The account of a day's desperation in the City. Written over a 10 month period while sleeping rough beneath a London bank. This first novel by Edmund Davie will not disappoint.
North Hackney Mental Health Team
Anita House Wilmer Place
London N16 0LN
Dear DR -----------
RE: Mr Edmund Davie, D.O.B. 14 October 1979
I saw this 34-year-old single white Caucasian man at the request of his GP for an initial assessment on 31 July 2014. His GP had referred him for help with low mood related to his living situation. The patient told me “I have been homeless for 10 months - I saw the GP because I’m homeless.” The patient told me that although he had suffered with low mood persistently, with fluctuations, since the age of 21, matters had become much more difficult over the past year, particularly as he comes to worry more fre- quently about what he sees as a bleak and hopeless future. Presently, he is capable of being distracted from his sad and anxious moods for useful periods, and admits some lift in his sense of hope and sadness since seeking formal help. He tells me that he has remained capable of deriving pleasure from being alone and reading. Suicidal ideation and diurnal variation of mind are absent, and he is ultimately hopeful that he can address his difficulties.
His appetite is satisfactory and he tells me that he eats regularly, although exploring this it seems he does have a somewhat sparse diet, rarely eating cooked meals that he can prepare for himself due to a lack of facilities. He drinks alcohol intermittently, mainly beer, but does not display a problem or dependent pattern of drinking. He admits that he has used alcohol to cope with anxiety in the past. He does not use illicit drugs. He enjoys drinking in the company of a female friend, herself a mental health service user, whom he met via the homeless services in November of last year. She now lives in a hostel for ‘vulnerable women’. He is not taking any prescribed psychotropic medication. He experiences insomnia most nights, and his sleep varies in accordance with his erratic living pattern, moving between homeless hostels and the sofas of friends. He lies awake, his mind busy with anxi- eties over the future, as well as angry thoughts at recent rejection from his parents, who failed to help him when he returned to his family home in the autumn of last year, desperate and homeless. He has a satisfactory libido, and is capable of arousal.
He underwent a normal birth and acheived satisfactory motor and social developmental milestones. His father was an optician (now re- tired), and his mother was a teacher. He has one brother who is doing well, “He’s the square one.”
He told me that he was unhappy as a child. and from very early on in life had a sense of himself as somehow different from others. At school he was “the one who did well,” and was often bullied for being somewhat different. The patient spoke in almost contemptuous tones of the environment in which he was raised, at home and at school. He obtained excellent grades at GCSE, but slightly less successful grades at A-level. He told me that he spent much of his time as a teen- ager alone, reading and practising keyboard.
At 18 he moved to London and studied French at UCL, obtaining a second class degree at the age of 24. He told me he was disappointed by London, which he found “full of more people who I couldn’t relate to.” He told me that he pursued an isolated existence throughout his time at university, and his mood plumetted during his year in France, working as a teaching assistant, at which time he found him- self lonelier than ever, and contemplated suicide in a methodical fashion for the first time. He began to self-medicate heavily with alcohol during this time. Upon graduation he tried to start a career as a musician, and socialise within the ‘muso’ scene, but despite some success early on, he preferred to work alone, composing rather than performing, and acheived little beyond musical dabbling, a hobby that he continues to pursue through to the present.
The patient told me that he has held down relatively few stable jobs in his 20s and early 30s, with frequent moves of home, and little in the way of stable, attached relationships. When I asked him to describe the reasons for his frequent moves and evictions, he gave a justifiable sequence of reasons all of which hinted at an underlying sense of irritability, vulnerability, and intolerance of others. This appears to have led to a steady down-spiral into homelessness, low mood and increasing isolation. In the autumn of last year, he finally returned to his family, with whom he has a strange relationship, and found that this did not go well. He returned to London and further ‘sofa surfing’. From time to time he stayed with his girlfriend - “I had to move out, she was furious at me”. This led to him sleeping rough for the first time in Feb- ruary, something which he regards as his personal nadir.
The patient told me that he has long had diffi- culties relating with others sufficiently well to obtain work. He told me he was bad at gettingjobs “because it’s so hard to do, so dispiriting.”
Despite his difficulties, he tells me that he has a small group of supportive friends, as well as some relatives, whom he sees intermittently, and hopes that in the fullness of time, he may find this net- work to find work, possibly as a proofreader, as he considers himself to be good at concentrating on the content of the written word for long periods.
Viewed objectively, the patient was a tired, thin looking pale white man who smelt unwashed. He had intermit- tent, under-confident eye contact throughout most of our interview, and rarely smiled. He did not warm or ‘open up’ particularly throughout the interview, and his mood, objectively, appeared to be a state of sullen irritability and gloom rather than primary depression. Primary features of an anxiety state were absent as were suicidal ideas.
There was no evidence of a psychotic disorganisation, and his speech was delivered in a flu- ent, steady manner, with no evidence of retardation, although there was some flattening of intonation. The themes of his thinking were dominated by a sense of irritable helplessness, and generally a resentful world- view alongside a hope that ultimately he would find a solution to his difficulties, something that centred upon obtaining a stable roof over his head in the first instance.
Towards the end of the interview, I challenged him with regard to the idea that he had unrealistic expectations of being helped, given his somewhat dismissive, con- temptuous view of fellow human beings. He was quick to point out the shortcomings of the facilities made available to him. For example, he told me he had no access to washing facilities, although a short telephone conversation with the patient’s homeless support worker confirmed that these facilities were indeed available to him, but that he did not make full use of them.
In summary, the patient is a 34-year-old single man who currently suffers with a steadily deteriorating state of dysthymic irritability occuring in the setting of a personality that is probably at the mild end of the austistic spectrum. He displayed an apparent disregard for the points of view of others, a subtle but persistent absence of facial and social cues, somewhat flattened if gloomy affect and noticeable self-neglect. He is also of well above average intellectual intelligence, and has for many years had difficulty relating to others, preferring isolated bookish pursuits. It is difficult to gain a clear grasp of this patient’s actual level of interpersonal skills from one interview.
The fact that he has one or two friends who are willing to provide him with short-term accomodation suggests that he is capable, at least in a vestigical sense, of relating to others and a full indication of his interpersonal skills is indicated. I think that there will be little benefit from this pa- tient using antidepressant medication. I will make a referral for assessment by our psychotherapy services to see whether they think that his long-standing irritabile low mood at its present difficulty might be addressed by our psychotheraphy services. I’ll also send a brief report to his housing support work- er emphasising his vulnerability on psychiatric clinical grounds to see if this will help in getting him housed.
Lights, A Novel With An Index. Edmund Davie 2018