The Mental Healthcare Act 2017 of

India_ A challenge and an opportunity

Vasudevan Namboodiri & Sanju George
& Swaran Preet Singh
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 Asian Journal of Psychiatry 44 (2019) 25–28

Contents lists available at ScienceDirect

Asian Journal of Psychiatry

journal homepage: www.elsevier.com/locate/ajp

The Mental Healthcare Act 2017 of India: A challenge and an opportunity T

a b,⁎ c
Vasudevan Namboodiri , Sanju George , Swaran Preet Singh
a
Institute for Mind and Brain, Kuranchery, Thrissur, Kerala, 680581 India
b
Rajagiri School of behavioural sciences and research, Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O., Kalamassery, Kochi, Kerala, 683104 India
c
Warwick Medical School, University of Warwick, CV4 7AL, United States

A R T I C LE I N FO A B S T R A C T

Keywords: The Mental Healthcare Act 2017 replaced the Mental Health Act 1987, subsequent to India’s ratification of the
Mental Healthcare Act 2017 United Nations Convention on the Rights of Persons with Disabilities in 2007. The Mental Healthcare Act
India (MHCA) 2017 upholds patient autonomy, dignity, rights and choices during mental healthcare and thus marks a
Psychiatry bold step in India’s mental health legislation. This new Law marks a major shift in the way mental healthcare is
delivered, as it aims to protect and promote the rights of people during the delivery of mental healthcare. Within
this Act, a capacitous individual cannot be coerced into receiving treatment for mental illness and inpatient
admissions can be ‘independent’ or ‘supported’. ‘Supported admission’ replaces involuntary admission from the
previous legislation. State mental health authorities and mental health review boards will play a major role in
the implementation of the new Act. The Mental Healthcare Act 2017 is aimed at bringing about radical trans-
formation to mental healthcare in India.

1. Introduction
The Mental Healthcare Act 2017 is a bold step in a new direction for
mental health legislation in India. India is the second most populous
country in the world and is home to a sixth of the world’s population.
(The World Health Organisation, 2019). India became an independent
country in 1947 and a Republic in 1950. India is a union of 29 States
and seven Union Territories. Individual States are ruled by democrati-
cally - elected State governments. Although most healthcare is funded
by the individual State governments, rather than the Central govern-
ment of India, mental health legislation enacted by the Parliament of
India is applicable to all States and Union Territories in India. A recent
National Mental Health Survey (NMHS) estimated the one-time pre-
valence of any mental illness in India to be 10.6% (2016) (National
Mental Health Survey of India et al., 2016; Gururaj et al., 2016). NMHS
estimated the treatment gap for mental health disorders in India to be
83%. This is in keeping with the estimated treatment gap by the WHO
consortium (2004). (Demyttenaere et al., 2004)
2. Mental health legislation in India
British India (prior to 1947) had several legislations governing
mental health care (Lunacy Acts, Indian Lunacy Act, etc.). The Republic
of India enacted The Mental Health Act 1987 (The Ministry of Health
and Family Welfare, Government of India, 1987), to replace its colonial
predecessor, The Indian Lunacy Act, 1912. The Mental Health Act,
1987, did not contribute much towards protection of the rights of the
mentally ill. The Mental Health Act, 1987 was repealed in 2018 and the
new Act is The Mental Healthcare Act, 2017 (The Ministry of Law and
Justice, 2017). The Mental Health Act 1987 provided legal provision for
healthcare of persons with mental illness requiring inpatient treatment.
The lack of provision for an independent judicial / quasi-judicial review
of the decision for compulsory admission was a major drawback of The
Mental Health Act 1987. There was no provision to ensure that com-
pulsory treatment was least restrictive of the patient’s rights. The pre-
vious Act was applicable only to specialist mental hospitals and thus
excluded a large proportion of people receiving mental health care in
general hospital settings from the purview of the Act.
India ratified the United Nations Convention on the Rights of
Persons with Disabilities in 2007 (CRPD, 2006). This necessitated a
review of the existing Mental Health Act to ensure compliance with the
Convention. In compliance with the Convention, the new Act is firmly
rooted in the rights of people with mental illnesses. It makes a pre-
sumption of equality in front of the law for people with mental illnesses,
unless an individual has impaired decision-making capacity for mental
healthcare decisions. The new Act focusses just on mental healthcare,
rather than care of persons with mental illness (for example, welfare
and management of property of a mentally ill person are not covered

⁎
Corresponding author.
E-mail addresses: vasudevan.namboodiri@gmail.com (V. Namboodiri), sanjugeorge531@gmail.com (S. George).
URLs: http://drvasudevan.mailbox@gmail.com (V. Namboodiri), http://sanjugeorge531@gmail.com (S. George).

