December 2009

Frank and April Wheeler had it all.  They were a charmed couple, or so it seemed to their neighbours and friends.  He was virile and handsome, a whizz in the city, she was beautiful and an actress.  They owned a pretty clapperboard house in the leafy suburbs.  They had two lovely children. They were special, but there was trouble in Eden. They were bored.  Her career as an actress never took off after she met Frank.  She soon found herself pregnant.  A few years later a second child came along and she was trapped. Her time was fully occupied with home and children.  Frank never really wanted to work in the city, particularly in the same firm as his father, but it seemed the only sensible option.  Their lives seemed set on a predictable pattern and they both felt desperate to escape. 

When they met, they recognized each other immediately.  They perceived the same zest for life, the same desire for the unconventional.  They were different, special, they had found the one they had been waiting for all of their lives.  As long as they had each other, anything was possible. Then children, his job, the nice suburban house on Revolutionary Road closed the door on their enchanted future. There was nothing to look forward to.  Their parents’ past had caught up with them. 

So when April suggested they just give it all up and take off to Paris, it rekindled the passion of their relationship.  But Frank gets offered a promotion.  ‘Such opportunities only occur once or twice in life, you’ve got to grab them by the balls.’, his boss tells him.  How ironic.  April finds out she is pregnant.  Only John, their neighbour’s son who is ill with depressive psychosis, has the clarity of thought to hold up a mirror to themselves. And so, they fail to achieve escape velocity and fall to earth in mutual destruction.  She gives herself an abortion and bleeds to death.  He is devastated and the meaning of his life ends as well.   

Frank and April could not come to terms with the mundane reality of life.  Without anything to look forward to, there was no point.  They had great expectations and now they have great disappointment and that is intolerable. That’s all there is. They realized that the good stuff is just a dream and is unattainable. The only satisfaction was  in themselves, but they were empty and could only look to external excitement to fill them up  Even sex couldn’t rescue them anymore.  They tried other partners but they didn’t arouse them.  They became locked into a meaninglessness, a hopelessness, an existential depression, a living death.  And so the only way out was to kill the thing they had produced and in so doing kill themselves.

Revolutionary Road, released this year,  starred Kate Winslet and Leonardo di Caprio and was directed by Sam Mendez. 

Charlie is a psychiatrist, an expert on trauma. His marriage to Agnes broke up after her brother, Danny, committed suicide.  Danny was a Vietnamese veteran whose buddy was killed by a booby trap device right next to him.  He was also Charlie’s patient.  He blew his brains out after Charlie had decided to probe the circumstances of his buddy’s death.   His mother always said that Charlie intruded too much.

Charlie met Agnes again after his mother’s funeral.  She was kind to him.  They made love, but by that time Agnes was married and he was getting involved with Nora,  a disturbed younger woman who suffered from traumatic nightmares.  Nora was also having an affair with his artist brother, Walt, though Charlie didn’t realize it at the time.  As Charlie’s mind begins to unravel under the stress of his situation, he moves to work in an isolated mental home in the Catskills.  But the town where he got an apartment, was also the scene of his own trauma, which was rekindled when Walt and their father, Fred, come to visit him.  Years ago when he and Walt were very young, Charlie witnessed a fight between his parents in their hotel bedroom just down the street. In his recurrent nightmare, it was Fred who was holding the gun to his head, but Walt explains it was it his mother; she had squeezed the trigger but it didn’t fire. ‘This is what you get when you come into a room without knocking.’ It’s then that he goes mad.  

Trauma is Patrick McGrath’s latest novel.  It lacks the power of Asylum, Spider and Dr Haggard’s Illness, but like them explores the meaning and method of madness, making it frighteningly accessible and storing  up the tension until the final denouement.  Only then can you see the patterns of his trauma, the ghosts of what has happened in the events that befall him and the choices he makes; his everyday life. 

