Although she experienced some of the usual after-effects of ECT such as short-term memory loss and disorientation in the immediate wake of each session, the psychiatrists judged the treatment to be an unmitigated success. Bethany herself said she felt ‘more alive’, and insisted she experienced the ECT interventions as positive — despite the fact that she was anaesthetised throughout and could have no recollection of them. But weirdness is relative in the territory occupied by the mentally deranged. Anything can manifest itself and, with the skewed anti-logic of anxiety dreams, it does: tins of mango slices containing encoded messages from the Office for National Statistics, a conviction that your skeleton will dissolve if you think about sex, a grouting phobia. A junior arsonist I dealt with once, who could cite the chemical compound of every flammable gas known to man, insisted on keeping his mouth open to avoid getting lockjaw. He’d sleep with a wedge of pillow clamped between his teeth as though his life depended on it. Life’s rich tapestry, Dad would have said, in his bridge-and-crossword days, before Cartoon Network and the drool-bib took over the show.

Since March, after an initial five weeks of weekly sessions, Bethany’s shock therapy has been administered on average once a month, as a maintenance dose, by one Dr Ehmet, whom I have not yet met, though I once caught sight of the back of his head and noted that he could do with a haircut. But effective though the ECT has been, Bethany’s refusal to discuss her parents and the catastrophic event that brought her here continues. What prompted her to attack and murder her mother with a screwdriver one April evening remains a mystery. Therapeutically, I am not sure how much this matters. Psychological principle has it that buried traumas must be exhumed and dealt with before a patient can move on. But I am less and less convinced by this reasoning. If there was a pill that could suppress horror, I would take it myself, and wipe out the last two years of my life. The brain is as uncharted and unfathomable as the sea, and as capricious. But it is also wise enough to do what’s required to keep a body going. Who says that for Bethany Krall, forensically analysing what she did to her mother, and why, will do any good? Sensing this on some level, might she be using the ECT as a means of obliterating a crucial section of autobiographical memory?

Aware of the time, I skim quickly through the rest, which includes a further note, added by Oxsmith’s principal psychiatrist, Dr Sheldon-Gray, at a later date. The patient’s father, Leonard Krall, has declined to see Bethany in Oxsmith. Therapeutically speaking, this may be to Bethany’s advantage, as his explanation for his wife’s murder is that Bethany was ‘possessed by evil’.

I too have a problem with words like evil. When my mother died, my father sent me to a Catholic girls’ boarding school, a place of unshakeable Bible certainties — certainties to which a man like Krall, and the millions like him who converted during the Faith Wave, can be no stranger. Living by such certainties, he knows that the only explanation for Bethany’s violence is nothing earthly, such as pain or revenge or anger or simply a chemical imbalance in the brain, but a ‘visit’ from a notion. True faith, the kind of faith that is described as ‘burning’, carries its own aura. A sort of righteous chutzpah. You see them on their mass marches, their faces illuminated from deep within. That conviction, that passion, that energy: you can envy it.

When I arrive in the studio for my meeting with Bethany a thickset male nurse is already there, talking on his mobile, deep in an elaborate technical discussion about shift schedules. I’ve heard that Rafik is tough and alert — but his with-you-in-a-minute gesture doesn’t inspire confidence. Despite having spent much of the last few months devising and practising new physical defence strategies involving the grabbing and twisting of vulnerable body parts and the strategic hurling of objects, I feel permanently vulnerable, a moving target. The notes have just told me that in December last year, Bethany Krall bit the ear off a boy who sexually attacked her. She chewed it up so badly it couldn’t be reattached.

Marvellous. Bring her on.

Then suddenly — far too suddenly — a huge escorting nurse with tattooed arms has done just that. The door has opened and a dark streak of a girl has walked right up to me. And already she’s too close. You never get used to everyone being taller than you, to seeing them from the wrong angle. She should step back a bit. But she doesn’t. Rafik exchanges grunts with his mountainous colleague, who nods at me as if to say package delivered, and leaves. I could shift again, but I don’t want to risk it. She’d know what it meant.

Bethany Krall is small, bird-boned and underdeveloped for a sixteen-year-old. On her head, a tangled mass of dark hair like a child’s angry scribble. Self-harm being an ever-popular hobby among the female patients at Oxsmith, her bare arms reveal the usual welter of cigarette burns and crosswise slashes, some old, some more recent.

