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Monday morning, again. The sun cannot penetrate a low sodden bank of cloud and the light wells from behind it, oozing up from the ground through a thick spongy pile of ground mist as I foot my way across the sward. The air around me distorts to form rooms and corridors, and rooms within them and sliding partitions which I never come up against. The ward has come out to meet me today; I feel its shape around me, its scuffed skirting boards at my ankles, as I move towards the idiot’s bench.

He is lying under it, caulked in free newspapers. Pathetic small ads show intaglioed across his neck. In the confined space he rolls over and clonks his shin against the bench leg. His face is exposed for a moment against the greasy collar of his anorak. His eyes have swollen up and exploded in a series of burst ramparts and lesions of diseased flesh. I feel my oily tea slop up from my stomach, the nausea is as clear and pure as pain. I vomit with precision and vomit again until my nausea has no function and I can look once more.

It’s not clear what has happened to the idiot. Has he drunk some bleach? Some oven cleaner? Or is it a disease of a rarefied kind, a human myxomatosis designed to eliminate the crap from the fringe of society, to stop the piss-heads copulating and producing more of their degenerate kind? Whichever. The fact is that it’s evident that he hasn’t been dead for long — his corpse is still moving into rigor. He has died in the night and I am the first to happen along. It is my responsibility to alert the authorities. And now I feel the presence of the Parstelin in my blood stream. It replaces the sense of nausea as — for the first time — a positive rather than a negative attribute. The drug provides me with another fuzzy frame of reference, within which the idiot’s death is no responsibility of mine. Someone else will report it, someone else will find him. I glissade down the hillside on my fluffy Lilo. The arguments from my conscience are remote, like memories of a television debate between contesting pompous pundits, witnessed several years ago …

A long morning in the hospital. On the ward there is an uncharacteristic, brisk efficiency. Valuam trots hither and thither with a clipboard compiling what look like inventories. For some reason he is dressed casually today, or at least in superficially casual clothes. It was always obvious that he would iron his jeans and check shirts, and also that he would wear sleeveless grey pullovers. Not for the first time it occurs to me that there is a strange symmetry between the sartorial sense of the psychiatric staff and that of their patients. Valuam with his strict dress which looks hopelessly contrived, Bowen with her bag lady chic, Busner with his escaping underwear. All of them match up with the patients in their charge …

I am working on something of my own which I hope will provide some inspiration for the patients. It’s a worksheet, about six feet square, on which I have done several representations of the hospital. Each one has been executed using a different technique: pen and wash, gouache, oils, charcoals, pencils, clay. This morning I spend time cutting the stencil for a silk-screen print.

Patients, en route for therapy sessions, or dropping out of the medication line, pause by the tables I’ve pushed together in the dining area and ask me about the work. An auxiliary, a middle-aged Filipino woman, stops her swirling, watery work with tousled mop and zinc bucket on the ward floor to discourse at length on swollen ankles, injustice and the vagaries of public transport. I listen and work distractedly; the image of the dead idiot imposes itself on me startlingly. It slides in front of my eyes from time to time with an audible click: the ridge of greasy, nylon quilted collar, the scrubby, scrawny neck, the long face, the exploded eyes …

At noon then. Jane Bowen comes and sits near me, salutes me but does not converse. She rolls one of her withered cigarettes and stares out of the window abstractedly, drawing heavily. Her hair is scraped back tightly from the violet, inverted bruises of her temples. She gazes towards the hill where the idiot lies. I have an impulse to tell her about it, which I repress. The weather outside the hospital is playing tricks again; long, high bands of cirrus cloud are filtering the wan sunlight into vertical bars, which cut across the area that lies between the hospital and the Heath, creating shadows of diminishing perspective, like the exposed working on an artist’s sketch.

Eventually I get up and go and stand beside her. I am conscious of her body retreating from me inside the starched front of her white coat, leaving behind a white buckler. We both look out of the window in silence. My gaze drops from the idiot’s bier-bench (I cannot see any evidence of discovery, service vehicles, or whatever) to the chronics’ balcony below, the open area projecting out from Ward 8.

As once before, two cretins are embracing in a painful muted struggle. Their gowns flap in the wind, they strain against one another, locked in a clumsy bear-hug. Then one moves with surprising speed and agility, changing his hold so that he grips the other from behind, pinning his arms — and at the same time leaning backwards over the rail that runs above the concrete wall bounding the balcony. The two faces tip up towards Jane Bowen and I, white splashes that resolve themselves into … Mark, Busner’s son, who was at school with me, who had a breakdown at university and attempted suicide. He is pinioned by the handsome, black-haired man who I saw in the treatment room with Jane Bowen. The man’s face is glazed over with brutish imbecility. I feel another jolt of nausea, stagger and place my hand against the pane for support. Jane Bowen looks at me pityingly and gestures with her fag.

‘Your predecessor, Misha, our ex-art therapist. Who just happens, purely by coincidence, to be my brother, Gerry.’

‘That’s Mark with him, Busner’s son!’

‘Yes, Zack felt it would be a good idea to have them farmed out to Ward 8 for a little while. He thought you might find it a tad shocking to encounter them as patients.’ She turned to face me and said quite calmly, in a flat kind of a voice, ‘Get out of here, Misha. Get out of here now.’

She wasn’t issuing advice on a career move. This was a fire alarm. I acted on it quickly, but hesitated on my way across the wide expanse of industrial-wear floor covering, skittering on one leg like a cartoon character speeding around a corner that turns into a vase. Abruptly I realise that the Parstelin has completely altered my sense of my own body. I am acutely aware of the connection between each impulse, each message and the nerve-ending it comes from. My whole physical orientation has shifted, but remains whole.

This apprehension occupies me as I run to the lift. Patients ‘O’ at me hysterically, but there is silence, or rather a descending wail that has nothing to do with speech and everything to do with what children hear when they press the flaps of cartilage over their ears, in and out, very fast. Sheuuooosheeeuuooo.

‘A, hehehahahoohoohoohoo!’ Clive does the twist by the coiled hosepipe in an anonymous bay, off the short corridor I run down on my way to the lift.

‘Misha, a word please,’ Valuam comes out from his office, trouser material high on each thigh, scrunched up in marmoset hands. His peeled face tilts toward me, fungus poking out from the door. Another door swings open five yards further on and a hand emerges to pluck at my sleeve, a round, dimpled hand on the end of that dripping sundae body. I run past it and in my mind the flashback of thrust seems hard and mechanical; my penis a rubberised claw torn from a laboratory retort and thrust into the side of a putrefying animal. I must take the stairs.

Four flights down I stop running. They’re going to let me leave the hospital. A drug is just a drug. I was bloody stupid to take it at all, to fuck with Mimi, but if I stop it now my head will clear in a couple of days and I’ll be back to normal. I won’t have this strange sense that I am someone else, someone who is compelled to be reasonable.