https://doi.org/10.1016/j.ajp.2019.07.016
Received 27 February 2019; Received in revised form 6 July 2019; Accepted 7 July 2019
1876-2018/ © 2019 Elsevier B.V. All rights reserved.
V. Namboodiri, et al.
under this Act). The preamble of the new Act reads as below:
“The Mental Healthcare Act is to provide for mental healthcare for
persons with mental illness and to protect, promote and fulfil the
rights of people with mental illness during delivery of mental
healthcare and services and for matters connected therewith or in-
cidental thereto”. (The Ministry of Health and Family Welfare,
Government of India, 1987)
3. Core principles of India’s new mental healthcare act
Mental Healthcare Act 2017, upholds patient autonomy, dignity,
rights and choices during mental healthcare. For the first time in the
country’s history, access to mental healthcare is described as a right of
every citizen. In contrast, physical healthcare is still not stated as a right
for every Indian citizen. This is commendable for a country like India
with large unmet psychiatric need (Demyttenaere et al., 2004). Capa-
city to make decisions regarding mental healthcare for oneself has a
pivotal position in this Act. The capacity for decisions on mental
healthcare is articulated in the Act as ability to understand relevant
information, (or) appreciation of consequences of decisions (or) ability
to communicate the decisions (Section 4 of this Act). Mental healthcare
for a capacitous individual can only be provided subject to informed
consent. A capacitous individual is the sole decision maker for her/ his
mental healthcare, irrespective of the mental illness or risks involved.
Unlike in many other jurisdictions, a capacitous individual cannot now
be forced inpatient treatment for mental health in India, even when the
risks related to mental health are high. Even at times of incapacity,
patient choice is to be listened to.
To ensure that patient choice is respected even in individuals with
impaired capacity, this Law uses three tools: advance directives, no-
mination of representatives and supported decision-making.
3.1. Advance directives (Sections 5-13 of the Act)
Any capacitous individual, irrespective of the presence of mental
illness, can execute an advance directive to help design the care they
will receive during an incapacitating mental illness. Valid advance di-
rectives are legally binding, unless revoked by the Mental Health
Review Board or a court of law. A medical practitioner or a mental
health professional shall not be held liable for any unforeseen con-
sequences of following a valid advance directive. Advance directives
are expected to be registered with the Mental Health Review Board
(Section 82(1)(a) of the Act). Advance directives have no place in the
care of a capacitous individual or at times of emergency treatment.
3.2. Nomination of representatives (Section 14 of the Act)
Each patient can nominate a representative to support decision
making at times of impaired capacity for decision-making regarding
mental healthcare. Nominations are made by the patient and accepted
by the nominee. The nominated representative is legally bound to give
due respect to the patient choice, will and preferences, while making
decisions for the patient. In the absence of a nominated representative,
other relatives, carers and specific appointees (following the specific
protocol in the Act) from the State can assume the role of a nominated
representative. A nominated representative can make decisions for the
patient only at times of incapacity.
Supported decision-making replaces substitute decision making in
times of incapacity (of the previous legislation). In the previous legis-
lation (The Mental Health Act, 1987), mental healthcare decisions were
made for the patient by the treating team in their role as the substitute
decision maker for the patient. The new Law instructs nominated re-
presentatives to make decisions, only after giving due credence to pa-
tient choice, best interests, will and preferences. Supported admission is
a concept introduced in the new Act to replace involuntary admission of
26
Asian Journal of Psychiatry 44 (2019) 25–28
the previous Act. Support lies on a continuum ranging from minimal to
near complete. People requiring high levels of support for decision
making are likely to require supported admission and treatment.
3.3. Remit of the law
The law covers all ‘substantive’ mental illnesses including substance
misuse disorders. Intellectual disability is, however, excluded. Mental
illness as per Section 2(s) of this Act is a substantial disorder of thinking,
mood, perception, orientation or memory that grossly impairs (a)judgment,
(b)behavior or (c)capacity to recognize reality or ability to meet the or-
dinary demands of life. People with substance misuse disorders are ex-
plicitly brought under the purview of the Act.
All institutions where people with mental illness reside for treat-
ment and care (excluding family homes) are considered as mental
health establishments requiring registration with the authorities. This
includes all rehabilitation homes, prisons, places for religious healings
and institutions offering complementary therapies. General hospitals
providing mental health care (in isolation or in combination with
physical healthcare) also come under the remit of the Act. This is clearly
a welcome step forward, as the previous legislation was restrictive in its
remit.
Unlike the previous Mental Health Act of India (1987), the current
law is restricted to mental health care (rather than care of the mentally
ill). There is a separate legislation, enacted in 2016, to cover certain
other aspects of life of people with disabling mental illness (Rights of
People with Disabilities Act, 2016) (Ministry of Social Justice and
Empowerment, 2017). This change is firmly grounded on the principle
of equality before law (Article 12) of The United Nation’s Convention
on Rights of Persons with Disabilities.
3.4. Rights of persons with mental illness
In addition to the constitutional rights, every citizen of India now
also has a right to access State-provided mental health care.
Discrimination because of mental illness in any sphere of life is illegal
(including for insurance purposes). This Statute also prohibits dis-
crimination to access mental healthcare on grounds of sexual orienta-
tion (article 377 of the Indian Penal Code which criminalized con-
sensual homosexuality was struck down by the Supreme Court of India
in 2017 (Anon., 2018).
The Law presumes that everyone with mental illness is capacitous
for mental healthcare (until proved otherwise) and enshrines the right
to protection from cruel, inhuman and degrading medical treatment.
The law demands equality of mental healthcare and physical health-
care.
The Law also views access to mental healthcare in the community as
a governmental responsibility to people with mental illness. Free legal
aid, access to medical information, access to community living, con-
fidentiality of medical information, access to personal contacts and
communication are all rights of patients receiving inpatient mental
healthcare enshrined under this Statute.
3.5. Admissions to mental health establishments
Admissions to mental health establishments under this Act can be
either ‘independent’ or ‘supported’.
Independent admissions (Section 85–86) are voluntarily requested by
capacitous patients, with freedom (and responsibility) to make deci-
sions and care plans. There is no limit to the time period for in-
dependent admissions. Independent admissions do not necessarily re-
quire a psychiatrist to be part of the process (even for discharge) and
they are not required to be reported to the Mental Health Review
Boards under the Law. Discharge requests made by independent pa-
tients are to be honoured, unless criteria of capacity and risks allow a
retention for 24 h for an assessment for supported admission.
V. Namboodiri, et al.
One of the core principles of the Act is parity for mental healthcare
and physical healthcare. Independent admissions require to pass a
threshold of severity. Besides an informed choice to access inpatient
mental healthcare, this Act limits independent admissions only to those
who pass a severity criterion. This can become a barrier to those who
seek inpatient treatment below the threshold. This is opined as against
the principle of parity with physical healthcare (Kumar, 2018).
Supported admissions (Section 89) replace involuntary admissions of
the previous legislation. The aim is to use support to minimize in-
voluntary admissions. Impaired decision making is essential, though
not sufficient, for supported admissions. Supported admissions are to be
used only when there is no less restrictive option. The patient is ex-
pected to benefit (as judged by the admitting clinician) from the hos-
pitalization. Risks to self, others or of self-neglect should be recent
(what can be ‘recent’ is open to individual interpretation). Support is
meant to be from a nominated representative (patient-nominated or
appointed by the State). Supported admissions can take place with
minimal or no agreement from the patient. The law mandates that even
patients with impaired capacity for decision making for mental
healthcare need to be supported and involved in decision making, as far
as possible. The Law views support as being on a spectrum, ranging
from minimal requirement of support to near total support.
Supported admissions (Section 89) require two independent pro-
fessional examinations and recommendations (a psychiatrist and a
medical practitioner/ mental health professional). All supported ad-
missions are to be intimated to the Mental Health Review Boards within
a week. The Mental Health Review Boards are quasi-judicial, led by a
judge. They have powers to discharge a patient from supported ad-
mission.
The State is bound to provide free legal aid to patients appealing
against supported admission. Decisions by the Review Boards are to be
within seven days of appeal and the maximum duration for an initial
supported admission is thirty days.
3.6. Extension of supported admission (Section 90)
Supported admission can be extended upon renewal. Extensions can
vary from 30 days to a maximum of 180 days. Each renewal must be
approved by the Mental Health Review Board. The Law mandates that
the treating team must make every effort to move the patient to a
setting outside the hospital as soon as possible. An extension of sup-
ported admission can be made on the recommendation of two in-
dependent psychiatrists. There are also processes for appeal and
hearing by the Mental Health Review Boards (described below).
Extensions can only be used at times of persistent risks and prior to such
