((CONTENT WARNING: Mental Illness))
((Caroline Ford continued from Least of All Young Caroline))
She was curled up in a comfortable maroon armchair. On one arm of it sat a box of tissues, unused. On the other, Caroline’s trembling left hand.
They were reaching the end of their session. She felt like she was only just beginning to understand how bad things really were. Her eyes darted to the art on the walls. The office was part of her therapist’s home, out of which he ran his practice. Abstract paintings in soft colours hung on several of the walls, no doubt intended to be comforting. They only seemed to overstimulate her tired eyes.
Sat across from her was a thin man in his early fifties, clad in a worn-looking corduroy jacket, rumpled green shirt and faded jeans. He had the persistent just-barely-a-beard facial hair of a man who doesn’t shave terribly often, and the intense glare of someone whose intellectual faculties far outstripped most of the people he met. His thinning grey-brown hair was combed back, though it always looked like he’d done so in something of a hurry.
George Bernard Paulson, Psy.D, PhD. Specialist in Abnormal Psychology. Over fifteen years of clinical practice under his belt. He had tenure at the University of Tennessee, and was apparently selective with his patients. For a family friend, he made something of an exception; Caroline’s mother knew him from her book club, which had been meeting regularly for many years. His friends called him Geordie. Caroline always called him Dr. Paulson. He was intimidating at first, but after the first session she found his presence quite comforting. It was good to hear from someone who at least seemed to know what they were talking about. Who might know what was going on with her. It was hard to imagine he didn’t have at least some idea. She certainly didn’t understand it.
She had been talking for what seemed like hours, starting and stopping as different facets of what she’d been experiencing came to the surface. She went into detail in some cases, left out others entirely, but she did not lie. It was important not to lie to him, because he was the only one who could help. He had to know what she had gone through.
Dr. Paulson had spent most of the past hour listening silently and writing into a patient ledger. Caroline continued her stumbling, monotone outburst, though at this point she felt that she was only repeating things that she had already said in so many words.
“Every day I have these thoughts that come to me. Horrible things. It’s like they’re not even mine. Things I wouldn’t even like, think. It just doesn’t stop and I can’t even remember what it was like to not be like this. It’s like I just found out something and I can’t forget it, even though I want to. Is this just how I think now? Not like I think that way, what I think isn’t the things that I’m a believer in; I don’t say the things that I really think. I mean, my head isn’t saying the things I think, they’re different things.”
Caroline’s eyes darted around the room. Dr. Paulson waited, patiently, though she could see the gears turning in his mind. He had been helpful so far. Maybe he had an answer that wasn’t the one she had come to. Her answer was much worse.
“Come unto me, all ye that labour and are heavy laden, and I will give you rest. I don’t feel very close to God right now. Maybe I just need to leave here. Maybe I’m not meant to stay up here. In my head. It’s wrong, and I know it isn’t something I should be thinking about. Maybe it’s just those intrusive thoughts again. But if I… like if I died, maybe that would be better than this? What even is this, this thing that‘s… hounding me?”
Dr. Paulson put up a hand, motioning for her to stop. He spoke with a distinctive and broad Midwestern accent, which gave him a strange levity to his voice, even when he was completely serious.
“Look, Caroline. This all seems very intractable. Experience tells me it isn’t. But there isn’t anything I or anyone else can say that is going to cause any sort of fundamental shift in perspective right now, it’s not quick.”
He scratched the end of his nose and ran his hand across his face, almost as if he was just realizing he needed to shave. It was a tick, one he expressed whenever he had a salient thought that was still forming as he said it.
“Look, there are a lot of things that can cause depression, and we don’t necessarily know exactly what they all are. We know some of them, but it’s never a sure thing. You’ve spoken about how have a difficult time explaining the distance you’ve put between yourself and your peers. In many respects you are correct in thinking it’s impossible to try and explain it – like, it’s hard for people who aren’t in this position to imagine what you’re going through, just as really bloody difficult right now for you to imagine being out of it.”
