Joshua Barrons had been referred to the clinic from an enlightened emergency shrink after he’d tried repeatedly to flush the family kitten down the toilet. A week before, a plumber had used an optical probe to locate a blockage in the drains at the Barrons’ family home. Joshua liked the probe and wanted to see it again and maybe even get a chance to use it. He thought that flushing the kitten would be a good way to do this, and when his nanny tried to stop him, he set fire to her handbag. According to the nanny, who we’d already met, Joshua’s behaviour, though extreme, was nothing new. His exasperated mother had taken to spending weeks at their country home, leaving Joshua in London so that she could avoid dealing with him. The boy’s father, Christopher Barrons, was rarely at home and when he was, there were fights. Once or twice, the nanny reported, she’d heard the sounds of scuffling and Emma had appeared with scratches and bruising, though, so far as she knew, the father had never hit his son. There were no other children. There was no kitten now either. The nanny had dropped it off at a shelter on her way to the doctor’s office. Hearing the story, the doctor had referred Joshua to a psychiatrist.
Over the years, Joshua had gone through many nannies and many diagnoses: ADHD, depression, defiance disorder… The list went on. He’d seen a psychologist and been prescribed, variously, methylphenidate, dexamfetamine, omega 3s and atomoxetine, been put on a low sugar, organic diet, and had psychotherapy. None of that had worked. The emergency shrink had done some initial tests and referred the boy to the clinic. In the report he was characterised as impulsive and immature with shallow affect, an impaired sense of empathy and a grandiose sense of himself. Left untreated, the psych thought the boy was a ticking time bomb.
Here at the clinic we specialised in kids like Joshua. During his initial assessment, we had run him through the usual preliminary tests – Hare’s psychopathy checklist and Jonason and Webster’s ‘Dirty Dozen’. Until I’d had a chance to assess him more thoroughly and run some scans I couldn’t be absolutely certain of a diagnosis, but there was little doubt in my mind. In my opinion, as well as that of the clinic’s therapeutic head, Anja De Whytte, Joshua Barrons was a manipulative, amoral, callous, impulsive and attention-seeking child whose neuropathy showed all the signs of conforming to the classic Dark Triad: narcissism, Machiavellianism and psychopathy. He wasn’t evil, but the way his brain worked could make him seem that way.
I was prepared for a tricky conversation. For the next hour or two I’d have to put thoughts of Tom and Ruby Winter out of my mind as much as I could and focus on my patient. Joshua Barrons and his family deserved that. It was my job to do whatever I could to help him. Plus, we needed him. There were children all over the country who displayed at least some of the traits of CU disorder but to find a kid whose personality was at the extreme edge was rare. Joshua had much to teach us. And we were keen to learn from him. His was exactly the kind of case most likely to win us the grant we needed to advance the clinic’s work on kids with personality disorders of all kinds.
Joshua’s mother was thin and brittle, with the anxious, hooded eyes of a starved cat. She took the seat I offered her, scoping out the featureless walls, the shelves stacked with neuroscience journals and research files.
I’d read about the Barrons family in the file. They were rich and local. Christopher Barrons had made a mint in the London property market in the eighties and nineties, buying up workers’ cottages like those around the Pemberton, installing laminate flooring and selling them on to middle-class professionals, using the profits to accumulate an enormous portfolio of ex-local authority flats which he rented out at exorbitant rates to twenty-somethings unable to get on the property ladder themselves. A few years ago he’d been knighted, though not, presumably, for buying up publically funded housing on the cheap and using it to subsidise his private empire, though these days, of course, anything was possible.
I introduced myself and went through a few preliminaries. Emma waited for me to finish. In an immaculately clipped voice, she said, ‘My husband refuses to believe there’s anything wrong with Joshua that one of the major public schools can’t fix. He thinks if we get Joshua into Eton, our son will stop flushing kittens down the lavatory.’
I’d run into the ‘my child’s too well bred to be a psycho’ argument before and knew it for what it was: embarrassment combined with a wafer-thin sense of superiority brought in as a defence against the situation in which a woman like Emma Barrons found herself. The Barrons were used to being able to buy themselves out of almost any situation. I didn’t judge them for that; what parent doesn’t do whatever it takes for their kids? But money wasn’t the point here and that was what left Emma and Christopher Barrons at a loss.
I leaned forward and steepled my hands to give myself more professional authority.
‘And what do you think?’
I felt her pull back. A pulse thumped in her throat at the suprasternal notch. She wasn’t here to have her opinion canvased. What she wanted was exactly what we couldn’t offer her: a cure. A tiny frown appeared on her otherwise waxy face. ‘I should have thought that was rather obvious. I’m here, aren’t I?’
‘You are, and I’m very glad about that, because we’re going to help your son.’
The tiny frown returned. ‘Forgive my scepticism, Dr Lupo, but Joshua has been diagnosed any number of times by a series of private psychiatrists and prescribed dozens of pills with names I can’t pronounce, but he’s still trying to flush kittens down toilets. I’m here because I’m afraid for my child and I don’t know what else to do and because the emergency psychiatrist who looked at Joshua hinted that he would section him if I didn’t agree to come.’
I sat back and settled in for the long haul. Emma Barrons had a point. Diagnosis of paediatric mental disorders was both complex and highly controversial. Cases of child psychopathy were missed or misdiagnosed all the time, in part because it was relatively rare and in part because psychiatrists were resistant to giving kids such a devastating label. Even the most experienced psychiatrists and neurologists often got it wrong, either because they couldn’t see it or because they didn’t want to.
As I began what I hoped was a reassuring speech about how different our approach was at the clinic, I found my mind once more wandering back to the situation at home. A bubble of anxiety burst at the back of my throat. By now Freya would have met her half-sister. What if they didn’t get on? What if Freya blamed her father and turned against him? Against both of us? So many what ifs. Hurriedly, I put those thoughts back into the box labelled ‘home life’ and returned my attention to my patient’s mother. My upbringing had made me good at compartmentalising. It was something Tom liked about me. The hallmark of survivors. He thought of himself as one too. ‘You and me both have a ruthless streak,’ he’d said to me once in the early days. At the time, I let it go. I let a lot of things go back then.
Emma Barrons waited for me to finish and said, ‘I sometimes wonder if Joshua behaves this way because he hates me. On the rare occasions Christopher comes home, Joshua runs into his arms. Runs. And then it’s all “Daddy this” and “Daddy that”. That’s why my husband can’t see it. He thinks I haven’t put in enough effort to find the right school for our son. He won’t accept that Joshua is too disruptive to go to a normal school.’
I mentioned we could arrange to have Joshua home-schooled by a specialist tutor, at least while he was still in treatment. As I was speaking, Emma Barrons began twirling the index finger of her right hand around the left. She wasn’t listening. I couldn’t blame her. By the time the kids in our clinic had been referred to us, their parents had usually gone through years of anguish. Most often they were on the brink. Taking an e-cigarette from her ostrich bag and holding it briefly in mid-air, she said, ‘Do you mind?’ and, without waiting for an answer, drew the metal tube to her lips and sucked like an orphaned lamb at the teat.
‘I suppose there’s no point in asking how Joshua got this way?’ she said.
‘We don’t know exactly. The only thing we’re