By the time I was twenty I was living in a slum house in Sheffield. I had a husband and no money; those things I could explain. I had a pain which I could not explain; it seemed to wander about my body, nibbling here, stabbing there, flitting every time I tried to put my finger on it.

When I packed my bags for London, at 18 years old, I went to live in a women’s hall of residence in Bloomsbury. It was a haven of warmth, calm and order. My course was engrossing, and it was taught by lawyers and academics of stature and reputation. I got involved in student politics: meetings that dragged on towards midnight. It was what I liked, and student politics at the London School of Economics had at least some crossover with the real world. The rattling, down-at-heel, overcrowded buildings pleased me better than any grassy quad or lancet window. And I was doing well; my tutors were beginning to talk to me about where my interests lay, about how I might like to specialise, in my third year. My path seemed to have taken a new turn; it seemed I was a step or two from success.

But there are times in life when the next, clear, logical step seems one you can’t take at all. I found it difficult to see myself completing my course, and emerging as a grown-up London person on the verge of a career. I seemed to have less money than other people. I had the state grant and – in theory at least – the small yearly contribution that my parents should make. I schemed to do without that contribution, but my schemes didn’t work. Intermittently through my first year, I worried about this, and about something more serious and long-term. I wanted to be a barrister. How was I to do this? The facts of life pressed in on me. I was female, northern and poor. My family would not be able to help me through my post-degree studies, or my pupillage. Women barristers were then in a small minority. A few brave women from unhelpful backgrounds had crashed the system. I had assumed I would be one of them. But now my resolve was undermined, because I was in love.

I had known this for six months before I came to London, but by the time the calamitous fact was admitted, between myself and the boy who was in it with me, we had already chosen our universities, and secured places at different ends of England.

We were, respectively, 17 and just turned 18. We couldn’t do anything about the parting that loomed ahead of us, but we had decided to be married, whenever it looked possible: sooner than that, if by any mischance I became pregnant. When we had a daughter, my lover said, he would like to call her Catriona; would that be all right by me? I was very happy about it. We were both admirers of Robert Louis Stevenson. Kidnapped was really our favourite, but we couldn’t call our daughter David, or name her after Alan Breck. She’d have to be named for the sequel.

Like all my contemporaries, in those first years when the contraceptive pill was widely available, I only half believed I could coerce my body, and suspected that it might have some filthy tricks in store; but the filthy tricks would be in the line of putting a baby in your arms before you were ready. I assumed I would be able to have Catriona at a time of my choosing. I didn’t know she would always be a ghost of possibility, a paper baby, a person who slipped between the lines. It’s a pity we didn’t like Travels with a Donkey. There’s a good name for a ghost: Modestine.

In our year apart my boyfriend and I wrote to each other every day. There was a hiatus when the postmen went on national strike; I don’t think it was to protest at us personally, though some of the letters were very weighty. In later years, we carried the correspondence about with us, in a plastic bin-bag, but when we first went to work abroad we threw it away. After all, we were planning never to be parted again.

Though I was happy in my London life, I looked forward with a sick intensity to his arrival for weekend visits. He had to be smuggled in, and kept like contraband in my room, my room-mate quartered elsewhere and a whole corridor of girls sworn to complicit secrecy; it was like Malory Towers, but with sex. When the girl along the corridor had a boyfriend stay, the fire alarm rang in the small hours, and I met her among the crowds on Malet Street, two hundred girls turned out in their night attire into the winter cold. Her face was white, her eyes were staring; she whispered: ‘I put him in the wardrobe.’

The expense of travelling, the logistical manoeuvres required, the wear and tear on the nerves, meant that the visits had to be well spaced out. And gradually, I realised that my world was changing. Light and colour were draining from the streets, and even spring didn’t restore it. The grey ache of absence was too much to bear; why bear it, if it could be remedied? I thought it could. By early summer, when my surroundings had taken on the chewed, grainy monochrome of crumpled newsprint, I went to the university authorities to put my case. Did they think I could go up to Sheffield, and continue my course there? My boyfriend couldn’t come to me, I explained, because he was studying geology, and geology isn’t portable. He had already chosen his mapping area and walked it at weekends, and it was rather easier to move one law student with a suitcase than to relocate a massive chunk of Carboniferous limestone in the Peak District, four square miles of rock swarming with corals, nautiloids and the ancestors of starfish.

Sheffield University’s law faculty was housed, in 1971, in a former maternity home, with ramshackle partitions and makeshift corridors. The students seemed dull, hostile, and pitifully young; they were my own age, in fact, but I felt I had had different experiences and was older. They were afraid of their teachers, and before tutorials they stood in rigid knots outside closed doors, waiting, tension building between them; those rooms, full of the awe and anticipation of women’s pain, were now darkened by juvenile dread of donnish sarcasm. But ‘donnish’ is pitching it too high perhaps; one of my tutors was a bored local solicitor who made it plain that he didn’t think women had any place in his classroom. They were just a waste of space; they’d only go and have babies, wouldn’t they?