The sight of Dannys exploded head, the blood and brains that splattered the wall, that reminded him of what nearly happened to him led to him leaving Agnes. It was his intrusiveness that led him to enter his parents bedroom and become a psychiatrist. It was his need to put things right that made him care for his mother in the confusion of her old age. But she hated him for it. Shame is so often a cause of hatred, as McGrath explains.  Charlie’s shame over Danny’s suicide made him leave Agnes. He looks after Nora; indeed he is attracted to her because she is so disturbed like his mother. But there are echoes of his early relationship with Walt in this. Walt always let Charlie take responsibility for dealing with their parents. And so although he was having an affair with Nora, Walt couldn’t handle her neuroticism and so encouraged the relationship with his brother. 

Trauma generates ghosts, thoughts that we cannot get rid of, memories that that continue to haunt our lives, influencing our actions and behaviour, determining the choices we make.  For the most part, what happens to us is not a matter of luck or fate, it is conditioned by the events and situations that have made us who we are. And so a traumatic situation that occurred many years ago can continue to reverberate in every choice we make, especially those intuitive choices that do not require analysis. In that way we re-experience the things that matter most to us over and over again, in the hope of resolution or at least the achievement of an understanding that will help remove the stain of shame.   

Charlie had protected himself from his trauma by dedicating his life to care and understanding, to trying to make it better. But the dreadful realization that his efforts might have actually made things worse led him to escape into madness. So what hope is there for recovery?  Medications can only dull an intolerable reality.  Psychotherapy may provide a safe space where his stuff can be experienced through the agency of the therapist, but the therapist and the therapeutic situation has to provide a suitable object or space for projection and transference.  No, perhaps his salvation is only possible through the redemptive power of love. Agnes husband has died.  Charlie is devoted to his daughter, Cassie.  Perhaps their love can restore the stability to exorcise the ghosts and heal his troubled mind.

‘Oh, dear, oh dear, oh dear, oh dear, oh dear, oh dear ……….’ 

It was like a metronome, every second.  At this rate, she would say oh dear, 3600 times an hour,  up to 50,000 times a day,  15 million times a year.  But the mantra had some more intense variations;  ‘oh no, oh no, oh no’ or just ‘no, no, no no’, and worse still, ‘oh please, oh please, oh please, oh please’ and then ‘oh Nick, oh Nick, oh Nick’  Anybody listening to this would be bound to think, ‘Whatever is he doing to that poor woman?’ 

Every so often she would stop and ask where we were going.

‘We going to Chatsworth mum. You know to my cottage’ and I’d make a motion with my hand as if to open the latch. 

‘Chatsworth’, she’d say puzzled and then the penny would drop. 

‘They brought the lambs in.’ 

‘Yes that’s right.’

‘What are we going there for?’

‘We’re going to have tea; turkey sandwiches, Christmas cake and mince pies.’

‘You’re going to leave me there.’

‘No, of course not.’

‘We’ll have tea and then take you back home.’


‘Yes, to your flat.’

‘My flat?’

‘Yes, number 9 the Woodlands, Shore Lane.’

‘Do I live there?


‘And then you’re going to leave me to walk?’


 And the litany would all start again, ‘oh no, oh no, please, oh please’.

 It is all very tiring.  Although I am not being cruel to her, it feels like it.  The reality is that her life is dreadful. She has lost her identity.  Since she can’t remember anything from one moment to the next, everything is alien to her and therefore threatening.  She  doesn’t know where she is or what is happening. 

And so a pleasant drive inro Derbyshire  is torture to her.  She has been taken out of her environment along roads she can barely remember to an unknown destination for no clear purpose.  And because she has never really been able to trust that things will be allright, she fears she will be abandoned and never find her way back.  It must be terrifying. 

When the Red Army invaded East Prussia in the winter of 1945, millions of people were forced by fear of murder and rape to flee their homes and join the columns of refugees escaping in sub zero temperatures towards the west.  That was their dreadful reality.  They didn’t know where they were going or why and many died on the way. Mum’s world must seem just as threatening.  She does not know where she is, she has no home and she sees confusion and danger everywhere.  Sometimes when I have to repeat the same facts to her for the twentieth time, it is important to realize that this an anchor point, however ephemeral, in a devastated world.

