do with his influence.’

Busner started stuffing his case with paper filling, as if it were a giant pitta bread. ‘I’m off, Misha. I shall see you in the morning, bright and early, I trust. I think it would be a good idea if you really sorted out that materials cupboard tomorrow.’

‘Yes, yes, of course.’ I got up, scraping my chair backwards and left the office. In the corridor the long lights whickered and whinnied to themselves. The ward was quiet and deserted. But as I passed the door to one of the utility cupboards, it suddenly wheezed open and a hand emerged and tugged at my sleeve.

‘Come in. Come on, don’t be afraid.’

I stepped in through the narrow gap and the heavy door closed behind me. It was dark and the space I was in felt enclosed and stifling. There was an overpowering odour of starch and warm linen. I almost gagged. The darkness was complete. The hand that had grabbed my wrist approached my face. I could feel it hover over my features.

‘It is you,’ said the voice, ‘don’t say anything, it’ll spoil it.’ It was Mimi. I could smell the tang of her sweat; it cut right through the warm, cottony fug.

The hand led mine to her breast which seemed vast in the darkness, I could feel the webbing of her bra and beneath it the raised bruise of her nipple. She pushed against me, her body was so soft and collapsed. Her flesh had the dewlap quality of a body that has had excess weight melted off it, leaving behind a subcutaneous sac. Her jeans were unzipped; she pulled at my trousers, a cool damp hand tugged on my penis and pressed it against her. We stood like that, her hand on me, mine on her. She led me forwards and hopped up on to what must have been a shelf or ledge, then she drew me, semi-erect, inside of her. My penis bent around the hard cleft of her jeans, the skin rasped against ridged seam and cold zipper. There was something frenzied rather than erotic about this tortured coupling. I clutched at her breast and tore away the two nylon layers. I plunged rigidly inside her. She squeaked and waves of sweat came off her and tanged in my nostrils. I ejaculated almost immediately and withdrew. There was a long moment while we panted together in the darkness. I could hear her rearranging her clothing. Then, ‘till tomorrow,’ a light touch on my brow. The door split the darkness from ceiling to floor, wheezed once and she was gone. After a while I straightened my clothing, left the linen cupboard and went home.

It wasn’t until I stepped out of the tube station and started the ten-minute walk back to the house where I lived that I noticed the outdoor scent. The smell of the ward and the hospital had become for me the only smell. The cold privet of the damp road I trailed along was now alien and uncomfortable.

At home I boiled something in a bag and sat pushing rice pupae around the soiled plate. Friends called to ask about my first day in the new job. I left the answerphone on and heard their voices, distantly addressing my robotic self. Later, lying in bed, I looked around the walls hung with my various constructions, odd things I had made out of cloth that may have been collapsed bats, or umbrellas. The wooden and metal struts filtered the sodium light which washed orange across the pillow. I fell asleep.

I dreamt that the man I had seen in the treatment room, the man taking notes in the chair while Jane Bowen crouched in the corner, was doing some kind of presentation. I was in the audience. We were sitting in a very small lecture theatre. It was enclosed and dark, but the descending tiers of seats, some fifty in all, were stone ledges set in grassy semi-circular banks.

The man in black stood in the centre of the circular stage and manipulated a kind of holographic projector. It threw an image of my head into the air, some four or five feet high. The image, although clearly three-dimensional, was quite imperfect, billowy and electrically cheesy. Gathered in the audience were all the people I’d spoken with on the ward: Busner, Valuam, Mimi, Jane Bowen, Tom, Simon, Jim and Hilary. Clive stood in the aisle, rocking.

The man in black took a long pointer or baton and passed it vertically through my holographic head. It was a cheap trick because it was quite clear that the hologram wasn’t a solid object, but the audience annoyed me intensely by sycophantically applauding. I began to shout at them, saying that they knew nothing about technology, or what it was capable of …

* * *

Morning. I had difficulty finding the hardened coils of my socks. And when I did there was something hard and rectangular tucked into the saline fold of one of them. It was a piece from The Riddle. I had no idea how it had got there, but nonetheless I murmured automatically, mantrically, ‘I’m solving The Riddle …’ Suddenly the events I experienced on Ward 9 the day before seemed quite bizarre. At the time I accepted them unquestioningly, but now … Busner and his game, the concave Bowen, the foetal Valuam, Simon’s unfeeling mother, Tom with the mimetic disease, the encounter with Mimi in the linen cupboard. Any one of these things would be sufficient to unsettle; taken together …

I rallied myself. Any psychiatric ward is a test of the therapist’s capacity; to embrace a fundamental contradiction, to retain sympathy whilst maintaining detachment. The previous day had been bizarre, because I had failed to maintain my detachment … it was said that if you empathised too closely with the insane you became insane yourself. Busner himself had had a period after the collapse of his Concept House project in the early Seventies when he had spent his time strumming electric basses in darkened recording studios, mouthing doggerel during radio interviews and undertaking other acts of revolutionary identification with those classified as insane. It was only fitting that I should start to fall victim to the same impulses under his aegis. Today I would have to watch myself.