He reached to the small table next to him, setting aside his ledger, and taking a drink from a coffee mug before continuing.
“It’s a product of your biochemistry, of how your mind is developing. Just because everywhere you look is catastrophe, that there’s no way out of it, that you have no hope – does not make it so. You cannot necessarily trust your instincts right now, in fact I’d say you more often than not have to fight against them, tooth and nail. It’s very difficult for a lot of people to admit that they cannot necessarily trust in their firsthand perception of reality. Really, quite difficult.”
Caroline sat forward, locking eyes with Dr. Paulson. If she didn't, his words would slip past her and she would get lost in her own head. All of her strength was poured into trying to find a line, anything she could hang onto, in what he would say.
“So I would first say that you need to remember that you aren’t alone in living with this, and there are those who I would say lack the internal fortitude that you possess, who have lived through it. Yes, there are people for whom I have seen it to be nearly impossible to help, you’re not wrong to think of this as an almost intractable problem.”
Dr. Paulson seemed to hang on that last point. His eyes drifted as he seemed to recall something that troubled him. He suddenly held up a finger, counting off a list of issues – clearly those he had seen or experienced personally, though described in a distinctly clinical tone.
“…but usually these people have no job, no friends, no intimate relationships, some kind of health problem, or a drug problem. It’s hard for them to dig themselves out because they might make progress on one front - and the other drags them back into the ‘pit’ like you’ve described. They’re so buried in what’s happening to them that they can’t even deal with the mundane, everyday aspects of their life.”
“…Things just pile up.” Caroline interrupted, trying to contribute to what he was saying. She wanted him to think she was listening. Even though she felt like the emotional equivalent of a dead lightbulb, she knew what he said had merit and didn't want to appear disinterested or ungrateful. Trying to signal emotions felt like being in a play where everyone except Caroline had the script.
“Exactly. You could ask them about a routine, and there’s just, there’s nothing. It’s not always the people you’d expect either –it could be someone who just finished their Ph.D and is just stuck in the mud without an objective or palpable direction and it’s this absolutely crushing, intimidating experience. It could be someone in a high-stress job who just has one bad day and can’t come back from it. Y’know, they just find themselves lost and stop actually living their lives, and it just spirals out of control. Even if they saw the real problem, it’s like everything’s just such a mess they wouldn’t even know where to start. It takes years – if at all.”
A moment of realization struck Caroline. Could he really know what this was like. Had he been there?
“-but that isn’t you. You’re not stuck on pride or ignorance. You took the big steps early. You know you have an affliction, and you’re doing what you need to do to get better. Just like anything else.”
Dr. Paulson paused, his gaze scrolling from one of the paintings to the other, then back to Caroline. She wondered what it was that they did for him, if they confused and disoriented her so much.
“You’ve got a lot going for you. You’ve got clear goals, you are a person who enjoys and embraces routine, and you’re looking after your physical health quite well. Your faith is an important structure in your life and everything I’ve seen tells me that your community has been a major pillar of support for you. In a way we’ve eliminated a lot of possibilities as to the genesis of what you’re going through right now.”
She cocked her head. He knew what it wasn’t – what use was that?!
“That’s part of what we’d call differential diagnosis – eliminating possibilities until we find the most likely cause. I suspect that this is predominantly a problem of chemical imbalance, perhaps with some relationship to an autoimmune disorder. Even at this early stage, the work that you’re putting into keeping your head above water is quite frankly impressive, given what you’ve told me. You’re coming to see me, you’re still keeping up with your studies, you’ve started on medication-"
With a sudden jerking motion, Caroline rose from the armchair, her fists clenched and her voice raised. It was theatrical, almost deliberately so.
“The pills don’t work! I can’t pat myself on the back for taking steps to get better, if it isn’t making me feel better! Or feel anything at all! I hate this, this gray world. What happened to the old one? I miss the old colourful world. I don’t want to just try and watch nothing change, or just keep my head above water, I want out!”
