Entry Island

The plaque on her door had told him that she was a Ph.D. and Clinical Director of the unit.

There had been no preamble. No chit-chat. She had asked him to sit, opened a file on the desk in front of her, and taken notes as he responded to her questions. Wide-ranging questions about his upbringing, his job, his marriage, his feelings on various topics, political and social. She had asked about his symptoms. When they had begun, what form they took, how often he slept. Did he dream?

For the first time she sat back and looked at him. Examining his face, he thought. A face that had grown increasingly unfamiliar to him as he examined it himself in the mirror each morning. Eyes bloodshot, deeply shadowed. Sunken cheeks. He had shed weight, and his hair had lost its lustre. Every time he looked at his reflection he felt haunted by the ghost of himself.

She smiled unexpectedly and he saw warmth and sympathy in her soft brown eyes. ‘You know, of course, why you are here,’ she said. It wasn’t a question. But he nodded all the same. ‘Your employers at the Sûreté have sent you to me because they fear that your condition is affecting your ability to do your job.’ She paused. ‘Do you think it is?’

Again he nodded. ‘Yes.’

Again she smiled. ‘Of course it is. In fact, it’s a given. The toxins that have accumulated in your body through lack of sleep are certain to have impaired both your physical and mental performance. As I’m sure you are aware, your concentration and memory will also have been affected. Tired during the day, irritable and fatigued, and yet unable to sleep at night.’

He wondered why she was telling him what he already knew.

She interlaced her fingers on the desk in front of her. ‘There are two kinds of insomnia, Monsieur Mackenzie. There is acute insomnia, which lasts for a short period, usually just a matter of days. And then there is the chronic variety, which can be defined as suffering sleep impairment for at least three or four nights a week for a month or longer.’ She stopped to draw breath. ‘Clearly you fall into the chronic category.’

‘Clearly.’ Sime was conscious of the sarcasm in his tone. She was still telling him nothing new. But if she was aware of it she gave no indication, perhaps writing it off to the irritability she had just described as one of his symptoms.

‘The cause of your condition can also be defined in one of two ways. As either primary or secondary insomnia.’

‘What’s the difference?’

‘Well, primary insomnia is unrelated to any other physical or mental conditions. It is simply a condition in itself. Secondary insomnia, however, means that your sleep problems are related to something else. There are many things that can affect your sleep. Arthritis, asthma, cancer. Pain of any kind. Or depression.’ She regarded him thoughtfully for a moment. ‘Which is, I believe, your problem. Extreme depression brought on by the break-up of your marriage.’ She inclined her head slightly. ‘Are you aware of being depressed?’

‘I’m aware of being unhappy.’

She nodded. ‘The vivid dreaming that you have described to me is frequently a symptom that accompanies anxiety or depression-induced insomnia.’

In an odd way it was almost a relief to have his dreams explained to him in this way. As a symptom. A condition brought on by something outside of his control. But normal, if the symptom of a psychological problem could ever be described as normal.

He became aware of Catherine Li watching him closely. ‘Are you still with me?’

‘Yes.’

‘There is a school of thought which argues that dreams are actually a chemical event. That they are directly affected by modulations in the brain’s neurotransmitters. You know what REM is?’

‘R-E-M?’

‘Yes.’

‘A band, weren’t they? Losing my religion?’

Her smile indicated anything but amusement. ‘You know, I’ve never heard that one.’

‘I’m sorry.’ He lowered his eyes, embarrassed.

‘REM stands for rapid eye movement. It describes a phase of sleep that you go through, typically, four or five times a night, accounting for anything up to 120 minutes of a night’s sleep. It is also when most dreams occur. During REM sleep acetylcholine and its regulators normally dominate, while serotonin is depressed.’

Sime shrugged, incomprehension written all over his face now. ‘Which means?’

She laughed. ‘It means that I might recommend prescribing you SSRIs.’

‘Of course, why didn’t I think of that?’

This time her smile was wry. She said, patiently, ‘Selective serotonin re-uptake inhibitors. That would increase serotonin levels and elevate your mood.’

Sime sighed now. ‘In other words, an antidepressant.’

She shook her head. ‘Not just any antidepressant. In fact, most popular antidepressants would probably only make your condition worse. I think this could help.’

Sime was unaccountably disappointed. He wasn’t sure what he had expected. But another pill just didn’t seem like any kind of a solution to his problem.

II