I took the long route across the Heath and passed by my father’s sculpture. I have no idea why he gave this specific one to the municipality. He had no particular love for this administration zone. And certainly no real concern with the aesthetic education of the masses. Not that the masses ever really come here. This is an unfenced preserve of the moneyed, they roam free here patrolled by dapper rangers in brown suits.

It is a large piece, depicting two shins cast in bronze. Each one some eight feet high and perhaps nine in circumference. There are no feet and no knees. No tendons are defined, there are no hairs picked out, or veins described. There is just the shape of the shins. It was typical of my father’s work. All his working life he had striven to find the portions of the body which, when removed from the whole, became abstract. With the shins I think he had reached his zenith.

I walked on towards the hill from where I had viewed the hospital the previous morning. The idiot was tucked up in a dustbin liner underneath his bench residence, his face averted from the day. His chest was sheathed in a tatter of scraps, reminiscent of Simon’s collage. I looked ahead. The hospital had today achieved another feat in distortion. Flatly lit, two-dimensional, depth eradicated, there was a strip of city, a strip of sky and interposed between these two the trapezoid of the sanitorium.

Sanity smells. How could I have forgotten it? No one can lose their reason under the pervasive influence of the nasal institution. It is too mundane. The doors of the lift rolled open and the pad clamped across my face. All was as the day before. Tom sat behind the nurses’ station, and his violet eyes focused on mine as soon as I emerged in the short corridor that led from the lift.

‘Colour-coded this morning, are we?’ Tom’s accent is a strange mixture of clipped pre-war vowels and camp drawl. I looked down and noticed that I had pulled on a particularly bilious V-neck.

‘Not intentionally.’

‘Dahling, never is, never is.’

I left him and went over to the materials cupboard. Opening wide the two ceiling-high sets of double doors, I gathered up felt-tip pens and isolated them. Then I did the same with the crayons, the charcoal sticks, the pastels, the stained enamel trays of impacted watercolours, the few squiggled tubes of exhausted oils, the sheets of sugar paper, the rough paper, the rulers, and the encrusted brushes. Amongst the jumble were lumps of forgotten clay, grown primordial.

At length Tom came over. He had draped a stole of pink toilet paper around his shoulders and smoked a roll-up with quizzical attention. He stood akimbo and regarded me without speaking.

I started work on the works themselves. They were jumbled up, like the materials. The layered skin of some exercise in papier mâché had been torn by the rudely carved prong of a wooden boat. Crude daubs of powder paint on coloured sheets of rough paper had run into one another and finally impacted over the ubiquitous spiralled vessels. I prised all of these apart gingerly. I only discarded the hopelessly battered. On the rest I imposed order.

As I worked, the association area remained empty. Except for Tom, who paraded back and forth from the nurses’ station to the great windows, to the serving hatch and back to my side, trailing his flushable fashion accessory and a second mantle of smoke. From time to time he paused and struck an attitude of such ridiculous campness that I was driven to stifled giggles. He came back just as I was reaching the higher shelves.

‘I wouldn’t …’ he said.

‘Wouldn’t what?’

‘Touch the work up there.’

I dragged over a plastic chair and stepped up on to it. Now at eye level I could see that the works up here were the top of the range. Simon’s collage, Hilary’s miniatures, Jim’s tableau and a couple of others I hadn’t seen before. One was particularly striking. It was an abstract, constructed entirely out of pieces from The Riddle. The red acrylic squares had been glued together to form a box, open at the top, within which four more pieces had been set, up on edge, facing each other.

Standing on the plastic chair, eyes level with that top shelf, I had a momentary double-take. I whirled round and, too late, heard myself saying something stupid. ‘Well, well, this seems to be where the top dogs put their stuff …’

Tom tugged at my trouser leg. I descended and he gathered me into a huddle in the corner of the great flat room, which was now washed with scummy light. My hand rested flaccidly on the ventilation grill. Tom said, ‘Get out of here Misha.’

‘What do you mean?’

‘Get out of here. This is a shit place, the people here are shit people. They’re fucked up and weird, more weird than you can imagine. They’re far more weird than mentally ill people. Mentally ill people are light entertainment compared to this lot.’

‘What do you mean? Explain yourself.’

‘Well, consider Simon, for one.’

‘What about him?’

‘You were there when Valuam assessed him?’

‘Yes …’

‘How many doctors have to examine a psychiatric patient before admission?’

‘Two.’

‘And …?’

‘Well, I suppose I thought that since Simon had plainly been in and out of the ward a great deal it was rather glossed over. Fair enough, really, if a little irregular.’

‘Wrong. Simon’s mother holds a teaching appointment with this ward … she regularly arranges to have her own son sectioned.’

‘It does sound a little irregular.’

‘Irregular! The whole thing is some weird fucking busman’s holiday maan …’ Tom’s arm tightened round my waist ‘… but that needn’t upset our love Misha, we can screw together like Mec-ca-no …’ I pulled away from him ‘… Bitch!’ And turned to see Jane Bowen, regarding me quizzically.

