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

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

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

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

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

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

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

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

  Nothing to Be Done.

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

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

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

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

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

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

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

  Dear Jane,

  I’m going to kill myself and end this farce. I’m sorry to leave a mess. I just can’t seem to get control of myself.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  The shock had dwindled in Vail’s eyes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  31

  MELANIE GREENE HAD ONLY a few weeks to live—that was Dr. Bell’s professional estimate. She had done her homework this time, bringing in three—count ‘em, three!—suicide notes. Not that he would need them. If he couldn’t manipulate a miserable teenager into topping herself, he might as well take down his shingle. There would be no mistakes this time.

  She told him about driving to her stepfather’s place, about her plan to tell his new wife about his sexual proclivities, and how seeing the little girl had prevented her. Such failure of nerve was typical with Melanie, and might prove a minor obstacle in getting her to make a decent exit. But only minor.

  “What made you stop?” Bell said. “You were going to tell his new wife, why not tell his new daughter what he had done?”

  “Well, she’s only around six years old, for one thing. Maybe seven.”

  “You didn’t think a six-year-old should hear about such things?”

  “No, of course not.”

  “These things that were done to you at a similar age? When you were seven?”

  “I don’t think little kids should even know about them, let alone do them. I mean, do you think people should be talking to six-year-olds about oral sex?”

  “It’s your feelings that matter, Melanie.”

  “Well, I’m not gonna talk to a little kid about that stuff. But the reason I stopped was just pure shock. I mean, bad enough The Bastard’s married again and he’s probably going to put this woman through hell. But to have another little kid. I was just, like, stunned. I nearly got run over by a car. She’s going to go through everything I went through on those fishing trips, on the boat, at WonderWorld.”

  Dr. Bell felt his control slipping. There was a sudden heat in his hands and he realized he was imagining choking her, shaking her, screaming in her face, “Can’t you see? You don’t belong here. Do us all a favour and kill yourself once and for all.” It was a struggle to quiet the pounding in his chest. He decided to take Melanie out of the present and back to her traumas.

  “What was the worst part of it? Back then, back when you were a little girl. What was truly the worst? Was it the physical pain?”

  Melanie shook her head.

  She’ll start chewing her knuckles in a minute, Bell thought.

  As if he had willed it, her left hand rose to her mouth and paused there as she gnawed on a knuckle.

  “There wasn’t usually any physical pain. Just once or twice when he, when he … you know. Oh, God. From behind.”

  “Anal sex?”

  “Um, yeah.”

  “Did you bleed?”

  She shook her head, stared at her feet. Bell saw her shiver as The Entity slipped into the room. The shadowed, hooded figure composed of ice and death enfolded the young woman under his caped arm.

  “He was usually very careful that way,” Melanie said. “And mostly it was oral. My lips would be numb. Sometimes I was sore between my legs. A few times, when I couldn’t sleep, my mother asked me what was wrong, and I wanted to tell her. Oh, I wanted to tell her so bad.”

  “But you didn’t.”

  “No.”

  “Because …”