Therapy

by David Lodge

  Tom clashed the folding gate shut, the nurse pressed a button and the lift began to descend very slowly with much creaking and groaning. Its ceiling was even more depressing than the ceilings of the corridors. My companions conducted a desultory conversation out of my sight. “Got a smoke on you?” said the nurse. “No,” said Tom, “I’ve given it up. Gave it up last Tuesday.” “Why?” “Health.” “What d’you do instead?” “Lots and lots of sex,” said Tom levelly. The nurse giggled. “I’ll tell you a secret, though,” said Tom. “I hid cigarettes all over the hospital when I gave up, in case I get desperate. There’s one in the basement.” “What kind is it?” “Benson’s. You can have it if you like.” “Alright,” said the nurse, “thanks.” The lift stopped with a jolt.

  The air in the basement was hot and dry from the central-heating plant, and I began to perspire under the blanket as Tom pushed me between walls of cartons and boxes and bins of hospital supplies. Cobwebs hung thickly from the vaulted ceiling like batshit. The wheels jolted over the stone-flagged floor, jarring my spine. Tom stopped for a minute to ferret for one of his hidden cigarettes. He and the nurse disappeared behind a mountainous bale of laundry, and I heard a little squeal and scuffle which suggested he had exacted a favour in return for the Benson and Hedges. I couldn’t believe what was happening to me. How could a private patient be subjected to such indignities? It was as if I’d paid for Club Class and found myself in a broken seat at the back of the plane next to the toilet with smokers coughing in my face (metaphorically speaking – the nurse didn’t have the nerve to actually light up). What made it worse was knowing that I’d get no sympathy from Sally when I told her the story: she disapproves of private medicine on principle and refused to join BUPA when I did.

  We moved on again, twisting and turning through the labyrinth of stores, until we reached another, similar lift on the far side of the enormous basement, and rose slowly back into daylight. There was another long journey through more corridors – then suddenly everything changed. I passed through swing doors from the nineteenth century to the twentieth, from Victorian Gothic to hi-tech modern. It was like stepping on to a brightly lit, elegant studio set after stumbling about in the dark, cable-encumbered space at the back of a sound stage. Everything was white and silver, stainless and gleaming in the diffused light, and the medical staff welcomed me with kind smiles and soft, cultured voices. I was deftly lifted off the stretcher and onto another, more sophisticated mobile bed, on which I was wheeled into an anteroom where the anaesthetist was waiting. He asked me to flex my left hand, and warned me in soothing tones to expect a slight prick as he inserted a kind of plastic valve into a vein in my arm. Nizar sauntered into the room, swathed in pale blue theatre overalls and wearing a snood over his hair, looking like a plump pyjama-clad housewife who had just risen from her bed and hadn’t taken her curlers out yet. “’Morning, old bean,” he greeted me. “Everything tickety-boo?” Nizar speaks immaculate English, but I think he must have read a lot of P. G. Wodehouse once. I was about to say, no, it hadn’t been at all tickety-boo so far, but this didn’t seem the right moment to complain about my reception. Besides, a warm drowsy feeling of well-being was beginning to come over me. Nizar was looking at X-rays of my knee, holding them up before a lighted screen. “Ah yes,” he murmured to himself, as if vaguely recognizing a snapshot of some fleeting acquaintance from the past. He came over and stood at the side of the bed opposite the anaesthetist. They smiled down at me. “A hand-joiner,” the anaesthetist commented. What was he implying, I wondered. My blanket had been removed, and not knowing what else to with my hands I had clasped them on my stomach. The anaesthetist patted my hands. “That’s good, very good,” he said reassuringly. “Some people clench their fists, bite their nails.” Nizar lifted the hem of my gown and squeezed my knee. I sniggered and was about to make a joke about sexual harassment when I passed out.

  When I came round, I was back in the two-bedded room but the Caribbean man had gone, nobody could tell me where. My right leg, swaddled in bandages, was as big as an elephant’s. Sally, who visited me on her way home from work, thought it looked very funny. As I anticipated, I got no sympathy when I described my morning. “Serves you right for queue-jumping,” she said. “My Auntie Emily has been waiting two years for a hip operation.” Nizar came in later and asked me to lift my leg gently a few inches off the bed. I did it very gently – gingerly, you might say – without adverse effect, and he seemed satisfied. “Jolly good,” he said, “spiffing.”