Later that morning, I started drawing up some group worksheets. These are an invention of my own. Large sheets that three or four people can work on at once. I would lay down a basic pattern of lines which the particular group could embroider on, using whatever materials they pleased, or ignore. I worked steadily, with concentration. Two patients who I didn’t recognise were sitting at a table in the association area. They were striking some kind of a deal. From where I sat I couldn’t hear a word they were saying. Every so often one of them, a little ferrety man wearing a yachting cap, leant out from the table to shoot me a stare. It occurred to me as not unlikely that the deal they were discussing with such attention to detail was, in fact, meaningless.

Eventually I heard a murmur of voices that suggested agreement. I turned to see them exchanging stacks of pieces from The Riddle. The acrylic squares had been threaded on to a cord or wire of some kind, through a hole pierced in the corner of each piece. The two men both had necklaces entirely constructed from the discarded elements of the pop psychological pastime.

The group worksheets took me all morning. No one paid any attention to me any more. I could see now that the atmosphere of the ward was as sodden as compost. It only took a matter of hours for any given individual to be enmeshed, and start to decay. I was yesterday’s novelty.

Busner wasn’t about. Valuam and I exchanged strained salutations, sometime in the empty mid-morning. He had a snappy little check number on today. His footsteps were even more like clockwork, more pathetically authoritative. I thought to myself, what exactly am I doing on this ward? I don’t need the money. I’m not sure that I altogether believe that my particular skills can help the patients. Busner’s cynicism had certainly had the effect of dampening whatever residual idealism I had had — I wonder if that was his intention?

Around noon a middle-aged patient called Judith had a partial fit in the short corridor that led from the association area to the women’s ward. At first it seemed as if she was simply having a rather heated exchange of words — albeit with herself. But this escalated into hysteria. She vomited as well. Mimi and another nurse arrived very quickly, while I was still standing, poised between the inclination to pretend I hadn’t noticed and the desire to show that I could cope. The nurses smoothed Judith’s limbs, set her on her feet and led her away. The vomit and distress was somehow accounted for and absorbed.

I was conscious all morning of wanting to avoid Tom and Simon. I didn’t really want to see Jim either. I ate lunch alone in the dining-room set aside for staff. I couldn’t understand why I was meant to be there. None of the other staff from the ward were. Later on it transpired that it was someone’s birthday and they had all gone for a drink in a pub across the road.

In the afternoon I got the patients who turned up to try and do something with the worksheets. Some of them were interested, some were immersed in their own projects. Clive turned out to be a surprisingly effective group leader. He dragooned three rather sheepish depressives into snaking wet trails of paint up and down the large gridded sheet. Their regular actions formed swirl after swirl. He stood back and surveyed them at work like some sort of gaffer. Looking at Clive, his jaw working, rocking as ever, I remembered that he was meant to have been discharged today. I wondered why he was still on the ward, but his pop-eyes, his shiny elbow pads, dissuaded me from asking.

Neither Tom nor Jim appeared for the afternoon session. The model flyover stayed on its shelf. Simon cut and pasted his collage. He had lost interest in me as well. He had reverted to the exaggerated, scab-picking parody of surly adolescence. I wondered where Mimi was, with the faint, sickly lust of an adolescent. I wondered if she had thought me a wimp, or chicken, for not helping out with Judith.

The afternoon ended and I was headed for the lift. This time it was the door to the cleaning cupboard that swung open an invitation. Her buttocks pulsed and scrunched against a plastic sack of soda crystals. Once again it was sickeningly brief. But this time before she left she made me eat two small, green, candied pills.

‘What are these?’ I said.

‘Parstelin — it’s a compound preparation of the MAO inhibitor tranylcypromine and trifluoperazine. It’s not recommended for children.’

‘Why should I take them?’

‘To understand, dummy. After all, since you aren’t mad, they won’t have any effect on you, will they?’ Her voice was offhand, light, mocking. It was no big deal.

‘S’pose not.’ I dryly swallowed them.

‘Don’t eat any cheese, or drink Chianti. You might have a bad reaction if you do.’ She slid out through the gap in the door. One breast, delineated by soiled nylon, and again by ridged cotton, was outlined against the doorjamb for a moment, and then gone.

The rest of the week passed on the ward. I carried on with the worksheets and seemed to be making some progress. Increasing numbers of patients came to the afternoon art therapy sessions and stayed to try their hand. I started to get on well with the quieter patients. This was a mixed blessing. On more than one occasion Hilary held me prisoner for over an hour with talk of her friends, and the mechanics of her exact rendition of them as watercolour images. Likewise Lionel, the mysteriously psychotic accountant, was intent on sitting down with me on Thursday afternoon, a companionable arm about my shoulders, and together we leafed through glossy sales brochures for office equipment. Each article was a revelation to him; one he viewed purely aesthetically. ‘Look at this one,’ he said, gesturing at a modular workstation done in mushroom, ‘lovely, isn’t it?’ It was all I could do to mumble assent.