an extension, every effort must be made to ensure lesser restrictive
options in the community are explored.
4. Discharges
All discharges from hospitals need to be coupled with discharge care
planning involving patients, clinicians and nominated representatives.
Compulsory community-based treatment is not possible under this Act.
However, the legislation binds the State to provide easily accessible
community mental health care and rehabilitation services. Individual
States and Union Territories are expected to create specific rules under
the Act regarding service provision. If the minimum services provided
by the government for mental healthcare is not available in the district,
the Law demands a reimbursement of expenses incurred by the patient
to access mental healthcare elsewhere. In India, with its high mental
health service availability gap, eligibility for reimbursement may not be
sufficient to ensure the gap gets bridged.
5. Mental Health Review Boards
These Boards consist of a District Judge Equivalent, independent
27
Asian Journal of Psychiatry 44 (2019) 25–28
psychiatrists, other independent clinicians and lay people. Though
there is a provision for an independent psychiatrist to be a member of
the Board, the Board can potentially be constituted even without a
psychiatrist. In addition to mandatory independent reviews and appeals
by patients and nominated representatives, the Boards are also en-
trusted with responsibilities of review of advance directives, review of
nominated representatives, approvals of extensions of supported ad-
mission, and ECTs for minors and psychosurgeries. Any appeals against
decisions by the Mental Health Review Boards are to be at the High
Court of the State. The Central and State Mental Health Authorities
oversee the implementation of Mental Healthcare Act.
The Mental Health Review Boards and Mental Health Authorities
are still in stages of infancy. Although it has been thirteen months since
the Act came into force, these boards are not functional entities yet. The
Act is ambitious and is aimed to bring out drastic change in the delivery
of mental healthcare.
6. Miscellaneous provisions
There is a distinct provision for emergency mental healthcare by
any registered medical practitioner for a maximum period of 72 h or
until a mental health assessment is completed (whichever is earlier). It
is clarified that advance directives do not apply to emergency situa-
tions.
Unmodified electro convulsive therapy, chaining and sterilization as
treatment for mental illnesses are explicitly prohibited. Certain proce-
dures like psychosurgery, ECT for minors and restraints are not pro-
hibited, but should be subject to prior approval from the Mental Health
Review Board.
The duties of Police to assist patients and families to ensure pro-
tection, safety and access to mental healthcare for people with mental
illness are explicit. Unlike in the earlier Act, the role of the judicial
magistrate in decisions of admission and discharge of people with
mental illness from inpatient settings is minimized.
Section 115 of this Act makes a presumption of severe stress for
suicide attempts and recommends that trial under the Indian Penal
Code is to be avoided for suicide attempts due to stress. The duty of the
government to provide care, treatment and rehabilitation for persons
attempting suicide is marking a change in the perspective towards
suicide in India.
Supported admissions require the ongoing involvement of a nomi-
nated representative during the inpatient mental healthcare.
Applications for supported admission, decisions for mental healthcare
for patients with impaired capacity during a supported admission and
request for discharge are explicit duties of the nominated re-
presentatives, even during a State-provided inpatient mental health-
care. These can be viewed both as empowering and burdensome09.
In India, with its huge judicial backlog in court systems (Anon.,
2019), the additional responsibility in relation to the Mental Health
Review Boards requires explicit commitment of resources from the
State. Legislatory reform is a necessary first step for changes in this
direction. There is a criticism that Indian mental health legislation is far
more progressive of the actual state of mental health service at the time
of enactment (Kumar, 2018; Duffy et al., 2018).
One of the options to ensure least restrictiveness of treatment is the
availability of compulsive (or ‘supported’ in the spirit of this Act)
treatment in the community. This avenue is largely unaddressed in this
Act. Compulsive treatment in the community is associated with a
marked diminution in the more restrictive hospital stay for persons with
mental illness requiring long-term admissions (Taylor et al., 2016). The
shift of focus from mental illnesses to mental well-being and from
hospital-based mental healthcare to community-based care is an in-
creasingly recognized need of the hour for India’s mental healthcare
system (Murthy, 2018). This legislation falls short of empowering
community based mental healthcare (Table 1).
The new legislation has received mixed response from mental health
V. Namboodiri, et al.
Table 1
Comparison of the previous and the current mental health legislations of India.
Mental Health Act 1987 (The Ministry of Health and Family Welfare, Government of
India, 1987) (Repealed in 2018)
Applicable only to specialty mental hospitals
(excluded general hospitals providing inpatient mental healthcare run by the
State).
Admissions – Voluntary, Involuntary and Reception Order from the Magistrate.
No provision for independent judicial review / appeal.
Compulsory inpatient treatment for mental illness posing risks (irrespective of the
capacity of the individual).
Substitute decision making for people undergoing involuntary treatment.
No special safeguards for minors requiring psychiatric admission.
A large role for judicial magistrate in admissions and discharge decisions.
Remit of the Law included not just mental healthcare, but care of people with
mental illnesses including guardianship.
professionals across the country. In summary, the new Act demands a
drastic change in the day – to - day practice of the average mental
health professional (Duffy and Kelly, 2017).
7. The future
Both mental health professionals and the judiciary are in un-
chartered territory here. Advance directives, supported decision -
making and nomination of representatives are all relatively new issues
for mental health professionals in India. The duty of care for a mentally
ill person lacking capacity, has shifted from the mental healthcare
professional to the nominated carers and the State. States, which were
not actively involved in bringing about this key legislation change, and
their already stretched judiciaries should find additional resources to
deliver the comprehensive care being promised in the new Act. India
has taken the initial steps of judicial reform to uphold the rights of the
persons with mental illness. The legislation is widely regarded as pro-
gressive, with a high level of concordance (in comparison with the
legislations of other jurisdictions) with the United Nations Convention
on Rights of People with Disabilities (Duffy and Kelly, 2017). There are
provisions in the Law to ensure that the government is duty-bound to
train all its mental health professionals in the use of this Act in their day
– to - day clinical practice. The law is ambitious and aspirational in its
spirit and offers opportunities for India to revamp the care of its citizens
with mental health difficulties, upholding their rights.
Financial disclosure
We, all authors of this paper, state that we have no financial in-
terests to disclose/declare.
Conflict of interest
None.
Asian Journal of Psychiatry 44 (2019) 25–28
Mental Healthcare Act 2017 (The Ministry of Law and Justice, 2017), in effect from 2018
Applicable to all settings where people with mental illness reside for care of mental illness
(including those providing traditional care).
Admissions— ‘Independent’ and ‘Supported’.
Provision for quasi-judicial review and appeal (Mental Health Review Board).
Supported inpatient admission and treatment are only for incapacitous individuals meeting
a threshold (including risks).
Protects and promotes the rights of individuals during mental healthcare.
Promotes choices of the individual through supported decision making, advance directives
and nomination of representatives.
Separate provision for minor admissions under section 87, with additional safeguards.
Minimal, if any, role for judicial magistrate in admission and discharge decisions.
The remit of the law is just mental healthcare.
Acknowledgement
None.
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28
Another random document with
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and wishing of a “Merry Christmas”; a few were still in the drawing-
room sorting out musical property.
Catherine felt a heavy hand on her shoulder. She turned ...
Verreker!...
In the half-light he looked almost demoniacally ugly. A great fur
overcoat hung ponderously to within a few inches of the ground, and
his hands were encased in huge fur gloves. Under his arm he carried
a rather incongruous cloth cap.
“Excuse me,” he began gruffly, “I’ve got a word to say to you.”
She pursed her lips scornfully.
“Be quick, then,” she said. “I haven’t much time to spare.” She
was being deliberately rude.
“I suppose you noticed I went out while you were playing?” he
went on.
“Did you?” As much as to say: “How should I know? Do you
imagine I keep careful watch upon all your movements?”
“The fact is, I went out because I remember your saying that you
never played well if I were present....”
“Did I say that?” (She was in a deliberately, irritatingly
obstructionist mood.)
“... So I thought I’d oblige.... Afterwards it occurred to me it would
be misunderstood.... That’s all.... It wasn’t anything else. Of course
you’re not obliged to believe me.”
“Why shouldn’t I believe you?” she said, with no discoverable
motive.
“I know of no reason at all,” he replied coldly.
Pause.
“And, as it happened, you did play rather well. Distinctly better
than usual.”
“Did I? ... How do you know?”
 “I listened behind the door.”
“Did you?”
She tapped her foot petulantly on the floor.... Pause.... Then ...
“All the same, I really don’t see quite what you mean.” She was
merely trying to annoy him. He had come to her humbly, and he was
going to be spurned. Yet from the look in his eyes she knew that this
last remark had been a mistake. He was not the kind of man who
waits to be spurned....
“Oh, well,” he said brusquely, “I’m glad I don’t need to
apologize.... Good-night!”
She called “Good-night!” so faintly that she was sure he never
heard it.
He was gone....