Frozen grapes are delicious served with chocolate truffles and cream.  If you let them warm up a bit, you can bite through them and feel the cold juice squirt around your mouth.  But Roz found this difficult.   

‘I can’t eat these. I have sensitive teeth.’

‘Well just try swallowing them and feel the cold go all the way down,’ I suggested. ‘Look it’s easy.’  And with that I popped one into my mouth, let it roll down back into my pharanx and swallowed, then waited for the wave to slide it down.   

The grape was as hard as a marble and cold as a lump of ice.  It got so far and stopped just behind the sternal notch, generating a dull ache that spread like a band around my chest.   I swallowed again. It still wouldn’t budge.  In fact I could feel it coming back up again and the pain intensified.  I swallowed a third time.  Nothing.  I could feel my face turning red and a wave of nausea rising up from my stomach. 

I stood there, my neck sunk into my chest, eyes bulging, not sure what to do. Simon was laughing, tears rolling down his face. ‘You’re such a  daft bugger!’

At that I started laughing too and then stopped.  There was a real risk of asphyxiation and while it might be a good way to go, I wasn’t ready for that yet. I needed to stay calm. I breathed gently in and out and when I felt in control, swallowed some water and felt the grape move painfully down.   

I turned to Judy, who was a scientist.  ‘Why don’t you write this up as an experiment  – the induction of reverse peristalsis by an ice cold bolus?  But first we need to test its reproducibility.’  Emboldened by experience,  I took another grape and swallowed.  The  obstruction behind my breastbone was exquisitely painful this time and it was so hard not to laugh when others were swaying about with general mirth.  But another glass of water did the trick.  Eureka! 

‘Now, Judy, we need to try this on somebody else. What about Roz?  And we need a genetic control.  Simon would do. And then you must do a series.  You could put a capillary tube down and measure pressures or you could fill the grape with contrast medium before freezing and then X-ray your volunteers.  Reverse oesophageal peristalsis is controversial in humans, but this could be the proof.  You could be famous, Judy.  It could be known as the Donnelly Provocation Test.  You could patent it.’ 

Ah well,  you can lead a scientist to water, but ………  Judy was not impressed.  Another opportunity missed! 

All of this reminded me of a demonstration forty five years ago in Cambridge. Dr Giles Brindley, then a young lecturer in physiology, stood on his head on the class bench and swallowed water through a rubber tube from a large Winchester bottle, just to prove that swallowing does not occur by gravity but by persistalsis.  The next issue of the Med. Soc. magazine demonstrated the trick.  Beneath the bench was the laboratory assistant who was opening a stop cock to drain the bottle. 

Who said science wasn’t theatre?

A Health and Safety Warning.  These experiments are risky. Please don’t be tempted to try them at home.

Getting a summons for driving without due care and attention just added insult to injury,  I had been knocked unconscious, fractured ribs, vertebrae, punctured my lung and my left kidney. But my letter advised me that it would go better for me if I admitted culpability.  I felt hurt and not a little grievous.         

So when the magistrate, a pleasant enough lady about my age, asked ‘Do you plead Guilty or Not Guilty?’, I looked at her with what I thought was an innocent smile and replied ‘Can I plead Don’t know?’  She stared at me, heavy lidded.  Undeterred, I went on to explain that I could not remember anything about the accident.  The time from filling up with petrol in Fulwood and coming to in the ambulance has been erased.  It still is.  How wonderful it would be if everything else could be erased like that.

Warming to my theme with a degree of righteous indignation, I indicated that that particular road junction was difficult.  The independent witness had drawn attention to the tall grasses that obscured vision, the junction is at an angle and at the top of a hill, so you had to look over your left shoulder to see anybody coming up from Sheffield while cars coming the other way could disappear into dead ground. Besides I hadn’t received the prosecution witness statement.      