As for Bowen and Valuam they murmured at me cordially and passed by. There was no apparent reason for contact and Busner remained absent. I suspected that his juniors were prejudiced against me because of my father and all the sentimental crap Busner mouthed when I arrived on the ward, but I didn’t particularly care. And at lunch I talked to auxiliaries or nurses.

Every night Mimi rendezvoused with me in another cupboard. I never knew which one it would be but somehow she always knew where to catch me just when I was about to finish clearing away the art materials and leave the ward for the night. Our couplings remained brief and stylised. She resisted my unspoken pressure towards some intimacy with offers of more green pills, which I took, hoping they might bring us together. On Friday she gave me four more after I had taken my normal two and told me to administer them myself over the weekend.

On Saturday night I went to see a film with a friend. We normally met up every month or so and at least half our time was, naturally enough, taken up with relaying a cursory outline of what we had been doing in the intervening period. On this occasion I was more circumspect than usual. I had the suspicion that what had been happening to me on the ward, especially my relationship with Mimi, was something that I shouldn’t talk about to outsiders. It wasn’t that it was wrong exactly — it was rather that the experience so clearly didn’t apply.

I was also very conscious of the green pills that lay in the soft mess of lint at the bottom of my pockets. My finger sought them out as we talked, and to the probing digit they felt preposterously large and tactile, the way objects in the mouth feel to the tongue.

We were sitting in the cinema. I was idly watching the film, when I felt for the first time what must have been an effect of the drug. It was remarkably similar to the sensation I had had on the ward, when I was standing up on the chair looking for the first time at the patients’ artworks on the top shelf of the materials cupboard. It was a feeling of detachment, but not from the external world; this was an internal detachment, a membraneous tearing away, inside of me.

After the film we went to get something to eat in a kebab joint. As we entered the eatery through an arch, band-sawn out of chipboard, I felt the rending inside me, again. For some reason I found myself unable to discuss the film. Abstracted, I started to casually shred the flesh from my splayed baby chicken with my hands. I had amassed quite a pile before my friend reacted with concerned disgust. I shrugged the episode off.

At the end of the evening I said goodbye to my friend and returned to my house. Sitting in the yellow light from the road, coiling and uncoiling my sock, I resolved, quietly and with no emotional fuss, never to see him again.

It’s funny. It’s funny — but after that it became easy to dismantle the emotional and spiritual framework of my life. Relatives, friends, ex-lovers; it became apparent that their relationships with me had always been as contingent as I had suspected. It only took an instance of irregularity, one, or at most two phone calls unreturned by me, an engagement not attended, for whole swathes of human contact to lie down, to fall into short stooks.

After a few weeks on Ward 9, and a generous handful of mutant M&Ms, everything began to resolve itself into the patterns I had always dimly thought I apprehended. The violet swirls, purple beams and glowing coils that lie within the world of the pressed eyelid — the distressed retina. I seemed to have acquired an air-cushioned soul. I felt no resistance to doing things that would have plagued my conscience in the past, at least that is what I felt. I had no precise examples of these things other than taking Parstelin itself. My liaisons with Mimi? But they were just knee-jerk experiences.

Why have I isolated myself like this? My only human contact now comes within working hours and mostly with the patients on the ward. I have no idea. I can make no claim to being depressed or alienated. Indeed I seem to have suffered from less disaffection in my life than most of my contemporaries, perhaps because of my father’s death. Yet I felt more at home on the ward than I ever felt … at home.

The patients have thrown themselves into the worksheets with a vengeance. There was something about the size and complexity of the job that really appealed to them. The method also gave them the opportunity to blend together all their different styles. When they were working quietly on the sheets in the late afternoon one could almost be in a normal working situation. All their idiosyncrasies and psychic tics seemed smoothed out by their absorption. Clive no longer rocked at all. Hilary, having integrated her miniatures into Simon’s new swirl of encrusted mâché, was content to work on backgrounds. Her bag-on-a-stand swished around her, a fixed point which delineated the circumference of her enterprise.

There was one thing missing in all of this: Busner. Despite the fact that I now seemed to get on with all and sundry on the ward; despite the fact that I felt accepted; despite the fact that when the lift door rolled back and I found myself at the head of the familiar, short corridor that led to the association area, I no longer felt the atmosphere as oppressive; on the contrary it was cosy, from beneath the covers. Despite all this there was Busner’s profound absence. An absence towards which I felt a surprising ambivalence.

Busner is the Hierophant. He oversees the auguries, decocts potions, presides over rituals that piddle the everyday into a teastrainer reality. And he is a reminder of everything I wish to bury with my childhood. A world of complacency, of theory in the face of real distress. My father and Busner would sit together for hours at the head of the dining-room table and set the world to rights. Their conversation — I realised later — loaded with the slop of banality and sentimentality that was the direct result of their own sense of failure. Their wives would repair to another room and there do things that had to be done, while they carried on and on, eliding their adolescence still further into middle age. The awful oatmeal carpets of my childhood and the shame of having been a part of it all. When I think of Busner now he is a ghastly throwback, threatening to drag me into a conspiracy to evade reality.