Some people have forgotten, or never known, why we needed the feminist movement so badly. This was why: so that some talentless prat in a nylon shirt couldn’t patronise you, while around you the spotty boys smirked and giggled, trying to worm into his favour. The birth control revolution of the late 1960s had passed our elders by – educators and employers both. It was assumed that marriage was the beginning of a woman’s affective life, and the end of her mental life. It was assumed that she neither could nor would exercise choice over whether to breed; poor silly creature, no sooner would her degree certificate be in her hand before she’d cast all that book-learning to the winds, and start swelling and simpering and knitting bootees.

My transfer to Sheffield University was not as smooth as I had hoped. On paper, my first and second year fitted together. In practice, they didn’t. I found myself at sea, both baffled and bored. My fellow second-years mostly intended to be solicitors. They were going into daddy’s practice, or into their uncle’s. I got into trouble by claiming mischievously that law was all an elaborate bluff and that legal language was cognate with magic.

All the same, Sheffield was a good place to be if you were a student. The townspeople talked to you at the bus stop and in the shops, and they didn’t seem to have any money either, so you could buy cheap cuts of meat and bargain tins and sustaining fresh loaves hot from the oven. But it was a dark winter; the miners were on strike, and there were long cold hours without electricity. Then on a January night, we were called home.

My fiancé’s father was called Henry. He was 53, a professional man, wry and studious, a father of five. In summer he was well and in September he was sick and the following January he was dead: cancer. A year later, to the day, my grandfather would die of the same disease; more winter journeys, over the dark Pennines, to stand about in hospital wards while screens were drawn around beds. But we were married by then.

Married, why? Because in times of disaster, it’s what you do. When families are destroyed, suddenly, you pick yourselves up and glue yourself together to form new units. More practically, and immediately, we married so that we could spend the night together, so that he did not have to roll out of bed and roll home over the midnight cobblestones; even my landlady, a kindly divorcée, thinking of her two growing children and their moral development, would not let me have a man in the house till dawn.

Yet not everyone was hostile to romance. Some comfortable soul could always be found, in those days, to recall: ‘They say two can live as cheaply as one.’ Can they? My family fell out with me, and didn’t fill in the forms for my subsistence grant. So we were about to find out if it was true.

No. 78 Roebuck Road was the cheapest house in the world. We had to go right across town every fortnight to pay the rent, but even we, having paid the rent, could afford to eat. My grandmother gave us a water-boiler to hang over the sink. My new mother-in-law gave us a cooker and some furniture. We slept on a sofa that flattened in the middle and so made a bed. We couldn’t get the stately family wardrobe upstairs, so it stayed down, its fine mirror reflecting the flickering of the silverfish as they busied cheerfully about their lives. I made stews, pies, cherry cakes, chocolate cakes and chocolate cherry cakes. I answered, as law students do, my weekly ‘problems’, in the set legal language, and each week turned out essays which were simply a more prolonged exercise in sifting and shuffling the same chary formulations.

I complained I had a pain in my legs, and I went to the doctor: and that was my big mistake.

I set out my aspirin, one two three four five six. I swallowed them. Once, in error, I picked up and almost swallowed a shirt button, lying on the table waiting for me to sew it on.

‘Sick?’ said the doctor, down at the Student Health Service. ‘Throw up? I’m hardly surprised. You do know that taking six aspirin is no more effective than taking three?’

I didn’t. As it was double any ordinary pain, I’d thought I could double the aspirin. We weren’t very sophisticated in those days. I don’t think we even had paracetamol. I had a big bottle of 100 aspirin, and I used to take what I thought would get me through.

‘Well, Miss –’ said the doctor. He glanced down at his file, and a little jolt shot through him, as if he were electrified. ‘Mrs?’ he said. ‘Mrs? Pregnant, are you?’

I hope not. If so, I’ve overdone it with the aspirin. It’ll have fins. Or feathers. Three extra aspirins, three extra heads. I’ll exhibit it. It will keep us in luxury.

‘I’m on the pill,’ I said. An urge rose in me, to say: we are sexually very keen so I take three a day, do you think that’s enough? But then a stronger urge rose in me, to be sick on his shoes.

I can see him, now that the years have flown; his crinkly fairish hair sheared short, his rimless glasses, his highly polished brogues. He was a nervous man, and when I bowed my head towards his feet he shifted them under his desk. I wasn’t sick. I put my hand across my mouth, and then threw up somewhere else.

I went home. ‘He said, don’t take so many aspirin. I said my legs ached and he said it was accounted for by no known disease. Except one called idiopathic something-something.’

I didn’t let on how I had grinned, when he said ‘idiopathic’. I knew it meant disease about which we doctors have no bloody idea. So he bridled, and swallowed the rest of the medical term; he wasn’t, anyway, entertaining it as a possibility, he was just boasting. And my smile called his bluff; I shouldn’t have smiled it. He was not on my side now. I thought that probably he never had been.

Go back, said my mister, grimly. You haven’t really told him. How tired you are. And how upset.

I was upset, it was true. I couldn’t bear my smashed relationship with my family. That my brothers should think badly of me. That I should have no money to buy a present for Father’s Day, only a bag of toffee, and nothing to give for Christmas but a box of biscuits and a bottle of wine.

That I had money to give even these was because of the intervention of a bureaucrat at County Hall in Chester, where lived the authority who paid (or not) my maintenance grant. For my visit I composed myself into pliant, pleading mode. I went to see him in his office, the necessary man, the bureaucrat who was on my case. I explained that my father hadn’t signed my forms to testify to his income. So therefore, he said, I could get no grant, not even the £50 that every student got, even the rich ones: for those were the rules. I know this, I said, but you see I shall just have to sit here till the rules are amended in my favour, because if I don’t get some money from you I’m out of house and home.