I was clearly perceived as being awkward.  Moi?  A doctor and therapist; a model of compliance and understanding – the very idea!  Heads edged together as the bench  decided what to do. Then with anxiety glinting in her eyes and a calm politeness that indicated caution, the good lady advised that I get a solicitor to represent me and return on the 18th, just a week before Christmas. I bowed to the court and departed with dignity.   

Mr Johnson was about my age, somewhat overweight with bluff, friendly manner;  Rumpole of The Wicker.  He looked me in the eyes, ‘Well, doctor, there’s no point in trying to defend this.  They will screw you for every penny they can.  You can’t win.  You’re a professional, you are perceived as rich and relatively privileged.  It’s not fair, but who said society was fair?  Best to plead guilty, explain the mitigation and accept three more points on your licence. I can come and do that for you if you like. It’ll cost you seventy pounds.’  

That agreed, he expounded on how much the law bends over backwards to protect the criminal.  ‘You can stamp on somebody’s head on a Saturday night in the Wicker, spend a night in the cells, and they’ll fine you a hundred quid.  I received a parking fine of £70 for leaving my car in the road round the back. I asked the officer if I could pay him an extra ten pounds and go in and rob ASDA, because that would only incur a fine of £80. But the law doesn’t treat decent, honest middle class people very well. And you won’t get legal aid.  You’ll have to pay for everything.’  

He picked up his blackberry, stubbed at the keys with pudgy fingers but couldn’t get through.  He held it at arms length and stared at it cross eyed as if trying to hypnotise it into submission. He looked at me, sighed, jabbed at the object in his hand.   ‘And this is the magistrates court.  They’ll play me music in a minute!’   

‘But don’t these things drive you mad.  I was at my doctor’s the other day.  As soon as I came in, he started typing away on his computer.  ‘Nigel, I said, look at me, look at me!’  I could have had a heart attack while he was typing away and he wouldn’t have noticed.  And if eventually he did, he would have written his report first and only then called the ambulance!’

‘The world has changed, doctor, changed beyond recognition.  And we’re seen as dinosaurs.  Nobody seems to understand any more.  And nobody knows anything!  None of my staff know their times table.  Do you believe it?  What are seven sixes – I ask and they look at me blankly and say ‘Dunno.’  He raised his eyes to the ceiling.  

We laughed!  It was ridiculous; no point in being too serious about it.  It was fun being grumpy for a bit. I’d found a kindred spirit, a friendly ghost of Christmas past – right out of Dickens. It was going to be a good Christmas after all.

It was 1937; and there was trouble on the horizon.  They recognized each other at a funeral. There was a spark.  Then they found they were sitting next to each other at the Cushing’s dinner party.  He was Dr Edward Haggard, house surgeon at St Basil’s and a bit of a loner; she, Fanny Vaughan, a delicate dark beauty; older, more sophisticated than he and married to the Senior Pathologist.  They conversed easily.  She made him feel confident and clever.  She laughed a lot. She insisted they talk about pleasure, not medicine.  Wickedly, she asked him if surgeons made good lovers.  Amazed at his temerity, he replied ‘try me’.  

She did. Their affair started a few weeks after. It was she who made the running and set the limits. They would meet, make love in his room, and then part without agreeing further assignations.  He would be in an agony of anxiety until she reappeared.  But slowly, a pattern emerged.  She bought stuff for his room; rugs, lamps, bed cover, flowers unguents, transforming it from a monastic cell to a boudoir.  Then she got careless.  On a whim, she came to meet him in the hospital.  They made love on a bench in the hospital lobby.  She was spotted and word got back to her husband.

When next Edward met the senior pathologist, they argued.  Dr Vaughan hit him and he fell down the stairs, breaking the neck of his right femur.  It was a double blow.  Fanny broke off their relationship and refused to see him again. 

Edward’s recovery was slow.  It was as if the pain of his grief was transferred to the pin in his hip.  Whenever he thought of her, it attacked him.  He became addicted to morphia. 