Where is he? Valuam told me over bourbons and tea that he was in Helsinki, reading a paper to a conference. Valuam dunked his biscuits and sucked on them noisily, which is something I wouldn’t have expected from this little scrap of anal retention. We talked a little about my art therapy work, but really he had no time for it and pointed instead to the success he was having with a new anti-depressant. ‘Seemingly intractable states, verging on total withdrawal, now with noticeable effect.’ He was referring to Lionel, who now no longer sat by the windows staring blankly down on to the chronics’ balcony, but instead paced the men’s ward like a caged lion, desperate to get back into business. Where was Busner? I didn’t believe Valuam; I kept expecting the door to the utilities cupboard to swing open and to find crouching there, sweaty pills in pudgy palm, the discredited guru, waiting with affectionate arm to jerk me off, for old times’ sake.

Monday morning, again. The sun cannot penetrate a low sodden bank of cloud and the light wells from behind it, oozing up from the ground through a thick spongy pile of ground mist as I foot my way across the sward. The air around me distorts to form rooms and corridors, and rooms within them and sliding partitions which I never come up against. The ward has come out to meet me today; I feel its shape around me, its scuffed skirting boards at my ankles, as I move towards the idiot’s bench.

He is lying under it, caulked in free newspapers. Pathetic small ads show intaglioed across his neck. In the confined space he rolls over and clonks his shin against the bench leg. His face is exposed for a moment against the greasy collar of his anorak. His eyes have swollen up and exploded in a series of burst ramparts and lesions of diseased flesh. I feel my oily tea slop up from my stomach, the nausea is as clear and pure as pain. I vomit with precision and vomit again until my nausea has no function and I can look once more.

It’s not clear what has happened to the idiot. Has he drunk some bleach? Some oven cleaner? Or is it a disease of a rarefied kind, a human myxomatosis designed to eliminate the crap from the fringe of society, to stop the piss-heads copulating and producing more of their degenerate kind? Whichever. The fact is that it’s evident that he hasn’t been dead for long — his corpse is still moving into rigor. He has died in the night and I am the first to happen along. It is my responsibility to alert the authorities. And now I feel the presence of the Parstelin in my blood stream. It replaces the sense of nausea as — for the first time — a positive rather than a negative attribute. The drug provides me with another fuzzy frame of reference, within which the idiot’s death is no responsibility of mine. Someone else will report it, someone else will find him. I glissade down the hillside on my fluffy Lilo. The arguments from my conscience are remote, like memories of a television debate between contesting pompous pundits, witnessed several years ago …

A long morning in the hospital. On the ward there is an uncharacteristic, brisk efficiency. Valuam trots hither and thither with a clipboard compiling what look like inventories. For some reason he is dressed casually today, or at least in superficially casual clothes. It was always obvious that he would iron his jeans and check shirts, and also that he would wear sleeveless grey pullovers. Not for the first time it occurs to me that there is a strange symmetry between the sartorial sense of the psychiatric staff and that of their patients. Valuam with his strict dress which looks hopelessly contrived, Bowen with her bag lady chic, Busner with his escaping underwear. All of them match up with the patients in their charge …

I am working on something of my own which I hope will provide some inspiration for the patients. It’s a worksheet, about six feet square, on which I have done several representations of the hospital. Each one has been executed using a different technique: pen and wash, gouache, oils, charcoals, pencils, clay. This morning I spend time cutting the stencil for a silk-screen print.

Patients, en route for therapy sessions, or dropping out of the medication line, pause by the tables I’ve pushed together in the dining area and ask me about the work. An auxiliary, a middle-aged Filipino woman, stops her swirling, watery work with tousled mop and zinc bucket on the ward floor to discourse at length on swollen ankles, injustice and the vagaries of public transport. I listen and work distractedly; the image of the dead idiot imposes itself on me startlingly. It slides in front of my eyes from time to time with an audible click: the ridge of greasy, nylon quilted collar, the scrubby, scrawny neck, the long face, the exploded eyes …

At noon then. Jane Bowen comes and sits near me, salutes me but does not converse. She rolls one of her withered cigarettes and stares out of the window abstractedly, drawing heavily. Her hair is scraped back tightly from the violet, inverted bruises of her temples. She gazes towards the hill where the idiot lies. I have an impulse to tell her about it, which I repress. The weather outside the hospital is playing tricks again; long, high bands of cirrus cloud are filtering the wan sunlight into vertical bars, which cut across the area that lies between the hospital and the Heath, creating shadows of diminishing perspective, like the exposed working on an artist’s sketch.

Eventually I get up and go and stand beside her. I am conscious of her body retreating from me inside the starched front of her white coat, leaving behind a white buckler. We both look out of the window in silence. My gaze drops from the idiot’s bier-bench (I cannot see any evidence of discovery, service vehicles, or whatever) to the chronics’ balcony below, the open area projecting out from Ward 8.

