The Drowning Lesson (21 page)

Luckily the post comes late. There is a large white envelope on the mat when I return from dropping the girls off at school, the psychiatrist's report, by its weight: if Alice had seen and guessed, her first day back at school might have been wrecked.

Zoë's puppy has puddled the floor again. I wipe the tiny pool, throw the J-cloth into the bin, then wince at my mistake: in Botswana it would be washed and dried in the sun, used and reused.

The little black dog is warm on my lap. These days, I'm always cold. I walk around in two jerseys and sometimes my duvet. Weight loss. Loss.

Rain is lashing the windows. It will be midday in Kubung now, the heat reaching into the shadows. Josiah will be asleep in his hut, Elisabeth serving lunch. Someone else will be standing at the door, her hand shading her eyes, calling her children in.

Kodi chews the envelope while I read the report, my hands pulling at the satin triangles of his ears. Kodi: Setswana for kudu, Alice's idea.

Report by Dr Harnham FRCPsych

Patient: Alice Jordan. DOB 10 August 2004

Diagnosis: Psychotic depression.

Generalized anxiety syndrome

Siblings:

Zoë Jordan. DOB: 19 June 2008. Alive and well.

Samuel Jordan. DOB: 17 November 2013. Missing, presumed deceased, March 2014.

Missing
. That word opening always into the vacant room: the empty cot, the black night beyond the shattered glass.
Presumed deceased
. I don't presume anything. Certainties have disintegrated. There are times I know Sam's alive, times when I hear him breathing in the silence of our room at night. Then, more often, and lately much more often, I know he's dead. I wish I hadn't opened the report. I wish it hadn't come. Though Adam and I have talked through everything that happened with the psychiatrist, it looks so much worse, typed out in black and white.

10.8.2004 Full term, normal delivery of female infant. Weight: 3.175 kg. Apgar score: 10.

Normal? It was cataclysmic, splitting me from the woman I had been; I'd become consumed, torn, embattled.

Early childhood uneventful.

(Uneventful? What about love? Breastfeeding, bedtime stories, walks in the park, the beach, the food? And what about the return to work, the tears, the promises, the late returns. The rushed talks. Events, good and bad, happened all the time.)

School

Academic record: Consistent excellence across the board (see attached report)

Extra tennis, Mandarin lessons, violin …

Personal and Social Development

History of pilfering: … stolen items … self-validating …

Alice calling for help, asking to be noticed. I flick back to Dr Harnham's report.

Home Life and Early Psychiatric Morbidity (ages 4 to 8)

Father Consultant Oncologist (full time)

Mother Consultant Obstetrician and Gynaecologist (now retired)

Parents co-habit: high level of expressed emotion … eased in holidays but not sustained … Child care delivered by series of au pairs.

They were safe, though. Efficient. I took up references
…

Reported symptomatology occurring at this time: poor sleep, obsessive tendencies
…

The footsteps I heard at night, months before we left for Africa, were Alice's, not Sofia's; Alice was listening to us even then.

The stolen things, the broken dolls, the rigid arrangement of hairclips: warning signs of a child who felt unsafe, attempting to order her world, the significance missed, then forgotten.

Alice felt left out of important family issues, e.g., exclusion from the fact of her mother's pregnancy. Retrospective diagnosis at this stage: mild depressive disorder, with associated anxiety.

I should have told her. I wish I had. She was tired but coping. That was what we thought. We didn't see anything … No: we didn't understand anything.

Third sibling: born 37 weeks gestation normal delivery
…

Alice experienced raised level of anxiety and depression around the welfare of the new baby and describes his birth in terms of a tipping point. She felt less visible to her parents from then on, and in addition to feeling more unsafe herself was concerned for the baby's wellbeing, and also her sister's. She has positive memories of time spent with a family friend, with whom bonding occurred, which mitigated these effects at this time.

Megan saving us, as she still does, but even so, in spite of everything, sometimes I look at her peaceful face, and think, Could it possibly, still, be you?

History of Presenting Incident

The family moved to Kubung, Botswana
,
in December 2013 in order for Dr Adam Jordan to take up a planned research sabbatical. Alice experienced further anxiety, due to interruption of normal routines; and the loss of relationships with the family au pair and the above friend. Alice had been informed by her mother she would be at home during their sabbatical so she experienced significant loss of trust when her mother unexpectedly returned to work at six weeks.

She hardly seemed to notice when I went back to work. I thought she was fine, quiet but fine. The opposite was true.

Two important relationships had developed concurrently. Alice became close to the nanny, Teko, hired to look after her brother. Teko provided a consistently supportive relationship.

Alice was positively attached to her tutor, Simon Katse, on whom she had projected idealized attributes. Delusional beliefs had clearly by then become part of her disturbed mental state and when the tutor left suddenly she developed further deterioration, which may have led to the auditory hallucinations (described in section 2.) below.

1. Delusional beliefs

Alice believed her mother disliked her brother because of his facial birthmark. She'd heard her mother positively discuss African babies being given away; she claimed Teko was sympathetic, having overheard the same conversation.

The latter delusion probably constitutes a psychological defence mechanism against self-blame; Alice was worried that the abduction was caused by wish-fulfilment; i.e., her desiring a safe home for her brother ‘caused' the abduction; inventing Teko's sympathy would lessen her own responsibility for her feelings because someone else shared them, a mechanism known as psychological scapegoating.

