Psy­chol­ogy put on the couch

The Weekend Australian - Review - - Books - Estelle Tang

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.

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