I don’t remember his face, only his office, his desk, his chair, the slant of the light. He left the room. I studied his carpet, on which I had sworn I would be sleeping: unless I slept on his desk. It was a warm, blossoming, summer day: perhaps I could sleep in a flowerbed? Sunlight rippled on magnolia walls. He came back smiling. I have got you fifty, he said, and let’s see, hereafter, maybe it can be worked – there are always some strange circumstances . . .

Perhaps he was an angel. Perhaps a mortal, but one of the elect. I’m praying for him still, in a wild agnostic fashion. Hoping he wins the national lottery: I pray some irregular prayers like that. Or that he’d come to see me and I could make him a pie or a cake.

‘Well, here you are,’ said the doctor, handing me a prescription. ‘I think what you need is some anti-depressants.’ I was depressed, so I knew it made a kind of sense. Twenty-four hours later, I found I couldn’t read; print blurred before my eyes. In the university library I tried to study the side effects of the drug.

I went to see my tutor in Equity, and said: look, Mr Loath (it wasn’t his name, I didn’t say it, it was just what the frightened spotty boys called him), look, Loath, I’m coming to your next session, but don’t harass me, right? (Really, of course, I spoke to him much more nicely than this.) Loath, please understand that I’ve been prescribed some necessary drugs that mean I can’t read my books. Blurred vision. Side effects, I said. Under my breath: you must have heard of side effects? Loath gave me a puzzled look. It was like primary school: I spoke, and my speech had no effect. The medical textbook (if I’d read it right, squinting, aslant) suggested that the blurred vision would last only a week or two, whereas the course of drugs lasted six weeks. Six weeks, in clinical practice, was the term set to depression. After that, I was sure, I’d be happy. Never mind who was dead and how. Never mind how few the coins in my purse. I’d be up with the lark, and rejoicing with the wrens: I’d be skipping up the hills of Sheffield, my pains vanished, my joints springing, swinging my bags of potatoes and self-raising flour as if they were feathers, as if I were self-raised myself, and scattering my careless laughter to the winds. For the time being, though, my spirits had sunk. The drugs seemed to be having an effect, but not the one required. The pangs of bereavement, of estrangement, had given way to a dull apathy. My sleep was broken and the climate of my dreams was autumnal, like the dim leaf-mould interior of a copse; their content was exhausting and yet somehow banal.

A day or two later, Mr Loath presided over his tutorial: the pasty, sweating, spotty boys, one other girl, and me. A small question of criminality was raised, and Mr L got testy: come along, come along, he said, do you know the maximum penalty under the Theft Act, do you, boy, or next boy, do you? I had to speak up and spare the boys, from their humiliation one by one: oh, Mr Loath, I said, it’s ten years. Mr Loath, fuming with frustration, was just about to snap the arm of his spectacles; his fingers relaxed, and ‘Thank goodness!’ he said. And just as he replaced his glasses on his head, to stare at me and give me his thin smile, a pain sliced through me, diagonal, from my right ribs to my left loin. It was a new pain; but not new for long. It stole my life: it stole it for ten years and for a double term, and then for ten years more.

A short time later I was vomiting a good deal. I had finished the course of anti-depressants, but felt no better, and my GP did what you do when someone says she is vomiting: send her to a psychiatrist. I should like to say I protested, but I was willing enough. I thought perhaps I was a fascinating case. I had been tested for anaemia, but I wasn’t iron-deficient. No one seemed to be able to think of another disorder to test me for, and if my body was in order it must be my mind that was acting up.

Dr G, the psychiatrist, was remote and bald. He had as much chance of understanding a girl like me as he had of rising from his desk and fluttering from the window on silver pinions. He soon diagnosed my problem: stress, caused by over-ambition. This was a female complaint, one which people believed in, in those years, just as the Greeks believed that women were made ill by their wombs cutting loose and wandering about their bodies. I had told Dr G that my mother was a fashion buyer in a large department store. Thereafter, he referred to her place of work as ‘the dress shop’. If I were honest with myself, he asked, wouldn’t I rather have a job in the dress shop than study law? Wouldn’t the dress shop, when all’s said and done, be more in my line?

I saw Dr G once a week. He must have obtained reports about me from my tutors, for he said: ‘Conscientious, hm, it says you’re very conscientious.’

Was I? I only turned in the work asked for. Didn’t other people bother?

‘And a mind for detail,’ Dr G said, ‘you have that.’ I tried to imagine the other kind of law student, the kind who favoured the broad-brush approach, who took on the law of trusts, for example, with a generalist’s sweep and dash. ‘Tell me,’ said Dr G, ‘if you were a doctor, what kind would you be?’

I said politely that to be a psychiatrist must be interesting. No, pick something else, he said, something less close to home. I’d often thought, I said, that GPs had an interesting job, the variety of people and problems, the need for quick thinking – but no, I could see by his face that wasn’t the answer required. Dr G sat back in his chair. I see you as a medical researcher, he said, one of those quiet invaluable people in the back room, unseen, industrious – a mind for detail, you see. And wasn’t it the same, he asked, with law? If I did go on with my studies, wouldn’t the niche for me be in a solicitor’s office, conveying clients’ houses – wasn’t it just what people needed, at such a stressful time in their lives, to have the services of someone very conscientious, like me?

