Dr. James is worried about Tristan and calls Toby in. She wants to discharge him. She then finds out he is not on Placebo, and she was also observed and tested.
A man in doorway. His shoulders heave with breathing. He shines with sweat. His light clothing seems to be spattered with stains of dark blood. it’s Toby. The stains are paint.
Toby
What happened?
Dr James
Sorry.
Toby
What is it?
Dr James
I feel something’s very very wrong.
Toby
… Okay.
Dr James
I think we should exclude one of the volunteers from the trial. A boy, a guy, the man who’s on placebo in fact. He’s shown aggression and instability, now he’s not eating. In any other environment I’d be worried for his mental health.
Toby
They’ve been in a sealed ward for weeks now, anyone would get frustrated —
Dr James
It may be linked to his relationship with the other volunteer.
Toby
In which case, there’s only one dosage left —
Toby
We have a duty of care to him at this stage.
Dr James
We can just discharge him today — !
Toby
That’s not appropriate.
Dr James
I’m used to helping people, you know, not putting them in a situation which distresses them. I don’t think I can do this.
Toby
Yes you can.
Dr James
Is it me? I’m terrified it’s me. Have I done something? The boy has stats off the chart and high risk symptoms but he’s clean. It doesn’t make any sense.
Toby
Okay, Lorna. Calm down. This isn’t what you think. He is a test subject. His symptoms are relevant. And we need to monitor him as such.
Dr James
I give out the pills, Toby, I know he’s / (on placebo) —
Toby
/ You don’t know what you’re giving out. They’re active agent just packaged differently. Deliberately. He’s on the drug. We’re testing practitioner bias, alongside.
Dr James
You’re testing me?!
Toby
It’s not un/ usual —
Dr James
You’re testing me!
Toby
I know how you feel about all this and I still got you the position here, because I know you’re a / good doctor.
Dr James
/ Oh god okay, I’m grateful.
Toby
All we’re doing is monitoring you for practitioner bias —
Dr James
Bullshit!
Toby
— in key areas, and I know you’re feeling exposed —
Dr James
You lied.
Toby
— or confused and you know that’s an irrational response.
Dr James
I thought I was losing it! That’s why you’re testing me isn’t it?
So our volunteer is being medicated with powerful psychiatric drugs and I’m telling you they cause aggressive behaviour and paranoia, it’s dangerous to continue.
Toby
We don’t know that’s the drug! You just said, you said yourself it’s clearly about the relationship with this girl! I’m not closing down a whole trial because of a lovers’ tiff!
Dr James
You were happy to attribute it all to the drugs when you thought the effects were positive!
Toby
And you’re only prepared to accept it’s the drug if the effects are negative!
Dr James
This can’t be pulled apart. We’re kidding ourselves to think it can.
Toby
This is why we do trials! We’re here to record side effects and if aggression is a side effect, we’ll note it.
Dr James
They’re not side effects, Toby, they’re just effects you can’t sell.
Toby
God you make the air taste bitter, Lorna.
Dr James
I wouldn’t mind being (monitored) — if I thought you took any … of your own fucking agenda and … If you took any responsibility for that …
Toby
I don’t know what you mean. I’m doing my job.
Dr James
I’ve seen you hold that brain and fleece them for money. But somehow I’m the one that’s biased —(!)
Toby
You sound it, you sound paranoid, listen to yourself. You’ve spent this whole time refusing to accept that the drugs have any effect, until you think there’s something damaging!
Dr James
While you just claim positive effect whatever, or just publish trials with the results you like! But apparently you’re unbiased and I’m … What?
Toby
You are a good doctor, who suffers from profound depressive episodes which she refuses to medicate. And you’re desperate for any evidence that supports that position.
Beat.
Dr James
(They don’t work.)
Toby
Pardon?
Dr James
They don’t.
Toby
How would you know?
Dr James
There’s no real evidence for the efficacy of anti-depressants, there never has been. Everyone who knows, knows this has been the biggest disaster in the history of medicine!