If she had actually felt angry, her voice would be trembling. She cried whenever she got really angry. There were no tears though, and she spoke clearly and deliberately. She raised it because she wanted to be angry. Faking it didn’t work. Dr. Paulson calmly continued, and Caroline slowly slid back into the armchair. Things didn’t feel any different standing up, so there wasn’t much point in making a scene.
“Caroline, I understand that you’re frustrated. It is frustrating that we can’t figure out the exact combination of medical treatment and therapy right off the bat. I’d gladly take the pay cut if it meant I could hand every patient a panacea on their way in but it doesn’t work that way.”
“Dr. Paulson, I want to die. Do you understand that? I don’t feel anything anymore, and this makes me want to die.”
Do it! Charlatan. Con man. Kill yourself, he doesn’t deserve your money.
“The place you’re in still has possibilities, and the opportunity to change, as awful as it feels. Suicide limits your options, arbitrarily so. We can’t work on you when you’re dead. We can’t exhaust every available option. You can’t throw out those possibilities before you’ve given them a chance. There are technical reasons why antidepressants work. It takes time.”
“Do I even have time? Do you think I can keep the negative thoughts away? They don’t stop.”
“You’re already ahead of the curve. I’ve had patients that it’s taken two years just to get them to even try an antidepressant. You’ve already started. It’s just one month. One month, and we’ll know.”
It may as well be a hundred years, Caroline thought.
“We might find out in a month or two and we’ll know this isn’t working out. Or it may help a bit, but not as much as we wanted. Then we try something else. We can’t be under any illusion this is the fix, but it’s a necessary step. It’s the best shot we have at getting you to a better place. All you have to do is hang on. Fake it until you make it, because one key element is that you have to convince your subconscious that everything is okay, because that’s the part of the body that actually induces the kind of response that creates these negative thought patterns in the first place. It has more to do with what’s going on under the surface than it does with your conscious intentions.”
“I’m… barely able to get up in the morning. How much do you think I can do?”
“Obviously there’s a lot of negotiating with yourself as to what you’re willing to do and what might be too much. You can fulfill your least objectionable responsibilities such that you can go to sleep at night, at the right time. Just check off the boxes, do something and make it to the other side. Find a reason – pride, spite, faith, whatever motivation you can get even the slightest purchase on. Remember to count your victories, however small. That’s the trick.”
“Just get through the days until the drugs can start to kick in. Then I can get out of here?”
“Out of therapy?’”
“Out of this gray world, like I said. The place where nothing feels real, where God feels far away and nothing seems to matter. You know, where I live.”
“…Yes, I suppose that’s one way to put it. The symptoms you’re describing – derealisation, that can abate with the right combination of therapeutic strategies and medication. It’s not an uncommon experience in those who deal with severe depression, though some report it as an initial side effect of antidepressants themselves. Again, that’s something we’ll have to wait and see for, probably in a week or two. At this point, two sessions in I still want to see if we can really get a handle on the full scope of this before we pursue any one angle of treatment in particular. Have you been keeping the thought diary, like we spoke of before?”
The dizzying tempest of words that Dr. Paulson spewed forth never felt especially warm. For someone like Caroline, the scholarly way he approached her problems was easy to understand. It wasn’t comforting, but it was helpful. A few things he’d said stuck in her mind from the last session, and she spoke them like mantras when things got really bad. In many ways it was more helpful than the pitying affection she got from friends and family. Their looks of concern felt like pressure from all sides.
Dozens of voices that just wouldn’t shut up and actually do something useful.
Dr. Paulson was a man of science, and a man of faith. He saw a problem he knew was solvable and he believed she could solve it. He was an expert, and if he knew what she knew, he’d understand how to solve her problem. The only problem was finding a way to tell him. She produced a wrinkled dollar-store notepad from her bag, and handed it to Dr. Paulson. He looked reticent, not reaching out to take it right away.