I could see her: a clerk very conscientious and quiet and dull, who wore snuff-coloured garb and filed herself in a cabinet every night and whose narrow heart fluttered when anyone mentioned a flying freehold or an ancient right of way. But you’re not looking at me, I thought. I was quite thin; nausea was wearing me away. I left Dr G’s consulting room and stood on the pavement to consider this new version of myself. I felt as if I had been dealt a dull blow, but I didn’t know which part of me ached.

The next time I went to Dr G’s office I sat and wept. I must have worked through a box of tissues, and no doubt it was his upset-girl ration for the whole month. Dr G spoke kindly to me; said gravely he had not known that things were so bad. I had better have some stronger pills. And maybe a spell in the university clinic?

I think, in retrospect, that it would have been better if I had denied that I had pains in my legs, if I had taken it all back, or brightly said that I was well now. But because I didn’t, the whole business began to spiral out of control. I still believed that honesty was the best policy; but the brute fact was I was an invalid now, and I wasn’t entitled to a policy, not a policy of my own. I feared that if I didn’t tell the strict truth, my integrity would be eroded; I would have nothing then, no place to stand. The more I said that I had a physical illness, the more they said I had a mental illness. The more I questioned the nature, the reality of the mental illness, the more I was found to be in denial, deluded. I was confused; when I spoke of my confusion, my speech turned into a symptom. No one ventured a diagnosis: not out loud. It was in the nature of educated young women, it was believed, to be hysterical, neurotic, difficult and out of control, and the object was to get them back under control, not by helping them examine their lives, or fix their practical problems – in my case, silverfish, sulking families, poverty, cold – but by giving them drugs which would make them indifferent to their mental pain, and in my case, indifferent to physical pain, too.

The first line of medication, in those days, were the group of drugs called tricyclic anti-depressants, and also what were then called ‘minor tranquillisers’ – the pills marketed as Valium were the most famous example of the type. The anti-depressants didn’t seem to be having much effect on me – or not the wanted effects, anyway, only the effect of making me unable to grapple with the written word, of making print slide sideways and fall out of the book. It didn’t seem as if I would be able to sit my finals, Dr G said, but never mind: in view of my good work record, the university would grant me an aegrotat degree. Did I understand aegrotat? It meant: ‘he was ill.’ I muttered: ‘He, she or it was ill.’ It would have been much healthier for me if I had stopped muttering, and kept smiling.

Valium, however, did me a greater disservice. Some people, given tranquillisers of that type, experience what is called a ‘paradoxical reaction’. Instead of being soothed, they are enraged. One day I sat by the hearth at Roebuck Road and imagined myself starting fires; not in my own chimney, but in the houses of strangers, in the streets. I imagined myself doing damage. I burned with anger. I wanted a weapon. And I agreed to the clinic because I thought that, if I were inclined to do damage, someone would see me and stop me – before, at least, it got to arson and murder.

At first I came and went from the clinic. I would go back to Roebuck Road during the day and do the cleaning. One day I went down town to buy myself a nightdress. But because my vision was blurred, I misread the label, and came back with a size 16 instead of a size 10. ‘Look at this monster garment!’ I cried gaily to the nurses; I was having one of my less murderous days, and trying to lighten the tone. ‘Look what I bought!’

My nightdress, I found, was viewed in a grave light. Why had I bought it? It was a mistake, I said, you see I . . . Didn’t you hold it up? they asked me. Well, no, I, I just liked the pattern, I . . . Didn’t you remember what size you were? Did you feel you didn’t know? Yes, I know my size, but you see, my eyesight, it’s misty . . . oh never mind.

Dr G came to see me. Well, and what was I doing with myself now that I was free from my struggles with my textbooks? I have written a story, I offered brightly. It was a long story – that is to say, a short story, but long as these things go. Short but long, said Dr G. Hm. And about? What was it about? A changeling, I said. A woman who believes her baby has been taken away, and a substitute provided in its place. I see, said Dr G, and where and when did this occur? In rural Wales, I said, funnily enough. (I’d never been to Wales.) I don’t have to say the date, but it feels like the early 1920s. I mean, judging by their furniture and clothes. Does it? said Dr G. It’s a time well before social insurance, anyway, I said. The doctor won’t come up the mountain to see them because they can’t pay. I see, said Dr G. And how does it end? Oh, badly.

If you didn’t respond to the first wave of drugs the possibility arose that you were not simply neurotic, hypochondriacal and a bloody nuisance, but heading for a psychotic breakdown, for the badlands of schizophrenia, a career on a back ward. To prevent this, the doctor moved the patient onto what were then called ‘major tranquillisers’, a group of drugs intended to combat thought-disorder and banish hallucinations and delusions.

The next time I saw Dr G he forbade me to write – or, more precisely, he said: ‘I don’t want you writing.’ He put more energy into this statement than any I had heard him make. He seemed as remote as ever, and yet inexpressibly angry. ‘Because – ’ he added; and broke off. He was not going to impart to me what came after ‘because’.