  After a few days on crutches, waiting for the swelling to subside, and several weeks of physiotherapy and controlled exercise to get the quadriceps back to strength, I started to get the same intermittent pain as before. Fuuuuuuckinell! I couldn’t believe it. Nizar couldn’t believe it either. He reckoned he’d identified the trouble – a bit of tissue called plica that was getting nipped in the knee joint – and cut it away. We watched the video of my operation together on the TV in his office. I hadn’t been able to bring myself to watch it before. It was a brightly lit, coloured, circular image, like looking through the porthole of a submarine with a powerful searchlight. “There it is, you see!” cried Nizar. All I could see was what looked like a slim silvery eel biting chunks out of the soft underside of a shellfish. The little steel jaws snapped viciously and fragments of my knee floated off to be sucked out by the aspirator. I couldn’t watch for long. I always was squeamish about violence on television.

  “Well?” I said, when Nizar switched off the video. “Well, frankly old bean, I’m baffled,” he said. “You saw for yourself the plica that was causing the trouble, and you saw me cut it away. There’s no evidence of torn meniscus or arthritic degeneration of the joint. There’s no bally reason why the knee should be giving you any more pain.”

  “But it is,” I said.

  “Yes, quite so. It’s jolly annoying.”

  “Particularly for me,” I said.

  “It must be idiopathic patella chondromalacia,” said Nizar. When I asked him to explain he said, “Patella chondromalacia,” means pain in the knee, and idiopathic means it’s peculiar to you, old boy.” He smiled as if awarding me a prize.

  I asked him what could be done about it, and he said, rather less confidently than before, that he could do another arthroscopy, to see if he had by any chance missed something in the first one, or I could try aspirins and physiotherapy. I said I would try aspirins and physiotherapy.

  “Of course, I’d do it in the BUPA hospital next time,” he said. He was aware that I had been less than enchanted with the standard of care at the General.

  “Even so,” I said. “I’m not rushing into another operation.”

  When I told Roland – that’s the name of my physiotherapist – when I told Roland the substance of this consultation, he gave his sardonic lopsided smile and said, “You’ve got Internal Derangement of the Knee. That’s what the orthopaedic surgeons call it amongst themselves. Internal Derangement of the Knee. I.D.K. I Don’t Know.”

  Roland is blind, by the way. That’s another thing that can happen to you that’s worse than a pain in the knee. Blindness.

  Tuesday afternoon, 16th Feb. Immediately after writing that last bit yesterday I thought I would try shutting my eyes for a bit, to give myself an idea of what it would be like to be blind, and remind myself how lucky I am compared to poor old Roland. I actually went so far as to blindfold myself, with a sleeping mask British Airways gave me once on a flight from Los Angeles. I thought I would see what it was like to do something quite simple and ordinary, like making a cup of tea, without being able to see. The experiment didn’t last long. Trying to get out of the study and into the kitchen I cracked my knee, the right one needless to say, against the open drawer of a filing cabinet. I tore off the blindfold and hopped round the room cursing and blaspheming so terribly I finally shocked myself into silence. I was sure I’d done my knee in for good. But after a while the pain wore off, and this morning the joint doesn’t seem to be any worse than it w
as before. No better, either, of course.

  There’s one advantage of having Internal Derangement of the Knee, and that is, when people ring you up, and ask you how you are, and you don’t want to say, “terminally depressed,” but don’t feel like pretending that you’re brimming over with happiness either, you can always complain about your knee. My agent, Jake Endicott, just called to confirm our lunch appointment tomorrow, and I gave him an earful about the knee first. He’s having a meeting with the people at Heartland this afternoon to discuss whether they’re going to commission another series of The People Next Door. I delivered the last script of the present series only a few weeks ago, but these things have to be decided long in advance, because the actors’ contracts will be coming up for renewal soon. Jake is confident that Heartland will commission at least one more series, and probably two. “With audience figures like you’re getting, they’d be crazy not to.” He said he would tell me the upshot of his meeting at lunch tomorrow. He’s taking me to Groucho’s. He always does.

