Her palms were clammy by the time her name was finally called. The doctor was a serious-looking man with a neatly trimmed white beard. He invited her to sit on a hard wooden chair in the middle of the cold room. Beatrice felt somehow smaller and more stupid, and diminished, as soon as she did so. Her hands were too large for her lap, but she did not know what to do with them. For the first time in her life she wished she could be dainty. The clock on the wall ticked too loudly and the air felt thin.

‘Thank you for coming in to see me, Lady Sitwell,’ the doctor said. His voice was as dry as sawdust. ‘What is it that troubles you?’

Beatrice swallowed hard. She knew her stutter would be bad, even before she opened her mouth. ‘I h-h-have b-been s-s-suffering with a l-l-low m-m-mood,’ she managed, spitting the words out like stones.

‘Indeed? Well, that is not so very unusual. We all experience sadness from time to time.’

Beatrice shook her head, already despairing at how to make herself understood. ‘It is m-m-more than being s-s-sad,’ she struggled through the stammer. ‘It is a f-feeling of c-c-c-complete d-d-d-despair. S-Some d-d-days I c-cannot get out of b-bed.’

Or eat. Or sleep. Some days I don’t feel like a human being at all. Some days I feel like a shell that has had everything sucked out of it.

‘I see,’ the doctor said, although Beatrice could tell that he didn’t see at all. ‘And have you recently suffered a bereavement or something of that nature?’

Beatrice shook her head.

The doctor frowned. ‘So, what is the cause of this despair you describe?’

Everything.

And nothing.

She felt a headache begin to stir behind her eyes.

‘There is n-no p-p-particular c-c-cause,’ she managed.

That was part of the problem. She tried to go on, but her tongue froze and the words jammed in her throat, even though she knew what she actually wanted to say.

Winter makes me sad sometimes. So does summer. The despair might be set off by recalling a moment from the past, or by feeling out of place in a crowded room, or by the nightingales returning in May. It makes no sense. It’s a sadness that can creep up on me, even in my happiest hours. Because this sadness has legs and it follows me wherever I go, and whatever I happen to be doing, and whomever I’m with. It might be triggered by a genuinely upsetting event but, most of the time, there is no reason to it, no logic – no discernible cause at all.

‘There is always a cause, Lady Sitwell,’ the doctor said. ‘It is only that sometimes we are not able to recognise what it might be.’ He glanced at a page of notes on his desk, then looked back at her and said, ‘You are unmarried, I believe?’

‘Y-Y-Y-Y—’