‘Hallelujah. The new psychiatrist.’ Her voice is babyish for her age but oddly hoarse, as though someone has scrubbed the inside of her throat with a chemical abrasive.

‘Good to meet you, Bethany,’ I say, manoeuvring myself to offer a handshake. ‘I’m actually a therapist rather than a doctor.’

‘Same shit, different asshole,’ she declares, not taking my hand. Like me, she’s wearing black: the garb of mourning. Does she still believe, on some level, that she has died?

‘Gabrielle Fox. I’m new here, I’ve taken over from Joy McConey.’

‘I always start by giving you guys the benefit of the doubt. That means ten stars out of ten to begin with,’ she says, assessing my wheelchair. ‘But you get an extra one for being a spaz. Positive discrimination, yeah? So you’re starting with eleven.’ The notes mentioned she was articulate but I’m still surprised. You come across it so little in this kind of place.

‘Ten’s fine, Bethany. In fact, very generous of you. I specialise in art therapy. Subscribing to the theory that art’s a good way of expressing feelings when words fail.’

Her eyes are dark, feline, heavily outlined in kohl. Sallow, olive skin, a narrow, asymmetrical face: she’s what you’d call striking rather than pretty. Or jailbait. Her hair looks matted beyond redemption. She seems a far cry from the girl in the family photo. Has she spent the last two years soaking up the institution’s own brand of teen culture, or is this attitude intrinsic? In either case, she behaves like she’s up for a fight, and she looks like trouble, and she sounds like trouble — but then most of them do, one way or another. Preliminary assessment: she’s more intelligent and more verbal than most, but otherwise, so far, so normal.

‘The bottom line is, I’m here to help you, and encourage you to express whatever you want to express here in the—’ I am unable to say Creativity Workshop: it gets stuck in my throat. ‘Here in this studio. Whatever it is. No limits. It’s an exploration. Sometimes it can take you to dark places. But I’m on your side.’

‘A spaz who patronises me. Great. Great to have you on my side in dark places. Psychobabbling away.’

‘I’m just someone to talk to. Or if you don’t want to talk, I’m here to supply you with paper and art materials. Not everything works in words. No matter how big your vocabulary.’

She waggles two fingers at her opened mouth to indicate disgust. ‘You’re down to five. I can see you don’t belong here.’ She looks at me levelly. ‘So perhaps you should just wheel yourself off into the sunset in that spazmobile of yours. Before something bad happens.’ She circles the chair, then stops behind me, and leans down to whisper in my ear. ‘So you’ve taken over from Joy. Tragic Joy. I guess you’ve heard all about the distressing way she left?’ Her knowing use of cliche. strikes me as a possible clue to her inner clockwork. She speaks as though her life is an object held at a distance, a source of amusement — a fiction rather than a reality. ‘I warned her about what would happen. I warned her.’

I’m snared by this, as she intends, but I know better than to show an interest in my predecessor, so I gesture at the walls. ‘Is any of this work here yours?’

There is a game you can play: match the artwork to the wacko. But having spent time — more time than I ever intended — in casinos, amongst roulette wheels and backgammon tables and stacked chips, I know that it’s too much like poker, another pastime it’s wise not to indulge in.

‘Yeah, Joy was tragic but you’re tragic too, I guess,’ she continues, ignoring my question. ‘I mean, you bother with make-up, when no one’s going to take a second look, are they, no matter how hot you are, right? Unless they’re some sort of perv. No offence. But hey, Spaz. Reality check.’

If you show them an abusive word has got to you, they know they’ve won. And then they can do anything. And they will. ‘I asked if you’d done any of the work here,’ I say lightly. ‘And you can call me Gabrielle.’

‘You mean these great masterpieces?’

She glances around with disdain. The artwork features the usual range of motifs: flowers, anarchic fuck- the-system graffiti, graveyards, jungle animals, bulging breasts and engorged phalluses. But there are some oddities too. One of the kids, a skinny twelve-year-old boy who helped his father murder his sister in the name of family honour, has been constructing a huge papier michi. hot-air balloon, striped blue and white, which hangs from the ceiling above us like a big light bulb. It is an enterprising, ambitious, hopeful and joyous balloon, a balloon that

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