I said to myself, if I think of another story I will write it. In fact, I didn’t think of another story for quite some years – not a story of the long but short type – and when I did I sent it to Punch and what I got back was not a malediction but a cheque. The changeling, too, paid off, in time, in a novel published in 1985, 12 years after the poor mite was first drowned; not in rural Wales, nor in the 1920s, but in the present day in a prosperous and dull Midlands town. The novel contained mad people, but no one suggested its author was mad. It’s different, somehow, when you’ve received money for your efforts; once you’ve got an agent, and professionalised the whole thing.

The first drug I was given was called Fentazine. That would do the job, Dr G thought.

Do you know about akathisia? It is a condition caused by anti-psychotic medication, and the cunning thing about it is that it looks, and it feels, exactly like madness. The patient paces. She is unable to stay still. She wears a look of agitation and terror. She wrings her hands; she says she is in hell.

And from the inside, how does it feel? Akathisia is the worst thing I have ever experienced, the worst single, defined episode of my entire life. No physical pain has ever matched that morning’s uprush of killing fear, the hammering heart. You are impelled to move, to pace in a small room. You force yourself down into a chair, only to jump out of it. You choke; pressure rises inside your skull. Your hands pull at your clothing and tear at your arms. Your breathing becomes ragged. Your voice is like a bird’s cry and your hands flutter like wings. You want to hurl yourself against the windows and the walls. Every fibre of your being is possessed by panic. Every moment endures for an age and yet you are transfixed by the present moment, stabbed by it; there is no sense of time passing, therefore no prospect of deliverance. A desperate feeling of urgency – a need to act, but to do what, and how? – pulses through your whole body, like the pulses of an electric shock.

You run out into the corridor. A man is standing there, gazing dolefully towards you. It is your GP, the man at the student health service, the man with the rimless glasses and the polished brogues. The tension rises in your throat. Speech is dragged and jerked out of you, your ribs heaving. You think you are screaming but you are only whispering. You whisper that you are dying, you are damned, you are already being dipped into hell and you can feel the flames on your face.

And the answer to this? Another anti-psychotic. An injection of Largactil knocked me into insensibility. I lay with my face in the pillow as the drug took effect, and sank into feathery darkness; as I ceased to panic and fight, the hospital sheets dampened, and wrapped around me like ropes.

After I woke up I was maintained on Largactil. It was not a friendly drug; it made your throat jump, pulse and close, as if someone were hanging you.

But then it was the end of term, the end of the year. My course of studies was over. The university’s responsibility was ended. I was discharged from the clinic. I went forth, and was sane. My legs didn’t seem to ache so much; I had more abdominal pain, I knew better than to make a fuss about it. For a time I claimed to be well.

But it was not so easy to shake off the events of the last year. The problem was the names of those drugs I had ‘needed’, spelled out like evil charms in my medical notes. Fentazine, Largactil, Stelazine. If I set foot in a GP’s surgery – as I did, because I was increasingly sick – I ran the risk of being prescribed a dose of them that would knock an elephant off its feet. Then there was my old friend Valium, which I knew I shouldn’t go near: not unless I wanted to be arrested.

In time I went back to a GP. I said I had backache, nausea, vomiting, that I was too tired to move. My GPs – to a man, and a woman – suggested a test to see if I was anaemic. I never was. They had no other suggestions; except perhaps some Valium, and a little spell away might do me good? By the time I was 24 I had learned the hard way that whatever my mental distress – and it does distress one, to be ignored, invalidated and humiliated – I must never, ever go near a psychiatrist or take a psychotropic drug. My vision blurred, these days, entirely without the help of the anti-depressants. Sometimes there were gaps in the world: I complained one day that the front door had been left open, but the truth was that I just couldn’t see the door. Sometimes it seemed that some rustling, suspicious activity was going on, at the left side of my head, but I couldn’t put a name to what it was. I couldn’t put a name to lots of things, my speech came out muddled: I called a clock’s hands its fingers, and a chair’s arms its sleeves.

I was all right if I stuck with abstractions, ideas, images. And some days I was half-well. I had a job, but I needed a pursuit, I thought. I went to the library and got out a lot of books about the French Revolution. I made some notes and some charts. I went to a bigger library and got more books and began to break down the events of 1789-94 so that I could put them onto a card index. I was very conscientious and had a mind for detail. If you had been having a revolution you would certainly – at such a stressful time in your life – have needed the services of someone as conscientious as me. I began to read about the Ancien Régime, its casual cruelties, its heartless style. I thought: I know this stuff. By nature, I knew about despotism: the unratified decisions, handed down from the top, arbitrarily enforced, the face of strength when it moves in on the weak.

One day, on an escalator in a department store, a man put a hand up my skirt. Enough, enough, I thought. I turned around and punched him in the eye. I got off at the top of the escalator and walked away.

I didn’t like the world I was living in. It didn’t seem too keen on me.

I was too sick to do a responsible job, a professional job. I got a job as a saleswoman, and I thumbed my nose at Dr G; I started to write a book.

Christmas week 1979. I was 27 years old. I was in St George’s Hospital in London having my fertility confiscated and my insides rearranged. When I was admitted, I knew I was very ill, but I didn’t know quite how bad things might be, and for a time there was no agreement on the nature of what ailed me. Only that it was physical; only that I had a pain and it was real: only that it was a disease Valium wouldn’t cure.