§9
Along the Bockley High Street she remarked thoughtfully to
George: “I didn’t know Verreker patronized your musical evenings.”
George replied: “Oh, it wasn’t that he came for. It was Helen. She
persuaded him to play.”
Catherine was surprised.
“Helen? Does Helen know him?”
“Oh, rather. She translates his books into French.” Again
Catherine was surprised. “Books? I didn’t know he wrote books! On
music, I suppose?”
“No, not on music.”
“On what, then?”
“Economic history.”
Once again Catherine was surprised....
 “He’s a curious chap,” George went on. “Economist and musician
combined. Queer compound. Helen likes him. She says his music’s
all the better for having the brains of an economist put into it, also his
economics don’t lose anything from being infused with a dash of
temperament. Can’t say I understand it myself, anyway.”

§ 10
And at the corner of Gifford Road he suddenly said: “I suppose
our engagement needn’t be a particularly long one, need it?”
She said: “Why? Do you want to break it off?”
He laughed, not altogether uproariously.
“No, no.... I mean—you know what I mean. Look here, why
shouldn’t we get married in the New Year?”
“Married?” she echoed vaguely. She looked at him as if the very
last thing an engaged girl thinks of is of getting married.
“Why not?” he said, point blank.
“I know of no reason at all,” she replied coldly, and was conscious
that she was echoing something she had heard before. The
stateliness of the phrase fascinated her.
“Then——” he began, and kissed her passionately. But the
passion did not thrill her. It was weak and watery compared with the
stuff in “Jeau d’Eaux.” Besides, she had grown blasé of his kisses.
Every night, week after week....
He kissed her again. He fondled her hair. He got hold of heaps of
it and crushed it voluptuously in his hand. This was a new
experience, and not devoid of interest to her. But even this became
stale in a very short time. He kissed her once more.
“Please!” she said, after some minutes of this sort of thing. “I
must go.... Really I must.”
So, with a long, lingering, sentimental caress he left her. And as
she climbed the stairs to the attic bedroom that night her one thought
was: “Fancy me marrying George Trant! Me!”
The idea at firsy seemed fantastic.
But after a while she accepted it as a more or less logical
sequence. And he was undoubtedly in love with her. And she with
him? Oh yes. At least.... “Why not?” she asked herself, and echo
within her answered solemnly, “I know of no reason at all....”
 CHAPTER XII
DISCONTENT
§1
HER first periodic “supervision” by Razounov took place early in the
New Year, and once again coincided with an engagement of
Razounov to play Chopin at the Bockley Hippodrome.
He puffed serenely at a cigarette while she played the Kreutzer
Sonata. At the end he said:
“Nicely, oh yais, quite nicely.... And thees ees—let me see—thees
ees Mees—Mees—”
“Weston,” put in Verreker.
“Ah, yais, ... plays quite nicely, eh? ... A leetle more technique,
and—more—more—what ees the word?—characterization, eh?”
Verreker nodded.
But Catherine was disappointed. For it was perfectly evident not
only that Razounov had failed to recognize her, but that her name
when told him had recalled nothing in his mind.