As once before, two cretins are embracing in a painful muted struggle. Their gowns flap in the wind, they strain against one another, locked in a clumsy bear-hug. Then one moves with surprising speed and agility, changing his hold so that he grips the other from behind, pinning his arms — and at the same time leaning backwards over the rail that runs above the concrete wall bounding the balcony. The two faces tip up towards Jane Bowen and I, white splashes that resolve themselves into … Mark, Busner’s son, who was at school with me, who had a breakdown at university and attempted suicide. He is pinioned by the handsome, black-haired man who I saw in the treatment room with Jane Bowen. The man’s face is glazed over with brutish imbecility. I feel another jolt of nausea, stagger and place my hand against the pane for support. Jane Bowen looks at me pityingly and gestures with her fag.

‘Your predecessor, Misha, our ex-art therapist. Who just happens, purely by coincidence, to be my brother, Gerry.’

‘That’s Mark with him, Busner’s son!’

‘Yes, Zack felt it would be a good idea to have them farmed out to Ward 8 for a little while. He thought you might find it a tad shocking to encounter them as patients.’ She turned to face me and said quite calmly, in a flat kind of a voice, ‘Get out of here, Misha. Get out of here now.’

She wasn’t issuing advice on a career move. This was a fire alarm. I acted on it quickly, but hesitated on my way across the wide expanse of industrial-wear floor covering, skittering on one leg like a cartoon character speeding around a corner that turns into a vase. Abruptly I realise that the Parstelin has completely altered my sense of my own body. I am acutely aware of the connection between each impulse, each message and the nerve-ending it comes from. My whole physical orientation has shifted, but remains whole.

This apprehension occupies me as I run to the lift. Patients ‘O’ at me hysterically, but there is silence, or rather a descending wail that has nothing to do with speech and everything to do with what children hear when they press the flaps of cartilage over their ears, in and out, very fast. Sheuuooosheeeuuooo.

‘A, hehehahahoohoohoohoo!’ Clive does the twist by the coiled hosepipe in an anonymous bay, off the short corridor I run down on my way to the lift.

‘Misha, a word please,’ Valuam comes out from his office, trouser material high on each thigh, scrunched up in marmoset hands. His peeled face tilts toward me, fungus poking out from the door. Another door swings open five yards further on and a hand emerges to pluck at my sleeve, a round, dimpled hand on the end of that dripping sundae body. I run past it and in my mind the flashback of thrust seems hard and mechanical; my penis a rubberised claw torn from a laboratory retort and thrust into the side of a putrefying animal. I must take the stairs.

Four flights down I stop running. They’re going to let me leave the hospital. A drug is just a drug. I was bloody stupid to take it at all, to fuck with Mimi, but if I stop it now my head will clear in a couple of days and I’ll be back to normal. I won’t have this strange sense that I am someone else, someone who is compelled to be reasonable.

There is no cause for alarm. I certainly cannot question the quintessential character of the stairwell. There is no denying its objective status. Thick bars of unpainted concrete punched through with four-inch bolts. The handrail a fire-engine red bar, as thick as an acroprop. Parstelin is a drug — I realise — that makes you acutely aware of things-in-themselves. Their standing into existence is no longer nauseous, but splendidly replete. That said, I gag a little and cough up a whitey dollop, somewhere between sputum and vomit, which plops into the drift of fluff wedged at the back of the stair I stand on.

Among the scraps of silver paper, safety-pins and nameless bits of detritus, a part of me. The fugue is broken by a whoosh of dead air that gusts up the well from below. Someone else has entered the staircase, pushed hard on a pneumatic door, maybe three flights down. The windows on the stairway are cut at oblique angles into the outer wall of the hospital. It is clear from the view, which affords me no sight of the huge bulk that contains me, that the staircase runs down the outer edge of the ziggurat’s sloping wall.

I pick my way down, pausing from time to time to cock an ear and listen for sounds of pursuit, but there are none. It is plain to me now that I have been suffering from a delusion, that the ward has overtaken me in part. I never denied that I was highly strung. I need some bed rest and the opportunity to read the papers. The lower I get the freer I feel. I know I haven’t really escaped from anything — and yet there’s the temptation to laugh and skip, to strike some attitudes.

I calculate that I am still two floors above ground level when the staircase blocks off its own windows. Light is now supplied by yellow discs that shine on the walls. The yellow light disorientates me. It must have done. I can genuinely no longer tell whether I am above or below ground level. The doors that lead off the staircase are blank oblongs. I panic and push at one, it wheezes under my palm and I tumble out into a corridor.

