Psychology put on the couch
The Skeleton Cupboard: Stories from a Clinical Psychologist By Tanya Byron Pan Macmillan, 304pp, $29.99 THE Skeleton Cupboard opens with an origin story worthy of a television-drama heroine: “I first became fascinated by the frontal lobes of the human brain when I saw my grandmother’s sprayed across the skirting board of her dark and cluttered house.”
Such a dramatic beginning befits a book by Tanya Byron, a British psychologist known for television and radio spots. Its six accessible and entertaining sections — episodes, if you will — describe Byron’s journey as a training clinical psychologist in London from 1989 to 1992. In various settings, from a hospital’s outpatient psychiatric department to a care home for the elderly, the younger, inexperienced Byron — not yet certain psychology is her vocation — navigates new professional duties.
Memoir and fiction have always shared a nebulous border, and this book straddles the two quite explicitly. Byron states in the introduction that “because confidentiality is a core principle of my profession”, her characters are not real people or even based on real people but “constructs” drawing on her early career. This fictionalisation has the effect of foregrounding the cases’ dramatic arcs rather than the people whose experiences they constitute. In Byron’s “cases”, psychological techniques are applied as forensically and successfully as a master sur- geon’s knife. But back to origin stories. Ensconced in her tiny first office (once a storage cupboard), Byron thinks, “Shit. I knew absolutely nothing.” Insecure and saddled with a terrifying supervisor, Chris, she’s keen not to screw up. Throughout an introductory session with a new patient — tough, well-built Ray — Byron internally assesses her grasp of treatment protocols and her rapport with him. Trying to discover what’s causing his panic attacks, she quizzes him on his past, eventually touching on the topic of his family. When she sees a tear squeeze out of his eye, Byron is relieved, then ecstatic: she can actually do her job.
Terrifyingly, the encounter takes a turn when Ray pulls out a knife, revealing that his “emotional breakthrough” was a psychopathic ruse to win her trust.
As well as the violent Ray, Byron treats a 12year-old girl who tries to hang herself, a highly intelligent elderly Holocaust survivor aware he is succumbing to dementia, and a fashion designer whose body and sense of self have been ravaged by AIDS.
Unlike the wondrously strange stories of the brain told by neurologist and psychiatrist Oliver Sacks, or psychiatrist and psychoanalyst Norman Doidge, Byron’s are more common ones: tales of drug addiction, sexual dysfunction or eating disorders. Common does not necessarily mean boring; these stories are moving and made fascinating by the humanist process Byron uses to diagnose and treat her patients, informed by book learning and her own developing instincts.
Running parallel to the psychological puzzles Byron gradually pieces together is her professional struggle; in this book, the focus is as much on the practitioner as the patient. When she feels she is helping, Byron considers her job “a privilege”. But when she makes mistakes or feels dangerously unequipped to deal with others’ trauma, she doubts herself immensely.
Balancing the sometimes truly dark and shocking clinical cases is the lighter fare of “office” life as a mental health professional; the staff’s gallows humour, a coping mechanism in the face of human suffering, is one illuminating example. Other details, however, such as Byron’s constant irritation at the eating habits of the scary Chris, seem repetitive and petty, es- pecially in the context of her patients’ suffering.
Although Byron claims The Skeleton Cupboard isn’t a memoir, her experiences explicitly frame the narrative and are an important part of it. Byron is a natural storyteller, passionate about her subject, and her chatty prose instantly evokes a sense of her personality. Yet the one story she doesn’t quite nail is her own, which isn’t as deeply investigated or compellingly developed as those of her patients.
In the name of demystifying her profession, Byron has produced a warts-and-all portrait of her younger self. Admirable as this mission is, some of her disclosures and word choices left me cold, and, I expect, will similarly affect other readers who believe that people desiring or requiring mental health attention deserve respect. In one anecdote, she cautions herself against being judgmental, then describes a preoperative transgender woman as having an “enormous man-hand” — a decidedly insensitive observation presented without comment.
Contemplative and mature, the book’s epilogue is a strength. In it, Byron reflects on the arrogance, naivety and anxiety of her early years, as well as her passion for the job and the various ways poor mental health can affect lives. “We understand these difficulties using narrative,” she writes of the clinical psychologist’s role.
So what is the story here? It’s a modest but worthwhile one: about how those seeking mental wellbeing are human, and how mental health practitioners, despite their often elevated status, are human too.