§2
At her next lesson with Verreker she said: “Razounov didn’t
remember me, apparently——”
Verreker replied quite casually: “Oh no, why should he?”
She coloured slightly.
 “Well,” she said, with some acerbity, “considering he took the
trouble to send for me after hearing me play at that club concert, I
think he might at least——”
Verreker faced her suddenly.
“What’s that?” he said.
“What’s what?”
“What you’ve just been talking about. I don’t understand in the
least.... You say he heard you at a concert?”
“Well, I presume so, anyway. What remarkably short memories
you musical people have! Razounov apparently heard me at the
concert, and sent me a message to come and see him the next day.
You ought to remember that: it was you yourself who brought it. You
tracked me down to the Forest Hotel.”
“Yes, yes. I remember that.... But the concert?”
She was becoming more and more sarcastic as his mystification
increased.
“Oh yes, the concert. I played Liszt’s Concert Etude in A flat (the
one you don’t like). As I remarked before, presumably Razounov
heard me, or else why should he send for me to——”
“I am afraid you have presumed falsely,” he interrupted. (She
shivered at the stateliness of the phrasing: it reminded her of “I know
of no reason at all.”) “Razounov could not possibly have heard you
play. He never attends local concerts. Besides, he must have been
on at the Hippo——”
“Then why did he send for me?” she cried shrilly.
He scratched his chin reflectively. She hated him for that gesture.
“I believe—I think he did tell me once.... I fancy it was something
rather unusual. Somebody—I can’t tell you who, because I believe
I’m pledged to secrecy—wrote to Razounov offering to pay for a
course of lessons for you. His name was to be kept out of it. I mean,
the name of the person.”
 He frowned irritably at the slip of his tongue, and still more at the
rash correction which had given prominence to it.
“A man?” she ejaculated.
“I can’t tell you that.”
“I know it was. Because you said ‘his.’”
“Then why did you ask me?”
She swung round on the stool and clasped her hands below her
knees. Her eyes were fiercely bright.
“What are Razounov’s fees?” she said quietly.
“Three guineas a lesson.”
“And yours?”
“For purposes of musical instruction I am Razounov. He only
supervises. It is a fortunate arrangement, because I am a much
better teacher than he.”
She looked at him a little amazed. For the first time she caught
herself admiring him. She admired the calm, straightforward,
unqualified way he had said that he was a much better teacher than
Razounov. It was not conceit. She was glad he knew how to
appraise himself. She admired him for not being afraid to do so. In
her eyes was the message: “So you too have found out that
overmodesty is not a virtue? So have I.”
But it was impossible to remark upon it. She plunged into the
financial side of the question.
“So somebody has been paying three guineas a week for me?”
(And she thought: “Whoever is it?”)
“Certainly. You don’t imagine Razounov would give lessons for
nothing, do you?”
“That is to say, you wouldn’t give lessons for nothing, isn’t it?”
“Certainly. I am not a philanthropist. I have other interests
besides music. Music is only my way of getting a living. I never even
reduce my fees except—except—well——”
“Yes?—except when?”
He turned away his head as he replied: “Except in cases where
the pupil has no money yet supreme musical genius.”
She flared up passionately.
“Look here,” she said, “why d’you keep on rubbing it in? How do
you know I shan’t be a great pianist? I say, how do you know? I tell
you, I don’t believe you. You wait; you’ll see me at the top before
long. And then you’ll have to eat your words. You’re got a good
opinion of yourself, haven’t you? Well, so have I. See? ... And I tell
you I will get to the top! I’ll show you you’re wrong! See?”
“I hope you will,” he said quietly. And added: “I’m glad my
criticism doesn’t discourage you. It isn’t meant to.”
To which she was on the point of replying: “But it has discouraged
me. There have been times when——” She did not say that. There
came a pause. Then she reverted to the financial side of the
business.
“So somebody’s already paid nearly a hundred pounds for me.”
“Sixty, I believe. The last quarter has not been paid yet.”
(And then the idea came to her immediately—George Trant!)
“Aren’t your fees payable in advance?” she asked sharply.
“As a general rule, yes.”
“Then why did you make an exception in my case?”
“Because I know the person fairly well, and am confident of being
paid soon. That’s all.”
“Is it?”
“Certainly,” he replied brusquely. “If your anonymous benefactor
doesn’t pay up within the next couple of months the arrangement
between you and me will terminate on the first of March. As I said
before, I am not a philanthropist.”
 “Obviously not.”
“I hope it is obvious. I have often been mistaken for one.”
“Curious! I can scarcely believe it.... Have you the address of my
anonymous benefactor?”
“I dare say I have it somewhere about. Why?”
“Because I want you to write and tell him something.”
“Indeed? And what am I to tell him?”
“Tell him he needn’t trouble to pay the last quarter’s fees. I will
pay them myself.”
“I hope you can easily spare the money——”
“Of course I can. I shouldn’t offer to pay if I couldn’t. I’m not a
philanthropist.”
“Very well, then. I will write and tell him what you say.”
Pause. He was beginning to look rather annoyed.
“And there’s just one other thing,” she said, putting on her hat
ready for departure.
“What’s that?”
“Our arrangement will not terminate on the first of March. I shall
continue and pay myself.”
“As you wish....” He shrugged his shoulders.
And she thought as she went out: “That was a neat stroke for me.
But it’s going to be confoundedly expensive....”