It is immediately clear that the stairway has diverged significantly in its path, that it hasn’t followed the lift shaft and deposited me in one of the open areas that form a natural reception concourse for each floor. Instead, it has thrown me off to one side, into the hinterland of the hospital, added to which I’m not on the mezzanine floor, I’m on the lower ground floor. I recognise where I am. I’m somewhere along the route Simon took me on my first day. I’m on the way to see the giant obsolete machine. I am in the same wetly shining concrete corridor. In either direction the naked neon tubes dash away; even they are hurrying off from this crushing place.

Which way? Whoever entered the stairwell while I was coming down is now on their way up. I can hear the cold slap of feet ascending and this hastens my decision. I turn to the left and start off down the corridor, trusting to my intuition to find my way to casualty and out of the hospital. As I walk I am aware that I’m positioned chemically at the eye of the storm. I no longer feel muzzy; I know that my body is saturated with Parstelin, but I’ve swum into a bubble of clarity. Nevertheless, I still don’t seem able to gain a definitive view of Busner and his ward. What has been happening? Those patients — with their madness — as stylised as a ballet. Were they the logical result of Busner’s philosophy? Were theirs the performances of madmen-as-idealists? Or just idealists? Their symptoms … was it true that they genuinely caricatured the recorded pathologies, all of them, not just Tom, or was my perception of them a function of the Parstelin?

These speculations give me heart. I feel my old self. I pause and look in a stainless steel panel screwed to a door. My reflection, dimpled here and there by the metal, looks back at me, amused, diffident. I feel cosy with my self-observation and immensely reassured by this moment of ordinary, unthinking vanity.

But where am I? No nearer casualty. The corridor has not swapped its concrete floor for tiling, there is no paint on the walls. I have turned the wrong way. Twenty feet ahead I can see the two swing-doors that lead to the conservatory. What the hell. I’ll pop in and have a look; it will be the last time I come near the hospital for a while. The doors whicker apart on their rusty rails and as I turn and pull them shut behind me they cut out the steady undertow of thrum that powers the hospital. The light in the high-domed room is the same as before and the obscure machine with its cream bakelite surfaces projects up above me, inviolate.

Tom and Jim step out from behind its flanged base, they move quite unaffectedly into my sight, as if expecting no particular reaction. I am very frightened.

‘Misha, where are you going?’ says Tom. Jim is casting his eyes about with rapid jerks of his head. He keeps flexing and rolling his arms back and forth, opening the palm forwards to disclose plastic mouth tubes — the kind used to stop people who are fitting from biting their tongues off — which he has adapted to some manual exercise routine.

‘I’m going off for the rest of the day, Tom, I came here by accident. I was looking for casualty.’

Tom listens to me, nodding, and then gestures for me to join him and Jim. The three of us then squat down between the outstretched paws of the great instrument, which are bolted heavily to the floor. We are like Africans under some fat-trunked tree, timelessly talking, until Jim drops his adapted muscle expanders on to the cracked tiles of the floor with a clatter.

‘I’m glad you listened to my advice, Misha. You’re leaving, aren’t you?’

‘Just for a couple of days. I … I need a rest. The atmosphere on the ward is quite overwhelming.’

‘Yes, it can be, can’t it. That’s why Jim and I like to come down here and play with the machine, it’s peaceful down here, quiet. Do you think I’m mad, Misha?’

‘What about me, am I mad too?’ Jim chimes in as well. I find myself embarrassed, which is absurd. To be frightened seems right, but to be embarrassed as well, that’s ridiculous.

‘Does the question embarrass you?’ Tom is rolling a cigarette with deft fingers. He flicks over the lip of paper and raises it to his budding, sensual mouth.

‘I hadn’t thought about it in those terms.’

‘Oh, oh, I see, you are a disciple of good Dr Zee, so we’re just behaving in a way which others choose to describe as mad. We’re simply non-conformists.’

‘I think you’re simplifying his position a little.’

‘Of course, of course. Are you mad, Misha?’ Jim snickers and rakes the tiles with long, cracked nails.

I can’t answer. My eyes cast up to the ceiling some twenty feet away. The conservatory is roofed with a glass cupola, the inside of which seems dirtied as if by soot. Beneath this a complete circle of dirty dormer windows lets in the grey light. From the very centre hangs a flex — which dangles a cluster of naked bulbs just above the highest shoulder of the machine.

After a while, Tom reaches out from where he squats and touches me lightly on the arm. ‘I’m sorry Misha, come on, let’s climb.’

‘Yeah, let’s.’ Jim is on his feet in one bound, a foot already on the kidney-shaped step, which is set two feet up into the base of the machine. In turn we haul ourselves up. Tom comes last. The machine is designed to be climbed; we ascend to a horizontal platform about seven feet up. This is girded with massive gimbals, the purpose of which is to tilt the platform under the main barrel of the contraption. What the machine ever did to the patients who were lain out on the platform is obscure. Perhaps it projected something through them: radiation; ultrasound; a light beam, or even something solid … The barrel itself has been de-cored; all that’s left is a hank of plaited black wires, spilling from its mouth.