My life had moved on by then, far from its early confines. My husband had exchanged Carboniferous limestone for the sands of the Kalahari, fossils for diamonds. We lived in a small town in Botswana, a railway line settlement, where geologists and agriculture specialists rumbled over the unmade roads in four-wheel drives, where ticks and mosquitoes bit, where the days were short and hot and monotonous, and I sat behind the insect mesh of my verandah frowning over my card index, documenting the fall of the French monarchy, the rise of the Committee of Public Safety. I had pressed the juice of meaning from every scrap of paper I had brought with me, every note on every source. The book was finished now. And so, it seemed, was I. We had come home to England on leave a month or so earlier. My book went to a publisher who offered to look at it. I went to a consultant who offered to look at me.

In Botswana in the late 1970s.

In the beds around me were women with complications of pregnancy, who were trying to hang onto their babies; women having abortions; women having their fertility ended by choice. One abortionee was opposite me, a tow-headed 16-year-old on her second termination. We hopped from bed to bed, Kirsty and I, sitting each at the foot of the other. She told me about her life. She went out to dance and to shoplift a little and if anyone looked at the boy she happened to be with she would belt them around the head; isn’t that right, she said, and we agreed that yes, it was the only thing to do. More perplexed than malicious, she called the nurses by whistling for them; she didn’t understand their genteel nursy euphemisms, and when they handed her a flask and asked her to pass water she came across to ask if I knew what the fuck they were talking about. She had adopted me on my first day on the ward; I wasn’t, she thought, getting my due. Until some time after I was admitted, the nurses could not manage to get a doctor up to the ward to organise pain relief for me. The strong pills I had brought with me were taken away, and I was given a Panadol. A hot bath was promoted as the remedy for my pain; I laughed. That first night, I lay on the bed, my knees drawn up. Kirsty shouted at the nurses. ‘Look at her, look at her,’ she roared. ‘Give her sumfin.’ And they did – a rare opportunity – they told me it was my turn to push around the cocoa trolley. My turn, though I’d only just arrived! So I rolled off the bed and did it. ‘Cocoa? Horlicks? Sugar with that?’ I was not quite able to stand up straight: some evil web inside me was bending me at the waist, pulling my abdomen, knotted with pain, down towards my knees.

I had been admitted without any certain diagnosis. The professor in charge of gynaecology had, in a civil way for which I remain grateful, found me a bed at short notice. Provided I didn’t mind being in hospital for Christmas, he said, they could have me in about the 20th and operate before the feast. ‘You say you think it’s endometriosis,’ the professor said when he had examined me in outpatients, a week or two earlier. ‘There’s a good chance you’re right.’ He said: ‘By the way, is it, should I, am I speaking to Doctor McEwen?’ I looked up to see if he was being sarcastic. No, I said, I’m not a doctor, why would you think that? ‘Only,’ he said, ‘your terminology is precise.’ Ah well, I thought. If only you knew me: conscientious, with a mind for detail. Little Miss Neverwell had graduated at last.

Endometriosis is a gynaecological condition with a dazzling variety of systemic effects. It is not rare, though mercifully it is rare for the disease to run on, unrecognised, for as long as it did in me, and it is rare for it to do such damage. Because of the number of symptoms it throws up it is sometimes hard to diagnose. It is always hard to diagnose for a doctor who doesn’t listen and doesn’t look. It is comparatively easy if you are the patient, and get into your hands a good textbook with a comprehensive account of its effects.

A few months earlier – in the remoteness of my small town on the fringes of the bush – I had thought, once again: enough’s enough. My doctor (his dusty downtown surgery darkened by eucalyptus trees) seemed disinclined to investigate, though happy to prescribe me stronger and stronger pain relief. Whatever he gave me (and however much alcohol I knocked back to accompany it) the pain grew over the top. So one day I went up to the capital, to the university library, and combed through the medical books. I found a textbook of surgery, with a female figure, her organs clearly depicted, and black lines – like the long pins with which they used to stick witches – striking through her hips and ribcage, carrying a name for each organ. For each organ, there was a pain, and of each pain, I had a sample.

I learned next how the disease process worked. The endometrium is the lining of the womb. It is made of special cells which shed each month by bleeding. In endometriosis, these cells are found in other parts of the body. (How they get there is a matter of dispute.) Typically, they are found in the pelvis, the bladder, the bowel. More rarely, they are found in the chest wall, the heart, the head. Wherever they are found, they obey their essential nature and bleed. Scar tissue is formed in the body’s inner spaces and small cavities. It builds up. It presses on nerves and causes pain, sometimes at distant sites. The scar tissue forms an evil stitching which attaches one organ to another. Infertility is a distinct possibility, as the organs of the pelvis are ensnared and tugged out of shape. Endometriosis in the intestines makes you vomit and gives you pains in the gut. Pressure in the pelvis makes your back ache, your legs ache. You are too tired to move. The pain, which in the early stages invades you when you menstruate, begins to take over your whole month. Lately I had known days of my life when everything hurt, everything from my collarbone down to my knees. But hey! There was nothing wrong with my ankles. My feet were performing nicely. And I could still think, and depress the typewriter keys. Stop complaining! I thought. Look where complaining gets you! In the madhouse.

