As with the non-fiction book, The Examined Life, this is about the human need to have another bear witness to our story, to be truly heard. It isn’t enough for Elizabeth that David is her designated psychiatrist; she needs to know that she can trust him emotionally before she can share her pain. It’s not only her adult experience of lost love that blocks her, but a pattern of insecure attachments stemming from childhood:
The effects of an unhappy beginning are various: shame, rage, anxiety, inhibition, insecurity, self-doubt, a propensity for self-harm; but there is one common factor: a fundamental mistrust, an insidious feeling that the world is not a place where you are welcome or can be at home. It can take a long time to get over that feeling – if it ever can be got over. (p9-10)
This resonates for David, not only professionally, but personally:
I don’t know when I first began to ask myself, at some point in any association, whether or not this person would be likely to shop me to the Nazis. (p69)
David is well aware that it is living in the shadow of death at the age of five that has drawn him to his particular specialism:
that hinterland where life and death are sister and brother, the suicidally disposed … It was a landscape I knew with that innate sense which people call ‘sixth’, with the invisible antennae that register the impalpable as no less real than a kick in the solar plexus from a startled horse. To some of us it can seem more real. It is said that the dead tell no tales, but I wonder. (p5)
What he doesn’t know at that point is that an intense connection with his suicidal patient can change his perspective on the death that has shaped his own life and free him up to make different choices for the future.
Given the author’s previous incarnation as a psychoanalyst, it’s no surprise that she should write so compellingly about the therapeutic dyad. She understands that therapy can be hugely transformative and also limited (p79); that it can be as emotionally charged for the therapist as for the patient (p88); and that the therapist’s own vulnerability is both an asset and liability (e.g. David’s sensitivity to loss is what enables him to tune in to Elizabeth yet also leads to a serious error of judgement regarding another patient). She also manages, without interrupting the narrative flow, to clarify the distinction between medical and non-medical psy professions (something I set out to do with this series, but don’t seem to have managed very well so far):
I was both a psychiatrist and a trained analyst – the two are not synonymous: a psychiatrist is medically qualified and attempts to cure principally with drugs while an analyst’s training, in Britain at least, is non-medical and the work is done entirely through words (p11)
Yet there’s no doubt that it is Salley Vickers the novelist who is shaping this story and, where the needs of the plot might conflict with standard therapeutic practice, she has rightly prioritised the narrative. However I was unnerved by the seven-hour therapy session punctuated by ordered-in sandwiches and glasses of whisky. I thought that a real Elizabeth might not feel entirely comfortable telling a man about her sex life in a deserted corridor of the hospital late in the evening and that a real David, even in a less ordered and managerial era than currently exists in the NHS, might have had concerns about how his unorthodox practice would look from the outside. Neither am I convinced that, narrative time being different to chronological time, it was necessary for the plot.
Nevertheless, this is a powerful and highly readable novel about the big issues that touch all our lives.
I’ll introduce you to another psychiatrist practising therapy in the next post in this series: Peter Newbold in Ann Leary’s novel, The Good House.