“You know, I don’t need to read it. It’s enough that you keep-“
“Please, read it. I finished this one anyways, it was cheap, you can give it back to me next time. Just let me know what you think. If you know more, then you’ll be able to help, right? It’s sometimes hard to say things out loud. I’ve got a second one I’m writing in now.”
Dr. Paulson reluctantly took the journal, and set it on the table beside him without opening it. Feeling a tingling restlessness, Caroline grabbed her bag and stood up, heading for the door. They were already ten minutes over. Someone was probably watching them, checking the time. Someone was watching them.
“Alright. I’ll see you next week? You have my number if you need to talk to me. If the ideation-“
“911. I know.”
“I see you, Caroline. I see you.”
Caroline turned to look at Dr. Paulson as she left, and her eyes widened. She blinked, and looked away from the tall, rapidly trembling figure looming behind Dr. Paulson.
“I’m sorry, what did you say?”
“I said I’ll see you next week ,Caroline.”
“Oh. Right.”
She reached out to shake his hand, and he took it with a firm but gentle shake. He always looked like he hadn’t slept much, himself. Paying little mind to the ever-widening, toothy mouth of the maroon silhouette that stood behind him, she turned on her heel and walked out the door, nearly slamming it shut on her way out.
Differential Diagnosis
1
Situation: Can’t focus on calculus.
Feeling: Dead inside. Bored. Feel stupid.
Automatic thoughts: You’re useless, and a fake. Eat the paper. Choke on it. Die.
Alternative Response: I haven’t eaten today because I wasn’t hungry. I am probably low on energy.
Future Action: I’ll make sure to eat and drink water after I get home, and take more breaks.
2
Situation: Keep hearing someone yelling my name. Ask and no one said anything. Yelling keeps going.
Feeling: Confused. Am I crazy?
Automatic Thoughts: I can’t tell anyone about this, they’ll make fun of me. Crazy Caroline is too easy. Also if you tell anyone I’m going to KILL YOU.
Alternative Response: This could be a sign of sleep deprivation or something worse. I should tell Dr. Paulson.
Future Action: The next time this happens, tell Dr. Paulson. DO NOT TELL DR PAULSON
3
Situation: Unclean thoughts about the bishop’s son.
Feeling: Upset. Excited. Screaming on the inside.
Automatic thought: Stupid slut. They all know you’re a slut. He knows. He’d fuck you to death if he knew he could get away with it. Don’t talk to him. Don’t look at him, he’ll know you’re a slut, Caroline.
more thoughts: don’t listen to him, he’s a nice boy and it’s normal to have these thoughts. you’re a wee bit stressed, get some air. you’ll be okay if you get some air. i’m here to help.
Alternative response: The natural woman finds these things appealing. Nature is what we are meant to overcome. It is normal to think of things like this, but I should work harder to keep my thoughts clean. “Let virtue garnish thy thoughts unceasingly. The Holy Ghost shall be thy constant companion”
Future Action: I will consult scripture and avoid immodesty if I see it.
4
situation is looking pretty grim. it knows about dr paulson
it frightens me.
if I say anything it’ll kill me
i don’t know what to do
help
5 5 5 5 5
Situation: butterflies crawling up the walls in my bedroom when i’m trying to sleep
Feeling: angry. why won’t they let me sleep
Automatic Thoughts: blanket feels like a cocoon. maybe i’ll be a butterfly someday?
Alternative Response: Sometimes close to sleep, a person can hallucinate, especially if their sleep patterns are disrupted. I should ask the bishop if chamomile tea would be acceptable to help me sleep.
sleep sleep sleep sleep sleep
Future: hot drinks
6
Situation: No one talks to me at school.
Feeling: Lonely. Empty. Scared.
Automatic Thoughts: “you’re never alone. you’ll never be alone again. you have many friendables.”
alternative thoughts: “friendables isn’t a word ye great Cheshire cat lookin’ git.”
automatic response: “shut up or i’ll kill her”
automatic thought response: “come and try it, you craven arse”
Future Response: I should talk to Chloe more often.