  It’s a year since my arthroscopy, and I’m still getting pain. Should I risk another operation? I Don’t Know. I can’t decide. I can’t make a decision about anything these days. I couldn’t decide what tie to wear this morning. If I can’t make a decision about a little thing like a tie, how can I make my mind up about an operation? I hesitated so long over my tie-rack that I was in danger of being late for my appointment with Alexandra. I couldn’t decide between a dark, conservative tie or a bright, splashy one. Eventually I narrowed the choice down to a plain navy knitted job from Marks and Sparks and an Italian silk number hand-painted in orange, brown and red. But then neither of them seemed to go with the shirt I was wearing, so I had to change that. Time was running out: I put the silk tie round my neck and stuffed the woollen one into my jacket pocket in case I had second thoughts on my way over to Alexandra’s office. I did, too – changed over to the knitted tie at a red light. Alexandra is my shrink, my current shrink. Dr Alexandra Marbles. No, her real name is Marples. I call her Marbles for a joke. If she ever moves or retires, I’ll be able to say I’ve lost my Marbles. She doesn’t know I call her that, but she wouldn’t mind if she did. She would mind if she knew I referred to her as my shrink, though. She doesn’t describe herself as a psychiatrist, you see, but as a cognitive behaviour therapist.

  I have a lot of therapy. On Mondays I see Roland for Physiotherapy, on Tuesdays I see Alexandra for Cognitive Behaviour Therapy, and on Fridays I have either aromatherapy or acupuncture. Wednesdays and Thursdays I’m usually in London, but then I see Amy, which is a sort of therapy too, I suppose.

  What’s the difference between a psychiatrist and a cognitive behaviour therapist? Well, as I understand it, a psychiatrist tries to uncover the hidden cause of your neurosis, whereas the cognitive behaviour therapist treats the symptoms that are making you miserable. For instance, you might suffer from claustrophobia in buses and trains, and a psychiatrist would try to discover some traumatic experience in your previous life that caused it. Say you were sexually assaulted as a child in a train when it went through a tunnel or something like that, by a man who was sitting next to you – say he interfered with you while it was dark in the compartment because of the tunnel and you were terrified and ashamed and didn’t dare accuse the man when the train came out of the tunnel and never even told your parents or anyone about it afterwards but suppressed the memory completely. Then if the psychiatrist could get you to remember that experience and see that it wasn’t your fault, you wouldn’t suffer from the claustrophobia any more. That’s the theory, anyway. The trouble is, as cognitive behaviour therapists point out, it can take for ever to discover the suppressed traumatic experience, even supposing there was one. Take Amy, for instance. She’s been in analysis for three years, and she sees her shrink every day, Monday to Friday, nine to nine-fifty every morning on her way to work. Imagine how much it’s costing her. I asked her once how she would know when she was cured. She said, “When I don’t feel the need to see Karl any more.” Karl is her shrink, Dr Karl Kiss. If you ask me, Karl is on to a good thing.

  So a cognitive behaviour therapist would probably give you a programme for conditioning yourself to travelling by public transport, like going round the Inner Circle on the Tube, travelling for just one stop the first time, then two, then three, and so on, in the off-peak time for starters, then in the rush hour, rewarding yourself each time you increased the length of your journey with some kind of treat, a drink or a meal or a new tie, whatever turns you on – and you’re so pleased with your own achievements and these little presents to yourself that you forget to be frightened and finally wake up to the fact that there is nothing to be frightened of. That’s the theory, anyway. Amy wasn’t impressed when I tried to explain it to her. She said, “But supposing one day you got raped on the Inner Circle?” She’s rather literal-minded, Amy.

  Mind you, people do get raped on the Inner Circle, these days. Even men.

  It was my GP who referred me to Alexandra. “She’s very good,” he assured me. “She’s very practical. Doesn’t waste time poking around in your unconscious, asking you about potty training, or whether you saw your parents having it off together, that sort of thing.” I was relieved to hear that. And Alexandra has certainly been a help. I mean the breathing exercises are quite effective, for about five minutes after I’ve done them. And I always feel calmer after I’ve seen her, for at least a couple of hours. She specializes in something called rational-emotive therapy, RET for short. The idea is to get the patient to see that his fears or phobias are based on an incorrect or unwarranted interpretation of the facts. In a way I know that already, but it helps to have Alexandra spell it out. There are times, though, when I hanker after a bit of old-fashioned Viennese analysis, when I almost envy Amy her daily Kiss. (The guy’s name is actually pronounced “Kish”, he’s Hungarian, but I prefer to call him “Kiss”.) The thing is, I wasn’t always unhappy. I can remember a time when I was happy. Reasonably content anyway. Or at least, a time when I didn’t think I was unhappy, which is perhaps the same thing as being happy. Or reasonably content. But somewhere, sometime, I lost it, the knack of just living, without being anxious and depressed. How? I Don’t Know.