§3
Henceforward Catherine assumed that George was her
anonymous benefactor. His inability to pay the last quarter’s fees
synchronized with his encounter with the Bishop’s Stortford
magistrates, resulting in a bill, including costs and all expenses, of
nearly twenty-five pounds. Undoubtedly it was George who was
financing her. And the question arose: Why? And the only possible
answer was that this quixotic and expensive undertaking was done
out of love for her. Catherine did not particularly like it. She was not
even vaguely grateful. She almost thought: He had no right to do it
without asking me. And if he had asked me I shouldn’t have let him.
Anyway, it was done behind my back. Treating me like a little child
that doesn’t know what is best for itself....
At times she became violently angry with him for his absolute
silence. Does he intend to carry the secret with him to the grave?
she asked herself. The absurd ease with which he parried any
attempts to entangle him in a confession intensely annoyed her. “I
don’t believe he intends ever to tell me,” she thought. “And if I’m ever
a well-known pianist he’ll congratulate himself in secret by thinking: ‘I
started her. I gave her her first chance. She’d have been nothing but
for me. And she doesn’t know it!’” The thought of George’s romantic
self-satisfaction at such a juncture oppressed her strangely.
There was also the subtle disappointment of discovering that
Razounov had not “found” her as great pianists are supposed to
“find” promising talent. But she was becoming accustomed to the
shattering of her idealist creations. Besides, she was at this time
deriving a good deal of hard satisfaction from her rapid and steady
advancement, and no amount of retrospective disillusionment could
cast a shadow across the future. Only she was annoyed at the
quixotism of George Trant.
One evening she asked him point-blank:
“Did you pay for my first quarter’s lessons with Razounov?”
She expected the blow by its very suddenness would tell. He
started very slightly.
“Me?” he said, in a tone of bewilderment which, if not genuine,
was at least consummate acting. “Me?—I don’t understand. What do
you——”
“Well, somebody did,” she replied curtly, annoyed that her blow
had been parried. “And I thought it might be you.”
 “Good heavens, no!” he said, and at that moment she did not
know whether to believe him or not.