7
Situation: He won’t stop playing.
Feeling: Annoyed, concerned.
Automatic Thoughts: I don’t want to tell him to stop because he’s nice. I just can’t stand bagpipes.
Alternative Response: Maybe we can settle on a time of day.
Future Action:
8
It starts screaming at me in church. it hates church.
Does anyone else notice? Do they just ignore him?
Maybe they’re too ashamed to say anything. They hate me.
Is any of this real?
I want to get out of here. Dr. Paulson or a razor blade.
9
Situation: Someone is poisoning the meat in the cafeteria. Richard was acting weird today. I think he wanted to do something to me.
Feeling: Threatened. What are they putting in the meat? And why?
Automatic Thought: You know what he wanted to do to you. You were stupid to sit there. Now he knows your scent. They’re coming for you. They poisoned him and he’ll be after you now.
Alternative Response: there’s no way out of this you stupid bitch. you’ll die screaming and I’ll be there to watch.
Future Action: Avoid cafeteria.
10 10 10 10 10 10 10 10 10 10
Sitch: Jerrod Canon is the President of America and he isn’t real.
Feel: Terror.
Autothought: there’s no way he’s real. it’s a fiction. the poisoners want us to believe he is so we don’t see what they’re doing. they lie, they’re all liars. They’re going to kill you, Caroline.
Alt-Resp: donot fear, we’ll be together soon. can’t fear what isn’t real. i should not be afraid
Future: Warn Dr. Paulson – Warn Dr. Paulson - Warn Dr. Paulson - Warn Dr. Paulson - Warn Dr. Paulson
11
S: can’t tell him out loud
F: trapped
A: screaming at me. threatens to eat me and rape chloe
AA: it can’t be real
F: tell Dr. George Bernard Paulson Ph.D Psy.D
12
Situation Dire: can’t find the scotsman
Too much feeling: alone
Fully Automatic Thoughts: i’m completely alone here, no one can save me. christ has abandoned me. where are the angels?
Alt-Response: Dr. Paulson can help me
Future Tense Action: the doctor will see me now.
13
I’m away from God. This is the outer darkness, isn’t it? I didn't reject Him. Did He reject me?
I don’t feel like there is a God here. There can’t be. God is love and joy.
There is no God, you stupid cunt.
Alternative Response: You lie, you bastard. Get out of my head.
Future Action: Pray.
14
Situation: Have to tell Paulson, today’s the day.
Feeling: Empty. Nothing. Stress? It’s quiet.
Automatic Thoughts: Still in the gray world. More like ash than darkness today. Can’t tell Dr. Paulson out loud though, or it’ll hear me.
Alternative Response: You will get treatment or you will escape the gray world the hard way. Everything will be fine.
Future Action: I will give Dr. Paulson this notepad and he will know.
((Caroline Ford continued elsewhere))
There were patients who felt like mysteries to solve, psychological enigmas whose afflictions were varied and indecipherable. The men most often didn’t know how to communicate their emotions, and struggled to explain what was happening to them. It felt like pulling teeth sometimes just to get some of them to talk. For the women it was difficult to get them to admit there was even a problem, though they seemed well-acquainted with every emotional foible, many had been told that they were just “unstable women” by husbands and fathers and siblings for their whole lives. For both, getting them to actually progress with treatment in any meaningful capacity was an uphill battle, nearly without exception.
Those conversations often functioned as cold water thrown onto the little remaining optimism Geordie had about the human condition. What enjoyment he derived came from the act of solving the puzzle, or rather watching his patients solve it themselves. Those moments made up for every session he left wondering if there were any just, decent people left in the world. Normally he didn’t take patients Caroline’s age. Back home he’d taken several high school students as patients following a terrorist attack, and had to take a year’s sabbatical immediately after the end of their sessions. It was very hard to shake the vivid mental images they painted for him.