Toby
Nonsense. Fifty to sixty per cent of people improve on anti-depressants.
Dr James
In the short term!
Toby
If you’re going to kill yourself tomorrow, what do you care if it’s short-term or not?
Dr James
We’re only just finding out what happens in the long term! People stay on them for life not because they’re ill but because the withdrawal is terrible!
Toby
Don’t hide behind this fashionable trashing of it all. Every time you have an episode, every time, the brain is altered and makes the next one longer and deeper. The sooner you start to medicate, the more you protect yourself. You could have done that —
Dr James
Without even knowing what causes it?
Toby
We know what causes it, mostly.
Dr James
No you don’t! You ask anyone on the street what causes depression they’ll say chemical imbalance, despite total lack of evidence. Even GPs will. Because you spend more on marketing than research.
Toby
Of course we spend money on marketing, we sell things! You sound like a teenager on a website.
Dr James
You know now we’re treating the bereaved and children and people in bad relationships —
Toby
Who are you to say who is and isn’t ill there? A bereavement can be ruinous to someone prone to depressive episodes, you should know.
Dr James
But it’s mostly a placebo effect!
Toby
There’s no such thing as placebo effect when it comes to depression, if it works it works!
Dr James
Thank you! So it’s just easier for us to think of ourselves as ill and easier for you to sell your pills, so everyone’s happy but no one’s actually happy.
Toby
In ten years we’ll have a blood test for depression. We’ll have a biomarker and a cure.
Dr James
You’ll never have your biomarker. It isn’t like that.
Toby
This is why I get annoyed, Lorna. You cling to the mystery. You celebrate it, almost.
Dr James
I do what?!
Toby
You don’t want it to be curable, you want to make it grand and tragic, it doesn’t have to be.
Dr James
You think I like it! You think I like being terrified of getting in the shower? Bones feeling like they’re dissolving and throwing up every morning?
Toby
It helps most people.
Dr James
Say I’m mad if you like. But don’t say I’ve got a disease. I don’t believe you.
Toby
Call it what you like, just don’t let it define you.
Dr James
It’s not an it, we’re talking about me. You want to cut a part of me out and call yourself a hero.
Toby
All I’ve ever wanted is to help you.
Dr James
I don’t want your help!
Toby
I know and it’s infuriating!
Beat.
Dr James
I’m not even sure you really believe all that. I swear Toby we’re going to look back at all this chemical imbalance shit like it’s the four humours all over again. I mean, why am I here?
Toby
What, here?
Dr James
Yes. Why would you offer me work? This isn’t what I do. I sit with people, I talk to them, I —
Toby
I want to help.
Dr James
Yeah but why? You see, I wonder if you feel guilty.
Toby
About you?
Dr James
Yes.
Beat.
Toby
I don’t think I caused your depression, by ending things, Lorna. I don’t think I contributed even. But maybe, maybe I Think I ended it because of your depression.
Dr James
Right.
Toby
And maybe that’s worse.
Dr James
No. Just sad.
And are you happy now?
Toby
Well not right now, but yes.
Dr James
So.
And how old is she, this new one?
Toby
What does that have to do with anything?
Dr James
Just wondering. Twenty-eight? Twenty-nine? You’re so keen to make me a prisoner of my insides. What about you? Her clear skin to indicate lack of disease? Waist not yet travelled up to her tits?
Toby
You’re ill, Lorn. Please.
Dr James
I’m not though.
Toby
My choices, or biology, or whatever, don’t cause me suffering.
Dr James
No, only others. So you’ll be fine. You’ll do fine.
Pause.
Toby
Are you going to finish this? One more dosage? I want you to administer the trial. I think you can do it. Then we can talk about the future.
Dr James
(Fine.)
Toby
Have you got something I can wear? Over this.
Dr James
You’re joking.
Toby
What?
She tears off her white coat and throws it at him.
Toby
I didn’t —