He was sacked from St Basil’s and left to take over a remote single handed general practice on the south coast.  He thought of Fanny constantly and was determined to keep their relationship alive n his mind. At times, her presence was so strong, he could smell her perfume, hear her voice, feel her softness of her skin. He even took to wearing her fur coat.

Then James, Fanny’s son, came to visit him, a slim delicate dark haired boy, much like the mother. He was stationed at the nearly RAF base. They became friends. He learnt that Fanny had died of nephritis, but he felt he had regained her through the son.  One day, while treating James for a shrapnel wound, he noticed that James did not only have his mother’s soft skin, he had ambiguous genitalia and some breast development. It was like he was transforming into her. James was killed when his Spitfire crash landed.  Edward cradled his head in his arms, kissed her for the last time. 

As in his other novels, Spider and Asylum, Patrick McGrath has written a dark gothic suspense on a background theme of mental illness. What was Dr Haggard’s illness?  He had fallen in love with Fanny, and whereas she was much more realistic and in control,  he had imbued her with all the virtues and attributes.  He made up stories.  She was the victim bride of a bully. He had to rescue her. She would run away with him. She was the  missing half that would make him whole. But for Fanny, it was an affair, a thrill, a bit of excitement in an otherwise dull life. It had a beginning, a climax and an end.

The ending was cruel, she was ruthless.  He was devastated. But even after she rejected him, Edward still continued to worship her idea. He suffered agonies in his hip from his broken heart but he would not, could not, let go. Without her, there was no meaning in life. 

Meeting her son restored the connection, but that was when reality and fantasy entwined.  The body was transforming into hers’.  He became his angel, a high flyer, who would die consumed by fire. His love had been returned to him.  And Edward was transforming too into a small figure in a black fur.  He was merging with her.

So as the story limped its painful path to a catastrophic conclusion, we realize that Edward is not only deluded but hallucinating.  With penetrating insight and consummate skill, McGrath has once again demonstrated the power of infatuation to instigate the decline of a lonely personality into obsessive psychosis.

Edward Haggard was always at risk.  He was intensely solitary, much preoccupied with metaphysics and passionately fond of poetry.  His father was a rector and Edward ‘had all the makings of a certain type of priest’.  It was predictable that he would imbue their affair with so much more meaning than she. He would create a phantasy (Melanie Klein’s spelling) out of it and would continue to inhabit that phantasy even though the reality had long gone.  His disease was an excess of meaning, a toxic imagination.  What started as the sort of identification that all lovers experience, descended by degrees to fixation, obsession, delusion and hallucination.  There is a point in the story when we realize that things are not right,  perhaps the embodiment of Fanny in James.  After that we begin to question the whole fabric of the story.  How much of it was delusion and when did it take hold?  There was probably an affair – some crisis had to propel Edward out of Earth’s orbit – but did he ever meet James, did James ever exist, did Fanny become frightened by his obsession with her and was Ratcliffe really the boorish bully he described? 

The passionate phantasy of love cannot last.  It has to be transformed into the fond reality of everyday life or shatter and be rationalized as a mistake.  Edward could do neither.  He preserved his meaning, fed it, allowed it to grow until it took over his whole personality, disconnecting him from the conventions of society and ultimately defining him as mad.  In selfishly seeking out the sensitive man who would provide some meaning to her life,  Fanny never considered the possible consequences.


Time flies, the old man cried, as the alarm clock struck him on the back of the head.  For the elderly, time does indeed fly; not just the clock but the days, the weeks, the years.  Time seems to shorten, to press in on itself, as we get older.

But for the young, a week can last forever.  Remember how we measured our age in fractions of years.  ‘I’m seven and a quarter’, I’d reply if asked.  And that 13 weeks I boarded at school felt like 13 years.  Mathematicians have suggested that our perception of time is relative to the duration of life.  A year is 10% of our life when we are 10, but only 1% when we are 100. 