It often made him wonder if he’d taken the right path in life. No matter what good he did for his little corner of the world, something horrible would inevitably happen, something neither he nor anyone else could have stopped. Geordie would spend several evenings drinking and wondering why he had to live in such a sick and twisted world where the lives of children could be so callously toyed with, for no good reason. There couldn’t have been a good reason for something so heinous.
Then some nights, the e-mails from old clients would come. They’d tell him he’d saved their lives, their jobs, their marriages. He’d find a way to go back to work, to help guide people through the suffering that was life. To find a way to make all of the pain and hardship worth it. Every life was going to end in tragedy somehow, but they could be worth living. It’s what kept him from living in the kind of gray, dead world Caroline spoke of.
Caroline wasn’t much of a mystery. She was as bright as they came, both academically capable and emotionally intelligent. Though she was struggling, she fought for herself in a way that took many patients years to figure out. It was admirable – encouraging, even - to see a young person who was so committed to rescuing themselves. He tried to maintain a reasonable amount of skepticism and trepidation, though. Usually the symptoms of depression in a girl her age would intensify and ebb year after year. It wouldn’t surprise him if she made a breakthrough, only to fall into a worse state some time afterwards. That in mind, she had every tool she needed to survive this part of her life.
For the first half of today’s session he’d remained largely silent as she drifted from point to point, describing what she’d experienced and then deconstructing it before him. The questions he’d thought to ask she would come to herself. It was scatterbrained and she often spoke in circles, but she appeared to know what she needed to talk about. It seemed she’d done research on therapy before arriving for the first session, even bringing notes. Her dedication was impressive, but as far as he could tell that was her only especially unique quality as a patient.
She wasn’t very interesting. It was clear she was suffering from a major depressive episode, with fairly extensive symptoms of depersonalization and derealisation. It was unusually severe, but she wasn’t suffering in silence. The suicidal ideation was concerning, but she possessed an encouraging amount of self-awareness and didn’t hide away from her family. In a few weeks they would probably see some small improvements. She was likely a classic case of a patient who’d otherwise have their life together if not for a particular chemical imbalance, the kind of person for whom antidepressants were extraordinarily effective. In other words, what Charlotte and Ronan Ford had paid for could probably have been done by any general practitioner with a basic knowledge of SSRIs.
Geordie sat in his office, alone. It was his actual office next to his bedroom, not the one he saw patients in. The room was messy and cluttered, and he liked it that way. What looked like chaos to others was a carefully ordered nest of old books, patient files, coffee mugs and the odd lowball glass. Though he lived alone, he still needed a space that felt like a retreat, far removed from the world's problems. The décor was a kind of white noise, to keep his mind from remaining on one troubling concept or puzzling thought for too long.
A pile of graded papers sat next to his laptop, on which lay the notepad that Caroline had left for him. He didn’t want to take it, but she seemed to have taken to the habit of filling it out with quite a bit of zeal. That she’d filled out the entire thing in the two weeks since their first session was slightly concerning, but he’d initially ascribed it to her restless nature and work ethic. Charlotte had told him that Caroline was the kind of girl who’d finish all of her homework the night of, and then keep studying afterwards. It didn’t seem unusual for her, when he thought about it.
So he’d left the it alone for a while. Skimmed the first page and saw that she’d been following the instructions more or less to the letter, and left it be. What was it going to tell him that he didn’t already know? It sat among the pile of clutter in his office for over a week, past their following session. It was uneventful, she was feeling some abatement in symptoms though nothing especially ground-breaking. At the very least by the third session, she'd said that she wasn't feeling ever-present suicidal thoughts to the same degree she had initially. For some reason though, that didn't entirely comfort him. It didn't make him feel much at all, and that was the reason he stared at the ceiling in his office at two in the morning.