Along with endometriosis goes, not infrequently, a hormonal disarrangement which shows itself as a severe premenstrual syndrome. In my case, it manifested in the prodromal aura of migraine headaches. Migraine, I had to learn, was not just a sick headache. It was a series of linked neurological phenomena of remarkable diversity. It was within the migraine aura that my words came out wrong, that the door disappeared into a black space: it was within the aura that I heard the dull hum and the muttering on the left-hand side of my head. Migraine stirred the air in dull shifts and eddies, charged it with invisible presences and the echoes of stranger’s voices; it gave me strange morbid visions, like visitations, premonitions of dissolution.

1979: I must admit that the very act of climbing into the hospital bed had brought me a kind of relief. I could stop pretending to be well. The odd thing, though, as I had already observed, was that the staff were inclined to treat the patients as malingerers. We could see them huddled at their nurses’ station, flicking through our notes and discussing our body parts. Young girls with flaky cervixes were probably no better than they should be, and anything in the pelvic inflammatory line attested to a vibrant sex life. Pregnant women weren’t sick, women wanting abortions weren’t sick, and as for the sterilisation brigade, they should probably be up and scrubbing the latrines. (That wouldn’t have come amiss.) And as for me – I soon got a jolly diagnosis. The senior registrar examined me and thought I was pregnant. He winked at me. That’s a baby in there, he said, confidently patting my swollen abdomen. He ran off to get a foetal heart monitor.

But there was no baby. Not Catriona, not anyone, only the ghost of my own heartbeat, amplified to the outside world. Oh well, the registrar said. Looks like I was wrong, eh?

The houseman came, to take a history. He was very new and young, with a starter moustache, which could be studied bristle by bristle; some bristles stuck out at a right angle to his skin. I kept my eye on it, and the movements of his mouth. You are very young, he said, and I am going to ask the professor, yes yes (he got up his resolve), I am going to talk to the professor, I am going to ask him if he can make a neat low incision, so that afterwards, you will be able to wear a bikini. He looked almost tearful. I nodded. I knew he would not be able to effect this, but I liked it that he cared so much. It is strange, to expose your soft girlish body to a man of your own age, who has not yet acquired dispassion but wears a white coat. In fact, I said, I never wear a bikini because I am too – I wanted to say, modest. But what modesty was left? I’d had more gynaecologists than I’d had lovers; alien fists in my guts. I said, you see, I am too white for a bikini. Too pale. I burn. Of course, he said. But all the same. He got up, flustered, his clipboard almost spilling his notes. At the bed’s end, he turned and smiled, and winked at me.

As Christmas approached, the ward emptied. A young woman remained in an opposite bed, six months pregnant, her face mottled with fever; she had a kidney infection and was, in the ward’s parlance, ‘poorly’. When the antibiotics began to work she sat up and looked about her with misty, Celtic eyes; her dark hair filmed the white pillow.

When the kidney girl sat up, it was already the eve of my surgery. No one had agreed yet on the nature of my problem. My husband had been told that, in the event that the growths were malignant, he should expect my death. I had not been given the message, but I didn’t really need it. I stubbornly believed in my own diagnosis. If I was right, I would survive.

Many hours after dark, the carol singers came. I was in the bathroom at the time, standing with my back to the dark mirror. I had begun to feel not afraid, but very lonely; I had given way to self-pity, and tears were springing out of my eyes when they piped up with ‘Once in Royal David’s City’. I stood till it was over, leaning against the wall. Then I heard a woman say, in a sweet bossy voice: ‘Perhaps you would care to choose a carol, dear?’ And Kirsty laughed: a long peel, like glad tidings. They had swooped on Kirsty because she was in the first bed they came to; they had handed her a hymn book, and when I shot out of the bathroom she was holding it as if it were hot, and her laughter was the sound of her incredulity. I took the book from her; she shot me a grateful glance. I flicked the pages over, and asked for ‘God Rest You Merry, Gentlemen’. The singers complied, though they looked a bit disappointed at such an old-fashioned choice. But I was thinking of our surgeons, coming tomorrow to cut me up; it was the last thing they would do, before going home to their families to carve the Christmas fowl.

After the singers had gone Kirsty fell into a dead sleep. I sat on the end of the kidney girl’s bed and we smoked a cigarette. ‘Ladies, back to bed!’ the staff cried. I was the only one up, but they made me plural because they wouldn’t confront me. Eventually I kissed the kidney girl goodnight, stroking back her dark hair; there was no one else to do it. I shuffled across to my own bed and edged myself beneath the covers. The mound of my abdomen was almost as big as the kidney girl’s pregnancy, and they still hadn’t sorted out pain relief. They gave me a sleeping pill, but it would have taken a mallet to knock me out; I was not afraid, but my brain was active.

I take death as serious and proximate, I always have. But recently, when a doctor asked for my family history, I had to knock him back on every score. No heart disease. No strokes. No cancer: except for Grandad, and he was a smoker. No reason, in fact (I said this wonderingly, raising my face), no reason, it seems, we should ever die.

But the Catholics’ litany tells us we will, and how it will look:

When my face, pale and livid, shall inspire the beholders with pity and dismay; when my hair, bathed in the sweat of death, and stiffening on my head, shall forebode my approaching end, Merciful Jesus, have mercy on me.