§4
He had been clever up to then. Afterwards he became too clever.
One of those periodic spasms of brilliance overwhelmed him.
The next morning she received a letter, typewritten, plain paper
and envelope, with the non-committal postmark: London, W. It ran:
The person who has undertaken the expenses of Miss Weston’s
musical training wishes it to be understood that he desires to remain
anonymous. Should he be questioned on the point by anyone he will
feel himself justified in adopting any attitude, even one involving
departures from the truth, which seems to him best calculated to
preserve the anonymity he so earnestly desires. Hence it is obvious
that enquiry, however persistent, can elicit no reliable information.
When Catherine read this she laughed outright. The absurdity,
the sublime ridiculousness of the thing tickled her. She knew now
beyond all doubt that it was George Trant. For this note had “George
Trant” written all over it. Only he could have devised something so
inanely clever and at the same time so incredibly stupid.
The fact of its being posted only three hours after their interview
of the evening before was enough to convince her. He must have
gone home direct, written it (he had a typewriter at home, she knew),
and gone up to London, W., immediately to catch the eleven o’clock
post. She pondered on his choice of London, W. Probably he thought
a London postmark would be least likely to give a clue. E.C., the
most common, would suggest Leadenhall Street, so he chose W.
That, probably, was his line of argument.
It was not a bad joke, she agreed. Yet if he acted upon it she
could conceive herself getting angry....

