Tammy Cohen on They All Fall Down

Dear Reader,

My latest psychological thriller, They All Fall Down, is set in a private psychiatric clinic for women at high risk of self-harm where Hannah Lovell is a patient. When two of Hannah’s fellow patients die in quick succession, suicide is the obvious assumption. Only Hannah is convinced there’s a serial killer at large in the unit, preying on her friends. But Hannah suffers from delusions. How can she expect other people to believe her when she’s so expert in lying to herself?

‘I’m frightened. I’m frightened that I’m right and I’ll be next. I’m even more frightened that I’m wrong, in which case I’m as crazy as they all think I am. Shut away in here, the only escape is in my own head. But what if my own head’s the most dangerous place to be?’

Let me confess right now. I’m fascinated by the human brain’s endless capacity for self-deception. We all do it. Convincing ourselves we’re still loved when it’s quite obvious the object of our affections has long since moved on; telling ourselves our child couldn’t possibly have done that bad thing, even when she’s been caught red-handed. Lovely young girls are quite certain they’re hideous, men who are drowning in debt still cling on to the conviction that the next bet will be the one that turns their fortunes around.

All of us construct our own narratives from the circumstances life throws at us, but how realistic that narrative is, or how far we are willing to go to adhere to it, even when events are taking us in a different direction, is often a very grey area. We want to live out the stories we’ve imagined for ourselves, where we meet the perfect partner, and our kids are happy and work is a succession of triumphs. And when that story takes a different turning, with an ending we didn’t envisage, sometimes we surprise ourselves with our capacity to blind ourselves to the truth in order not to lose sight of the fairy tale.

So far so commonplace. But there’s also another level of self-deception, which is rooted more in fear than in logic. Where our brains will simply try to convince us that blue is really black, that our loved ones have been kidnapped and replaced by aliens, that we alone are responsible for all the ills in the world – for the famine in Africa, for England losing in the World Cup, for the fact that it’s raining. Our brains will tell us that all joy has been stripped from the world and it will never return, that our families would be better off without us, that people are disgusted by our flabbiness, even though we’re only eating a quarter of an apple a day.

How would it feel to be trapped inside thoughts like these day in day out? What must it be like to have to battle not only with the inevitable negative messages coming from the outside, but internal ones also? What if, as Hannah says, the inside of our own heads is the most dangerous place to be?

This was the inspiration behind They All Fall Down. We talk about psychological thrillers as meaning any book concerned as much with the why of a crime as the who, what, where and how. But I wanted to take the psychological thriller a step further, to set it as much in the landscape of the human psyche as in the physical building that is The Meadows, the psychiatric clinic where most of the action takes place.

New patient Hannah Lovell is struggling to come to terms with the terrible thing she’s done, with her own capacity for deceiving herself and the people she loves and with the degree of responsibility she must take for how her once perfect life has spiralled out of control. So when strange things start happening in the clinic, she has first to try to work out how much is real rather than imagined. Then, when events start to snowball dangerously, and she finds herself at risk, she has to convince those around her – the very people she’s persistently lied to – that she is now telling the truth.

It felt like a huge responsibility to tell Hannah’s story properly, and that of her fellow patients. I was very aware I didn’t want to either catastrophize or, on the other hand, trivialise their various conditions. That’s why I talked at length to NHS psychiatrists and GPs, wanting to get it all as right as I possibly could.

It would be too easy for a book like this to turn into a sort of freak show, a sort of ‘us’ and ‘them’ with the reader watching safely from behind a plate glass window, whereas really, the only sane reaction to mental illness is ‘there but for the grace of god’.

Like many of us, I’ve seen first-hand how easy it is to stray over the line from what is considered ‘normal’. One close friend has had two nervous breakdowns, another has addiction problems. And that’s not even touching on those of us for whom mood-stabilising anti-depressants are an everyday fact of life. The truth is I think we’re all a hair’s breadth away from losing it.

I fully believe that none of us knows exactly what we’re capable of. We’d all like to believe we could never inflict violence, but in reality until we’re tested with the ultimate provocation we have no idea how we would react. We think we know ourselves inside out but there are vast uncharted spaces inside us all that most of us will never explore – and if we do we might well find we don’t much like what we find.

The outside world, we’re constantly being told, is a scary place. But the world inside our own heads is far, far more terrifying.

Tammy Cohen