When mine ears, soon to be for ever shut to the discourse of men, shall be open to hear the irrevocable decree, which is to fix my doom for all eternity, Merciful Jesus, have mercy on me.

I admire particularly the phrase about the hair stiffening on the head. This road to dissolution the good Catholic was encouraged to walk regularly, following Christ to Calvary. St Peter, we were taught, was crucified upside down; this was more merciful for him, since he would have lost consciousness. I was told this three times during my high school education, by the same woman, and each time in my mind I rehearsed her solemn upending, as if she were a geometrical figure that I had been asked to envisage in some other position. I think she believed Peter had got off lightly.

When the last tear, the forerunner of my dissolution, shall drop from mine eyes, receive it as a sacrifice of expiation for my sins; grant that I may expire the victim of penance, and in that dreadful moment, Merciful Jesus, have mercy on me.

Note that excellent semi-colon. People ask how I learned to write. That’s where I learned it.

The whole of a Catholic life is lived in the shadow of the happy death – as if your life were to be enacted through a silvered, speckled mirror, ancient and flattering.

When I was half-awake, a day later, they came to tell me what they had done. After a general anaesthetic, you dip in and out of consciousness: sitting up and smiling, you may be the picture of alertness, but your attention has faded. They should have told me again, I think, when I was properly awake. They should have told me once or twice. They should have written me a letter, they should have written me an essay or maybe a small book.

Certain things were over for me now. I sensed it would not be easy to shore up my collapsing marriage. When women apes have their wombs removed, and are returned by keepers to the community, their mates sense it, and desert them. It is a fact of base biology; there is little kindness in the animal kingdom, and I had been down there with the animals, grunting and bleeding on the porter’s trolley. There would be no daughter, no Catriona; not that I could claim I had wanted her too hard: at 27 I hadn’t ever tried to have a baby. We seemed fine as we were, the two of us. ‘The children of lovers are orphans,’ said Robert Louis Stevenson. That would have been a sad fate for her, little Miss Cat. She would never be born now, and we were no longer lovers.

I was missing a few bits of me, besides my womb and ovaries, my reproductive apparatus. A few lengths of bowel: but you’ve plenty to spare.

Like a cretin, like some dumb little angel, I had believed what I was told. I believed that the pains which ran through my body each month were part of the burden of womanhood. I didn’t say to my doctors: by the way, my menstrual periods are agony. I thought they would say: get away, you, little Miss Neverwell! And when I had, timidly, approached the topic, they’d said robustly: whoah, now, you don’t want to worry! Period pains? That’ll clear up, my dear, after you have your first baby. Just you wait and see!

I was brought up as a Catholic and it’s not easy to throw over the faith. I believed that, short of crucifixion, you shouldn’t really complain.

About four months later, after repeated courses of penicillin had got me over the infections that I had contracted while in the hospital, I returned to Botswana, to my ailing marriage, my house, my dogs and cats. I am going to be better now, I said, I am going to be different. I went back to the GP who had been treating me, or failing to treat me: downtown, the dusty consulting room under the eucalyptus trees. I found it hard to talk; I thought I had nothing to be ashamed of, but somehow I felt ashamed, and I was not sure how confidential was my consultation; secrets did seem to leak, in this small bush town. I told him about the surgery, shuffling my feet. ‘So,’ I said, ‘you see, in the end, it turned out there wasn’t much to be done. It turned out a bit of a catastrophe.’

‘Oh well,’ he said. He shuffled his own sandalled feet under his desk. ‘There’s one good thing, anyway. Now you won’t have to worry about birth prevention.’

I had been, until Christmas, a woman who thought she had a choice. I was 27 and I thought I could have a baby, even if I didn’t want one, even if my husband didn’t; I was free in the matter, there were possibilities. Now I was not free and the possibilities were closed off. Biology was destiny. Neglect – my own, and that of the medical profession – had taken away my choices. Now my body was not my own. It was a thing done to, a thing operated on. I was 27 and an old woman, all at once. I had undergone what is called a ‘surgical menopause’ or what textbooks of the time called ‘female castration’. I was a eunuch, then? Castration is a punishment. What was my crime? It used to be fashionable to call endometriosis ‘the career woman’s disease’: the implication being, there now, you callous bitch, see what you get if you put off breeding and put your own ambitions first. I was no good for breeding, so what was I good for? Who was I at all? My hormonal circuits were busted, my endocrinology was shot to pieces. I was old while I was young, I was an ape, I was a blot on the page, I was a nothing, zilch. The publisher had turned down my French Revolution book. It seemed I couldn’t even write. But come now – let’s break open the champagne! At least I won’t have to worry about birth prevention!

There are times in life when you are justified in punching someone in the face. But I didn’t react. I knew it was for the doctor to direct the blow, and for me to absorb it. Sometimes one takes a little pride in endurance of this kind. At that stage, it was all that was left.

Send Letters To:

The Editor
London Review of Books,
28 Little Russell Street
London, WC1A 2HN

Please include name, address, and a telephone number.

Read anywhere with the London Review of Books app, available now from the App Store for Apple devices, Google Play for Android devices and Amazon for your Kindle Fire.

Sign up to our newsletter

For highlights from the latest issue, our archive and the blog, as well as news, events and exclusive promotions.

Newsletter Preferences