Personal time is perceived according to what new happens.  For children, the milestones are much closer. Their days are so packed with novelty, life is a constant stream of stimulation; their attention span so short that expectation seems endless.  As we get older, and accumulate responsibilities, the thrill of anticipation is replaced by the burden of obligation. There is little novelty, just more associations to work through, organise and file away. Too much to do; too little time!  With the end on the horizon, there is neither time nor inclination to look forward, so we tend to look back, reminisce, regret a bit and try to put it right. Events and thoughts collapse in on each other until time itself is confused. 

Although our perception of time passing can alter through life, our body has a remarkable ability to mark time. It knows exactly when it’s time to go to sleep, time to eat and time to defaecate, and when we change time zones, it is some time before this body clock can be reset. we have some kind of accumulator in our brain that records the oscillations of temporal neurones, or the beats of the heart?  Probably not!  Nobody has identified a cerebral clock, but neuronal and hormonal activity is responsive to environmental cues or zietgebers like day/night cycle, day length and temperature.  So while real time is relatively static in our bodies, our perception of time is elastic.  When I am running, the same route goes much more rapidly if I am in a relaxed meditative state than if I aware of my performance, even though my pulse rate is much the same.  Time is like a river; the flow may be constant, but the calms, rapids and waterfalls of our thoughts can make seem to slow it down or speed it up.   

It has been suggested that our perception of time depends on our degree of arousal.    During extreme arousal, time slows down and intensity of experience is magnified, our memory expanded.  The more energy the brain spends in representing an event, the longer it lasts.  We can get more done in the morning when our level of arousal is at its optimum.

Think of how slowly time goes during a crisis. If we are going to crash, everything seems to go into slow motion. You have an argument with your lover and then part; you remember every word, every gesture, every look. Time dilates  Psychologists call this amydala memory.  When the panic button is pressed, the brains cine film speeds up.  If you’re laying down a lot of memory, time goes by a lot more slowly, but does it just seem that way in retrospect because there’s more to play back? 

Generally time passes much more slowly if you are waiting for something, but that too depends on your perspective. Take two men at a football match. The score is 1-0. There are ten minutes to go.  To the one whose team is ahead, that ten minutes is an eternity of dread, but to the others desperation to score accelerates the final whistle.

It would seem that our perception of time is an emotional quality.  Time is suspended when you are in the thrall of love, but if you know you must part, then it speeds up alarmingly.  Samuel Johnson said that there is nothing like a hanging to concentrate the mind, but he could have equally transposed ‘time’ for ‘mind’. 

So is our perception of time a factor of the emotional energy of our thoughts?  The more energy we devote to things, the more we are conscious of time. Take boredom, for example, or depression.  Boredom is not passive or boring. Far from it, boredom is an active state of anticipation and frustration; an urgent need for something to happen, a  desire to kill time and attack your situation. Similarly most depression is a highly aroused state of anxiety and despair.  Driving my car down the motorway is the most boring thing I do. A journey to London is like a trip to the moon.  But if I listen to an audio-book at the same time, then I hardly notice it.  Children (of any age) who can lose themselves in creative play are rarely bored.  Boredom more usually applies to administrative tasks that I resent, like writing a grant application, filing a report or completing the tax return. Such a waste of time! But if I am preoccupied by some concern, that anything that takes me away from it, becomes boring. Perhaps time passes so slowly for the young because their lives are so occupied by the anxious frisson of change, that for nothing to happen is intolerable.       

Time races by if we’re absorbed in a task.  It’s a form of meditation. I have spent two hours writing this article and yet it seems I have only just started. The same phenomenon occurs if we watch a good film or when we’re relaxed at a dinner party, talking to friends.  This acceleration of time is enhanced by alcohol and recreational drugs.  I can lose time having a good time. During therapy, the 50 minute hour goes very quickly when the client is engaged and relaxed, but if he’s defensive and resistant, it drags.  We can spend seven hours asleep completely unaware of time yet if anxiety keeps us awake all night,  the slow blind slither of night-time is exquisite torture.  

So how should we spend time?  Should we seek solace in creative activity and allow time to speed by unnoticed?  Or should we seek to extend it with stimulus and novelty in an accelerating desperation to avoid the end?   What is the bigger waste of time?

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