“Your mistake wasn’t that you diagnosed her with depression when she was actually psychotic.” He tried to interrupt me but I continued, “Your mistake is that you didn’t once think that she might be telling the truth.” Again he tried to interrupt me. Did he interrupt you too as you tried to tell him what was happening to you? I thought psychiatrists were meant to listen. I suppose in an emergency NHS appointment, probably shoehorned into a full clinic, there’s not much time for listening.
“Did you even consider that the phone calls threatening her were real, just as the man who followed her to the park that day and murdered her was real?” I asked.
“Tess wasn’t murdered.”
I thought it strange he was so adamant. After all, murder would have let him off the misdiagnosis hook. He paused, then forced the words out as if they physically pained him.
“Tess was having auditory hallucinations, which I’ve told you about, and we can disagree about the interpretation if you wish. But she was also having visual hallucinations. At the time, I interpreted them as vivid nightmares, not uncommon for a patient who’s depressed and bereaved,” continued Dr. Nichols. “But I’ve reread her notes and it’s clear they were hallucinations, which I missed.” The beat of upset in his face I’d seen earlier seemed to spread across his features. “Visual hallucinations are a clear signifier of acute psychosis.”
“What were the ‘hallucinations’?”
“I have to respect patient confidentiality.”
I thought it strange that he suddenly thought of doctor/patient confidentiality when it hadn’t hindered him up until now. I wondered whether there was a reason for it, or whether it was just another incidence of his incompetence.
“I asked her to paint what she saw,” he continued, and his face looked kind. “I thought it would be helpful to her. Maybe you could find a painting?”
The secretary came in. Time was up, but I didn’t leave.
“You must go to the police and tell them you have doubts she had puerperal psychosis.”
“But I don’t have any doubts. The signs were there, as I said, but I missed them.”
“You’re not the reason she died, but you could be why her murderer gets away with it. Because of your diagnosis, no one is even looking for him.”
“Beatrice …”
It was the first time he’d used my Christian name. The bell had been rung; it was after school, so now he could be intimate. I didn’t stand up, but he did.
“I’m sorry, but I can’t help you anymore. I can’t change my professional judgment because you want me to, because it fits with a construct that you have put onto her death. I made a mistake, a terrible misjudgment. And I have to face up to that.”
His guilt was seeping out around the edges of his words, a trickle to start with before becoming the mainstream subject. He looked as if it was a relief to finally give way to it.
“The harsh facts are that a young woman with puerperal psychosis went undiagnosed and I must take my share of blame for her death.”
I thought it ironic that decency can be harder to argue with than its self-serving reprehensible opposite. The moral high ground is just too certain, however uncomfortable.
“I thought he believed he’d made a terrible mistake and was genuinely appalled with himself.”
“Did you ask him to go to the police?” asks Mr. Wright.
“Yes, but he maintained he was certain she had puerperal psychosis.”
“Even though it reflected badly on him professionally?”
“Yes. I found it surprising too. But I put his motive down to misplaced moral courage—agreeing with me that Tess didn’t have psychosis but was murdered would be a cowardly option. By the end of our meeting I thought he was a hopeless psychiatrist but a decent man.”
We break for lunch. Mr. Wright has a lunch meeting scheduled and I leave on my own. Outside it is still raining.
I never did answer your e-mail and tell you the real reason I saw a therapist. Because I did go in the end. It was six weeks after Todd and I had become engaged. I’d thought getting married would stop my feeling so insecure. But an engagement ring around my finger wasn’t the new hold on life I’d thought it would be. I saw Dr. Wong, a highly intelligent and empathetic woman who helped me understand that with Dad’s leaving and Leo’s dying within the space of a few months, it was hardly surprising that I felt abandoned and, consequently, insecure. You were right about those two wounds. But it was being sent to boarding school, the same year, that felt like the final abandonment.