The three of us then sit in a row on the platform, passing back and forth the wet end of tobacco. The curved well of dead light that falls on to us and the heavy machinery we sit on conspire to effect timelessness. Jews about to be shot or gassed are caught against the straight rod and round wheel of a railway engine. Crash survivors crawl from buckled aluminium sections rammed into the compost earth of the rainforest. We sit and smoke and I hear the ‘peep-peep’ of a small bird, outside the hospital, sounding like a doctor’s pager. It completes the dead finality of my situation. My neck, rigid with absorbed tension, mushy with tranquillisers, feels as if it is welling up over my head to form a fleshly cowl.

The texture of things parodies itself. The creamy hardness of the machine’s surfaces, the dusty clink of the tiled floor, the smelly abrasion of the arm of Tom’s sweater. Even surfaces refuse to be straight with me. Tom’s profile is rippably perfect, a slash of purity. Jim’s bulbous nose and styled, collar-length hair make him absurd, an impression heightened by his simian arms which rest on the platform like the prongs of an idling forklift truck. But he reassures me now. They both reassure me. I put an arm around each of them and they snuggle into me, adults being children, being parents. They are my comrades, my blood brothers.

‘Go now, Misha.’ Tom pulls away and pushes me gently, indicating that I should get down from the platform. I climb down heavily. My limbs have the dripping, melting feeling that I know indicates the absorption of more Parstelin. But I don’t know why; I haven’t taken any. On the floor I turn, not towards the doors, but away from them, and circle the machine. Jim and Tom watch me but say nothing. I pick my way over twisted lianas of defunct cabling, once pinioned to the floor but now adrift. Behind the machine, directly opposite the door to the corridor, the door that faces the Mass Disaster Room is open.

Outside there is a scrap of land, room-sized, open to the air that voyages fifteen storeys down to find it and its tangled side-swipe of nameless shrubs. There, set lopsidedly on the irregular rubbled surface, stands one of the rectangular melamine-topped tables from the dining area on the ward. I can see a fold of belly, a dollop of jowl, a white hand fidgeting with an acrylic rectangle, the failing end of a mohair tie. Dr Busner is trying to solve The Riddle.

‘Ah, there you are, Misha. Come out, come out, don’t hover like that.’ Busner sits, flanked by Valuam and Bowen. On the table in front of them are ranged objects that clearly relate to me: a pot of green pills, Jim’s bas-relief which had so impressed me, a note I had sent to Mimi in an idle moment. I move across the little yard and sit by Valuam, who surprises me by smiling warmly. Flash of recognition: the slashed profile. If the features were un-drowned? Valuam and Tom are brothers.

‘We are all family here, Misha.’

‘What’s that?’

‘We are all family … I see that something is coming home to you, as you have come home to us. It hardly matters whether we are doctors or patients, does it, Misha? The important thing is to be at home.’ Busner rises and starts to pace the area. The massive walls of the hospital are joined irregularly to the squat citadel that houses the Mass Disaster Room. Busner describes a trapezoid on the uneven surface, sketching out with his feet the elevation of the hospital.

‘You see, what we have here is a situation that calls for mutual aid. My son, Jane and Anthony’s siblings, Simon, Jim, Clive, Harriet, indeed all of the patients on the ward, could be said to be casualties of a war that we ourselves have waged. That’s why we felt it was our duty to care for them in a special kind of environment. You, of course, noticed the curious involution of the pathology that they exhibit, Misha, and that was right — you passed the first step. They are not mad in any accepted sense, rather they are metamad. Their madness is a conscious parody of the relation in which the psyche stands to itself … but you know this. Unfortunately, you didn’t do so well on the other tests …’ Busner tipped out some of the Parstelin from the pot on to the table. ‘You took these, Misha, and you fucked Mimi in just about every available cupboard on the ward. This is not the behaviour of a responsible therapist. You had a choice, Misha. On Ward 9 you could have been therapist or patient; it seems that you have decided to become a patient.’

Busner stopped pacing and sat down again at the table. I sat, trapped in sweet gorge. What he said made sense. I did not resent it. Jane Bowen picked her nails with the edge of a Riddle counter. The same bird paged Nature. The four of us sat in the peculiar space, in silence. One thing confused me.

‘But Dr Busner … Zack, my parents, my father. They had nothing to do with any therapeutic application of psychology, they were both artists. Surely I don’t qualify for the ward?’

‘Later on, Misha, later on … Your father became a sculptor in his thirties. Before that he studied with Alkan. He would have made an excellent analyst, but perhaps he didn’t want you to pay the price.’

The doors behind me clacked in a down draught. The interview was clearly over.

‘Would you take Misha back up to the ward, Anthony. We can foregather and handle the paperwork after lunch.’

Yes, lunch, I felt quite hungry. But I didn’t like it down here. There was something moribund about this patch of ground, cemented with white splashes that streaked the high walls and starred the crusted earth. I wanted to get back upstairs — I want to get back upstairs — ha! Perhaps that’s the effect of the chloropromasine, a kind of continual time lag between thought and self-consciousness — I want to get back upstairs … and lie on my bed. I need a cigarette.