For whatever reason it hadn’t blended into the rest of the clutter in his office. Every time he’d glanced at it, he found another excuse not to go through the whole thing. It was hard enough to treat patients when he was getting paid for it. He didn’t want to – no, he shouldn’t expose himself to more than he could handle. What was reading the mood journal of an eighteen year old girl going to do to really help her treatment, anyhow? The exercise was for her, to help identify her illness and develop thought patterns to combat negative ideation. From Caroline it would probably read like a textbook.
Eventually he ran out of excuses. It was around the same time he’d ran out of bourbon, and he found himself with the journal in his hands. It'd be an exercise in tiring his eyes enough to sleep soundly, he thought. Fourteen of the pages had thought journals written in them, some following the lines of the page and others scrawled in all directions, barely legible. There was a lot of paper in the coil binding of the notepad where she had torn out paper.
As he turned the pages, the prospect of falling asleep felt increasingly less likely.
On some she had drawn what looked like doodles, though with Caroline’s careful hand they were quite clear. Frenzied renditions of a toothy, wide-mouthed silhouette took up several of the pages, peering out from one corner of the paper or another. Others depicted a man in Highland dress, with an empty space where his face should have been. She had taken up an entire page to draw a putrid-looking sandwich, with a grotesque caricature of an eyeless Jerrod Canon salivating nearby. Another was full of dozens of butterflies with human mouths, shouting at a sleeping figure.
The last image in the notepad was a sketch of Geordie sitting in his chair in their therapy session, with the tall, maroon silhouette standing behind him. It had empty black voids for eyes, and a large mouth lined with pointed teeth. Caroline’s rendition of Geordie was accurate, even flattering – but the silhouette looked like it had been drawn in a panic. At the time he had thought she might have been preoccupied with a painting behind him, or was just glancing away out of shyness. Why would he have thought otherwise?
George Paulson wouldn't sleep that night. He had made a horrible mistake.
Those conversations often functioned as cold water thrown onto the little remaining optimism Geordie had about the human condition. What enjoyment he derived came from the act of solving the puzzle, or rather watching his patients solve it themselves. Those moments made up for every session he left wondering if there were any just, decent people left in the world. Normally he didn’t take patients Caroline’s age. Back home he’d taken several high school students as patients following a terrorist attack, and had to take a year’s sabbatical immediately after the end of their sessions. It was very hard to shake the vivid mental images they painted for him.
It often made him wonder if he’d taken the right path in life. No matter what good he did for his little corner of the world, something horrible would inevitably happen, something neither he nor anyone else could have stopped. Geordie would spend several evenings drinking and wondering why he had to live in such a sick and twisted world where the lives of children could be so callously toyed with, for no good reason. There couldn’t have been a good reason for something so heinous.
Then some nights, the e-mails from old clients would come. They’d tell him he’d saved their lives, their jobs, their marriages. He’d find a way to go back to work, to help guide people through the suffering that was life. To find a way to make all of the pain and hardship worth it. Every life was going to end in tragedy somehow, but they could be worth living. It’s what kept him from living in the kind of gray, dead world Caroline spoke of.
Caroline wasn’t much of a mystery. She was as bright as they came, both academically capable and emotionally intelligent. Though she was struggling, she fought for herself in a way that took many patients years to figure out. It was admirable – encouraging, even - to see a young person who was so committed to rescuing themselves. He tried to maintain a reasonable amount of skepticism and trepidation, though. Usually the symptoms of depression in a girl her age would intensify and ebb year after year. It wouldn’t surprise him if she made a breakthrough, only to fall into a worse state some time afterwards. That in mind, she had every tool she needed to survive this part of her life.
For the first half of today’s session he’d remained largely silent as she drifted from point to point, describing what she’d experienced and then deconstructing it before him. The questions he’d thought to ask she would come to herself. It was scatterbrained and she often spoke in circles, but she appeared to know what she needed to talk about. It seemed she’d done research on therapy before arriving for the first session, even bringing notes. Her dedication was impressive, but as far as he could tell that was her only especially unique quality as a patient.