Alice must have overheard my stupid joke on the veranda; it would have fed into her deteriorating state with terrifying effect. She might have confided her worries to Teko in simple Setswana; if she believed Teko had understood a complex conversation in English, Alice must have been truly delusional.

2. Auditory hallucinations

Alice claimed she heard breathing noises, footsteps and voices in the days preceding the abduction. She attempted to tell her family but other explanations were found and her fears dismissed.

We didn't listen when she mentioned footsteps. Not properly. Adam thought she had heard him getting up at night. She blamed him for the whispers she could hear. Even though she looked ill, it never once occurred to me she was hearing voices.

3. Severe feeling of guilt and self-blame

Despite ‘inventing' Teko's sympathy (i.e., psychological scapegoating referred to above) Alice maintains she herself, not Teko, actively helped in the abduction.

The night before the day her brother was abducted, Alice believes she was persuaded by a threatening shadow or ghost of some kind (possibly part of a nightmare) to assist in removing her brother from her own ‘bad' family to a ‘better' one where he would be loved. Alice becomes confused and highly distressed if encouraged to elaborate. Such hallucinatory episodes are known to have the subjective quality of nightmares; until Alice is comfortable with exploring this experience, there would be little benefit in encouraging her to relive it.

The understanding at present is that Alice claims she was told in the nightmare/hallucinatory episode to take the household members away from the house on the afternoon of her brother's abduction. She did not inform the nanny, Teko, hoping the latter's presence in the house would protect her brother. When Alice realized her brother had been abducted despite Teko's presence, she assumed responsibility for his disappearance.

Making sense of catastrophic events through retrospective hallucinatory experiences by highly intelligent and sensitive children is not unknown though rare.

In the aftermath of Teko's disappearance Alice concluded that Teko had been subsequently kidnapped as well; she took on responsibility and grieved for both losses. As the search for Samuel continued she realized how distressed her parents were and became actively suicidal
.

Since the family's return to England, in spite of, and subsequent to
,
her self-harming episode, Alice has worked closely with all members of the psychiatric team to uncover the sequence of beliefs and delusions related above.

Alice and I talked on the plane journey to London from Gaborone or, at least, I tried to, but it was obvious something was very wrong. After her outburst she'd wept and insisted she was to blame. Between sobs she claimed Sam had been taken in order to save him. Nothing she said made sense. She was wild with grief. I held her, told her we loved her, that it wasn't her fault. Gradually she became silent, then slept. I knew we had a major problem, but I hadn't sensed she was psychotic.

Megan met us as planned and got us through the seething crowds of journalists at Heathrow, then helped us push past the reporters outside our house.
Once home, I phoned the psychiatric on-call team. I thought Megan was with Alice; she thought I was. Then Zoë told me she couldn't get into the bathroom; in the end, Megan unlocked it with a screwdriver. Alice was on the floor. She'd taken paracetamol from the cupboard and swallowed it, along with a handful of diazepam from my bedside drawer.

Adam caught the next plane back. By then Alice's stomach had been pumped and she was on the paediatric medical ward for liver-function monitoring. We spent the next few days beside her, holding her hand or lying with her on the bed as she slept. I watched her constantly, terror and love consuming me. We didn't sleep for two days. We could have lost her so easily. Alice as well as Sam. It doesn't take much paracetamol to poison a child. She recovered slowly from the overdose, and, as her psychosis unravelled, we knew we couldn't believe anything she said. The psychiatric team asked us to step back.

The puppy feels heavier – he has relaxed into sleep. When I lift him to my neck, he stirs and sleepily pushes his nose under my chin.

After counselling and psychotherapeutic intervention, Alice is beginning to accept that she was not to blame. She admits that her understanding of events preceding and around the abduction were both delusional and hallucinatory, arising from
psychotic depression and related anxiety at the time. As events recede she understands that she had and has no knowledge of why/how her brother went missing
.

Despite grasping elements of the Setswana language, this would not have been sufficient to allow Alice to comprehend the conversations she claims she had with Teko; and it is currently unclear whether auditory hallucinations or delusional beliefs account for Alice's belief that they were able to communicate fully. Psychotherapeutic work is ongoing to try to distinguish this as it has prognostic implications.

Treatment

Supportive psychotherapy

Julie Edwards, child psychologist: two sessions a week

Paroxetine; 10mg o.d.; monthly review with Dr Harnham

After a while I settle Kodi in his basket by the stove; he turns and falls in a soft heap, nose to tail; his back rises and falls under my hand, his skin twitching. I put the report on Adam's desk for him to read when he comes home. The polished surface is empty; his orderliness has become fierce.

The rest of the day passes. Washing the floor and making the beds is something to cling to: when I smooth the sheets with my hand, I feel calmed, as if I'm smoothing out my mind.

I check the street through the blinds; journalists often lie in wait outside the house. We've been on
television three times, holding hands. Adam co-operates with the press but I avoid them.

There have been reports of sightings in Africa, in Kenya and Nigeria, all false and each one seeming to push Sam further away. I've had my own sightings too. Across the aisle in front of us in church at Christmas, Teko became a tall stranger when she stood up. Only three weeks ago I followed a girl with hair just like hers right up to the checkout in Sainsbury's until she turned to face me, her face full of fear. What Teko would have been doing in a north London supermarket was a question I didn't think to ask myself. I'm unsure why I'm compelled to do this because, unlike Adam, I know we have lost him.