  “So how are you today?” Alexandra said, as she always does at the beginning of our sessions. We sit facing each other across ten feet of deep-pile pale grey carpet in two easy chairs, in her handsome, high-ceilinged office, which, apart from the antique desk by the window, and a tall functional filing cabinet in one corner, is furnished more like a drawing-room. The chairs are placed each side of a fireplace, where a gas fire made of imitation coals burns cheerfully throughout the winter months, and a vase of freshly cut flowers stands in the summer. Alexandra is tall and slim, and wears graceful, flowing clothes: silk shirts and pleated skirts of fine wool long enough to cover her knees demurely when she sits down. She has a narrow, fine-boned face on top of a very long, slender neck, and her hair is drawn back in a tight bun, or is it chignon? Imagine a rather beautiful, long-lashed female giraffe drawn by Walt Disney.

  I began by telling her of my pathological indecision over the ties. “Pathological?” she said. “What makes you use that word?” She’s always picking me up on negative words I use about myself.

  “Well, I mean, a tie, for God’s sake! I wasted half an hour of my life anguishing about … I mean, how trivial can you get?”

  Alexandra asked me why I had found it so difficult to decide between the two ties.

  “I thought, if I wore the plain dark blue one you would take it as a sign that I was depressed, or rather as a sign that I was giving in to my depression, instead of fighting it. But when I put on the bright one, I thought you would take it as a sign that I’d got over my depression, but I haven’t. It seemed to me that whichever tie I wore would be a kind of lie.” Alexandra smiled, and I experienced that deceptive lift of the spirits that often comes in therapy when you give a neat answer, like a clever kid in school.

  “Yo
u could have dispensed with a tie altogether.”

  “I considered that. But I always wear a tie to these sessions. It’s an old habit. It’s how I was brought up: always dress properly when you’re going to the doctor’s. If I suddenly stopped wearing a tie you might think it signified something – disrespect, dissatisfaction – and I’m not dissatisfied. Well, only with myself.”

  A few weeks ago Alexandra got me to write a short description of myself. I found it quite an interesting exercise. I suppose it was what got me going on the idea of writing this … whatever it is. Journal. Diary. Confession. Up till now, I’ve always written exclusively in dramatic form – sketches, scripts, screenplays. Of course, there’s a bit of description in every TV script – stage directions, notes on characters for the casting director (“JUDY is a good-looking bottle-blonde in her twenties”), but nothing detailed, nothing analytical, apart from the lines. That’s what TV is – all lines. The lines people speak and the lines of the cathode-ray tube that make up the picture. Everything’s either in the picture, which tells you where you are, or in the dialogue, which tells you what the characters are thinking and feeling, and often you don’t even need words for that – a shrug of the shoulders, a widening of the eyes will do it. Whereas if you’re writing a book, you’ve got nothing but words for everything: behaviour, looks, thoughts, feelings, the whole boiling. I take my hat off to book writers, I do honestly.

