under. Maybe that would help.’
‘I suppose …’
‘Well then, let me explain a little about patient confidentiality,’ Wray said. ‘It’s a matter of duty-of-care. Any psychiatrist, in any facility, is governed absolutely by the wishes of their patient. If a patient is eighteen or over their right to total confidentiality is assumed unless they choose to waive it. They may agree to limited information being made available to their spouse, or their parents. But equally, a patient may insist that they don’t want anyone to know anything. And when that is the case, we are obliged to respect their wishes.’
‘Are you telling me Mariana doesn’t want to see me?’
‘I’m not telling you anything about her.’
‘She’s my wife, for God’s sake. Doesn’t that count for anything?’
Wray sighed. His voice softened a little. ‘I understand, Mr Crookham, really I do. But there’s nothing I can do. I’m afraid that any kind of mental illness is incredibly hard on the patient’s loved ones in many different ways, and this is just one of them … Ach!’
Wray’s fingers made another trip through the wild greasy strands of his hair, pausing to scratch the top of his scalp. He frowned, then said, ‘Look, as well as my work here, I practise at a private clinic, hmm? When they come to us, some of the patients are in a terrible state, close to death, or suicidal. Their families are often desperate for news. I’ve had mothers calling me, wanting to know whether their sons or daughters are alive and I’ve not even been able to tell them that.’
‘But that’s just being cruel.’
‘I know … it’s not easy for us, either. But our first and only concern as doctors has to be for our patients. And those patients own their conditions. Whatever they are going through, it is their experience, their struggle and, in the end, hopefully, their cure. You see? So they have the right to decide whether they want to share that experience with anyone else.’
‘But they’re ill, you said so yourself. How do they know what they really want?’
‘Ha! Even patients who are psychotic or delusional in one aspect of their lives may be perfectly rational in another. And they can make reasonable decisions about the degree to which they do or do not want anyone to know about their illness. Do you understand?’
‘Yes, but I still don’t understand why patients wouldn’t want to be with the people who love them. Wouldn’t that make them feel better?’
‘Not necessarily. It might make them feel ashamed. Should they see a family member, or someone they love, and that person is upset, that will only cause terrible feelings of guilt. And the deeper the love, the greater the guilt. The patient thinks, “I am doing this to someone I love. I’m hurting them. I must be such a bad person.” This adds to the feelings of shame that they already possess about themselves: feelings that may very well have caused their problems in the first place. That’s why they can’t bear to be seen.’
‘Well is there anything you can tell me? Anything at all?’
Wray looked at me with a completely flat, unresponsive expression that was somehow more infuriating, more provocative than anything he’d actually said.
‘You don’t get it,’ I said, getting to my feet as my voice rose again. ‘I mean, screw Mariana’s guilt and shame! What do you think I feel like? I’m tense all the time, day and night. It never goes away.’
I started pacing up and down, desperately trying to burn off some of my nervous energy, ranting more than talking in an unbroken stream of consciousness.
‘I feel nauseous. My guts are churning and I’ve got a choking feeling in my throat. And it hurts, physically hurts, like I’m being bruised from the inside out. My mind is racing round and round, but it never gets anywhere …’
‘Mr Crookham, take it easy. Try to relax.’
‘Relax? How the hell am I meant to relax?’ I tapped a finger hard against
‘I suppose …’
‘Well then, let me explain a little about patient confidentiality,’ Wray said. ‘It’s a matter of duty-of-care. Any psychiatrist, in any facility, is governed absolutely by the wishes of their patient. If a patient is eighteen or over their right to total confidentiality is assumed unless they choose to waive it. They may agree to limited information being made available to their spouse, or their parents. But equally, a patient may insist that they don’t want anyone to know anything. And when that is the case, we are obliged to respect their wishes.’
‘Are you telling me Mariana doesn’t want to see me?’
‘I’m not telling you anything about her.’
‘She’s my wife, for God’s sake. Doesn’t that count for anything?’
Wray sighed. His voice softened a little. ‘I understand, Mr Crookham, really I do. But there’s nothing I can do. I’m afraid that any kind of mental illness is incredibly hard on the patient’s loved ones in many different ways, and this is just one of them … Ach!’
Wray’s fingers made another trip through the wild greasy strands of his hair, pausing to scratch the top of his scalp. He frowned, then said, ‘Look, as well as my work here, I practise at a private clinic, hmm? When they come to us, some of the patients are in a terrible state, close to death, or suicidal. Their families are often desperate for news. I’ve had mothers calling me, wanting to know whether their sons or daughters are alive and I’ve not even been able to tell them that.’
‘But that’s just being cruel.’
‘I know … it’s not easy for us, either. But our first and only concern as doctors has to be for our patients. And those patients own their conditions. Whatever they are going through, it is their experience, their struggle and, in the end, hopefully, their cure. You see? So they have the right to decide whether they want to share that experience with anyone else.’
‘But they’re ill, you said so yourself. How do they know what they really want?’
‘Ha! Even patients who are psychotic or delusional in one aspect of their lives may be perfectly rational in another. And they can make reasonable decisions about the degree to which they do or do not want anyone to know about their illness. Do you understand?’
‘Yes, but I still don’t understand why patients wouldn’t want to be with the people who love them. Wouldn’t that make them feel better?’
‘Not necessarily. It might make them feel ashamed. Should they see a family member, or someone they love, and that person is upset, that will only cause terrible feelings of guilt. And the deeper the love, the greater the guilt. The patient thinks, “I am doing this to someone I love. I’m hurting them. I must be such a bad person.” This adds to the feelings of shame that they already possess about themselves: feelings that may very well have caused their problems in the first place. That’s why they can’t bear to be seen.’
‘Well is there anything you can tell me? Anything at all?’
Wray looked at me with a completely flat, unresponsive expression that was somehow more infuriating, more provocative than anything he’d actually said.
‘You don’t get it,’ I said, getting to my feet as my voice rose again. ‘I mean, screw Mariana’s guilt and shame! What do you think I feel like? I’m tense all the time, day and night. It never goes away.’
I started pacing up and down, desperately trying to burn off some of my nervous energy, ranting more than talking in an unbroken stream of consciousness.
‘I feel nauseous. My guts are churning and I’ve got a choking feeling in my throat. And it hurts, physically hurts, like I’m being bruised from the inside out. My mind is racing round and round, but it never gets anywhere …’
‘Mr Crookham, take it easy. Try to relax.’
‘Relax? How the hell am I meant to relax?’ I tapped a finger hard against
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