She wasn’t very interesting. It was clear she was suffering from a major depressive episode, with fairly extensive symptoms of depersonalization and derealisation. It was unusually severe, but she wasn’t suffering in silence. The suicidal ideation was concerning, but she possessed an encouraging amount of self-awareness and didn’t hide away from her family. In a few weeks they would probably see some small improvements. She was likely a classic case of a patient who’d otherwise have their life together if not for a particular chemical imbalance, the kind of person for whom antidepressants were extraordinarily effective. In other words, what Charlotte and Ronan Ford had paid for could probably have been done by any general practitioner with a basic knowledge of SSRIs.
Geordie sat in his office, alone. It was his actual office next to his bedroom, not the one he saw patients in. The room was messy and cluttered, and he liked it that way. What looked like chaos to others was a carefully ordered nest of old books, patient files, coffee mugs and the odd lowball glass. Though he lived alone, he still needed a space that felt like a retreat, far removed from the world's problems. The décor was a kind of white noise, to keep his mind from remaining on one troubling concept or puzzling thought for too long.
A pile of graded papers sat next to his laptop, on which lay the notepad that Caroline had left for him. He didn’t want to take it, but she seemed to have taken to the habit of filling it out with quite a bit of zeal. That she’d filled out the entire thing in the two weeks since their first session was slightly concerning, but he’d initially ascribed it to her restless nature and work ethic. Charlotte had told him that Caroline was the kind of girl who’d finish all of her homework the night of, and then keep studying afterwards. It didn’t seem unusual for her, when he thought about it.
So he’d left the it alone for a while. Skimmed the first page and saw that she’d been following the instructions more or less to the letter, and left it be. What was it going to tell him that he didn’t already know? It sat among the pile of clutter in his office for over a week, past their following session. It was uneventful, she was feeling some abatement in symptoms though nothing especially ground-breaking. At the very least by the third session, she'd said that she wasn't feeling ever-present suicidal thoughts to the same degree she had initially. For some reason though, that didn't entirely comfort him. It didn't make him feel much at all, and that was the reason he stared at the ceiling in his office at two in the morning.
For whatever reason it hadn’t blended into the rest of the clutter in his office. Every time he’d glanced at it, he found another excuse not to go through the whole thing. It was hard enough to treat patients when he was getting paid for it. He didn’t want to – no, he shouldn’t expose himself to more than he could handle. What was reading the mood journal of an eighteen year old girl going to do to really help her treatment, anyhow? The exercise was for her, to help identify her illness and develop thought patterns to combat negative ideation. From Caroline it would probably read like a textbook.
Eventually he ran out of excuses. It was around the same time he’d ran out of bourbon, and he found himself with the journal in his hands. It'd be an exercise in tiring his eyes enough to sleep soundly, he thought. Fourteen of the pages had thought journals written in them, some following the lines of the page and others scrawled in all directions, barely legible. There was a lot of paper in the coil binding of the notepad where she had torn out paper.
As he turned the pages, the prospect of falling asleep felt increasingly less likely.
On some she had drawn what looked like doodles, though with Caroline’s careful hand they were quite clear. Frenzied renditions of a toothy, wide-mouthed silhouette took up several of the pages, peering out from one corner of the paper or another. Others depicted a man in Highland dress, with an empty space where his face should have been. She had taken up an entire page to draw a putrid-looking sandwich, with a grotesque caricature of an eyeless Jerrod Canon salivating nearby. Another was full of dozens of butterflies with human mouths, shouting at a sleeping figure.
The last image in the notepad was a sketch of Geordie sitting in his chair in their therapy session, with the tall, maroon silhouette standing behind him. It had empty black voids for eyes, and a large mouth lined with pointed teeth. Caroline’s rendition of Geordie was accurate, even flattering – but the silhouette looked like it had been drawn in a panic. At the time he had thought she might have been preoccupied with a painting behind him, or was just glancing away out of shyness. Why would he have thought otherwise?
George Paulson wouldn't sleep that night. He had made a horrible mistake.