  A SELF-DESCRIPTION

  I AM FIFTY-EIGHT years old, five feet nine-and-a-half inches tall and thirteen stone eight pounds in weight – which is two stone more than it should be according to the table in our dog-eared copy of The Family Book of Health. I didn’t acquire the nickname “Tubby” until I was a National Serviceman in the Army, after which it stuck. But I was always a bit on the heavy side for my height, even when I played football as a youth, with a barrel-shaped torso that curved gently outwards from the chest to the point where shirt met shorts. My stomach was all muscle in those days, and useful for bustling opposing players off the ball, but as I got older, in spite of regular exercise, the muscle turned to flab and then spread to my hips and bum, so now I’m more pear-shaped than barrel-shaped. They say that inside every fat man there’s a thin man struggling to get out, and I hear his stifled groans every time I look into the bathroom mirror. It’s not just the shape of my torso that bothers me, either, and it’s not just the torso, come to that. My chest is covered with what looks like a doormat-sized Brillo pad that grows right up to my Adam’s apple: if I wear an open-necked shirt, wiry tendrils sprout from the top like some kind of fast-growing fungus from outer space in an old Nigel Kneale serial. And by a cruel twist of genetic fate I have practically no hair above the Adam’s apple. My pate is as bald as an electric light bulb, like my father’s, apart from a little fringe around the ears, and at the nape, which I wear very long, hanging down over my collar. It looks a bit tramp-like, but I can hardly bear to have it cut, each strand is so precious. I hate to see it falling on to the barber-shop floor – I feel they should put it in a paper bag for me to take home. I tried to grow a moustache once, but it turned out rather funny-looking, grey on one side and a sort of gingery-brown on the other, so I shaved it off quick. I considered growing a beard, but I was afraid it would look like a continuation of my chest. So there’s nothing to disguise the ordinariness of my face: a pink, puffy oval, creased and wrinkled like a slowly deflating balloon, with pouchy cheeks, a fleshy, slightly bulbous nose and two rather sad-looking watery-blue eyes. My teeth are nothing to write home about, either, but they are my own, the ones you can see anyway (I have a bridge on the lower right-hand side where a few molars are missing). My neck is as thick as a tree-trunk, but my arms are rather short, making it difficult to buy shirts that fit. For most of my life I put up with shirts with cuffs that fell down over my hands as far as the knuckle unless restrained by a long-sleeved sweater or elastic bands round the elbows. Then I went to America where they have discovered that some men have arms shorter than average (in Britain for some reason you are only allowed to have arms that are longer than average) and bought a dozen shirts at Brooks Brothers with 32″ sleeves. I top up my wardrobe from an American mail-order firm that started trading in England a few years ago. Of course, I could afford to have my shirts made to measure nowadays, but the snobby-looking shops around Picadilly where they do it put me off and the striped poplins in the windows are too prim for my taste. In any case, I can’t stand shopping. I’m an impatient bloke. At least, I am now. I used not to be. Queuing, for instance. When I was young, queuing was a way of life, I thought nothing of it. Queuing for buses, queuing for the pictures, queuing in shops. Nowadays I hardly ever ride on a bus, I watch most movies at home on video, and if I go into a shop and there are more than two people waiting to be served, more likely than not I’ll turn round and walk straight out. I’d rather do without whatever I came for. I especially hate banks and post offices where they have those cordoned-off lanes like Airport Immigration where you have to shuffle slowly forward in line and when you get to the head of the queue you have to keep swivelling your head to see which counter is the first to be free, and more likely than not you don’t spot it and some clever dick behind you nudges you in the kidneys and says, “Your turn, mate.” I do as much of my banking as possible by a computerized phoneline system nowadays, and I send most of my letters by fax, or have Datapost call at the house if I have a script to mail, but occasionally I need some stamps and have to go and stand in one of those long Post Office queues with a lot of old biddies and single parents with snuffling infants in pushchairs waiting to collect their pensions and income support, and I can hardly restrain myself from shouting, “Isn’t it about time we had a counter for people who just want to buy stamps? Who want to post things? After all, this is a Post Office, isn’t it?” That’s just a figure of speech, of course, I can restrain myself very easily, I wouldn’t dream of shouting anything at all in a public place, but that’s the way I feel. I never show my feelings much. Most people who know me would be surprised if I told them I was impatient. I have a reputation in the TV world for being rather placid, unflappable, for keeping my cool when all around are losing theirs. They’d be surprised to learn that I was unhappy with my physique, too. They think I like being called Tubby. I tried dropping a hint once or twice that I wouldn’t mind being called Laz instead, but it didn’t catch on. The only parts of my body that I’m reasonably pleased with are the extremities, the hands and feet. My feet are quite small, size seven, and narrow, with a high instep. They look good in the Italian shoes I buy more frequently than is strictly necessary. I was always light on my feet, considering the bulk they have to support, a nifty dribbler of a football and not a bad ballroom dancer. I move about the house very quietly, sometimes making my wife jump when she turns round and finds me right behind her. My hands are quite small too, but with long, shapely fingers like a pianist’s, not that I can play any keyboard except an IBM one.