§5
 Her opinion of George went up somewhat after the receipt of this
letter. She was immensely struck by its absurdity, yet she had to
admit that in addition to being a joke it was quite a clever joke. For
several weeks she did not mention the affair, and he too avoided all
reference to it. Then she began again to be annoyed at his silence.
Besides, she was immensely curious to know what his attitude would
be. The full flavour of the joke had yet to be tasted.
An incident—trivial in itself—lowered her opinion of him
incalculably.
She had gone for her usual weekly lesson from Verreker. It was
springtime, and “Claremont” was being painted, both inside and out.
The music-room in which she took her lessons was crowded with
furniture from other rooms, and for the first time she saw the
evidences of Verreker’s labours apart from the world of music. Large
book-cases had been dumped anyhow against the walls, and tables
littered with papers filled up the usually spacious centre of the room.
The piano had been pulled into a corner. She had several minutes to
wait, and spent the time perusing the titles on his bookshelves.
There was a fairly large collection of modern novels, including most
of the works of Wells, Bennett, Conrad, Hardy, Chesterton and
others; complete sets of the works of Shaw and Ibsen, most of the
plays of Galsworthy, Granville Barker and Henry Arthur Jones; and
some hundreds of miscellaneous French novels. A complete
bookcase was occupied by works on economics and economic
history—she read the names of Cunningham, Ashley, Maitland,
Vinogradoff, Seebohm and Money. Then there was a shelf entirely
devoted to Government Blue-Book publications, Reports of
Commissions, quarterly and monthly reviews, loose-leaf binders full
to bursting with documents, and such like. It was a very impressive
array. She was conscious of her own extreme ignorance. Scarcely
anything that was here had she read. She was not particularly fond
of reading....
On the table near his desk she saw a yellow-backed copy of
Ibsen’s Ghosts....
 One result of their frequent bickering was that their conversation
had acquired a good deal of familiarity....
“Rather a muddle,” he commented, as she was preparing to go
after the lesson. He waved a hand comprehensively round the room.
“You’ve a lot of books,” she said.
“Yes; and I read them.” (As much as to say: “If you had a lot of
books you wouldn’t read them.” In other words, a purely gratuitous
insult. But she ignored it.)
“Reading Ghosts?” she remarked, taking up the yellow-backed
book from the table.
“Re-reading it,” he corrected.
Something erratic and perfectly incomprehensible prompted her
next utterance.
“Absolute biological nightmare,” she said casually. (It was
something she had once heard George say.)
He looked at her queerly.
“Have you read it?”
“No,” she said, and blushed. She knew his next question would
be, “Then how do you know?” so she added: “I once heard
somebody say that about it.” She plunged further in sheer
desperation. “Don’t you think it’s rather a biological nightmare?” she
persisted, with passionate eagerness, as much as to say: “Please
don’t make a fool of me. Please let the matter pass this once.”
“I confess,” he replied coldly, “it never appeared to me in that,
light.... But, of course ...”
(Truly he was a master of stately phrasing!)
Naturally she regarded it as George’s fault primarily. It was clear
she had overestimated George’s critical faculties....

§6
 She was so annoyed with George on the way home that she
arrived at the astonishing decision: I will not marry him....
That evening, under the trees of the Bockley High Road, she
produced the typewritten anonymous letter and asked him point-
blank: “Did you write this?”
“No,” he said immediately.
“Did you type it, then?” (It showed her mean opinion of him that
she judged him capable of such a quibble.)
“No.”
“Do you know its contents?”
“How should I?”
“Then please read it.” She handed it to him.
“If you like,” he said, and read it. “Well?” he remarked, after doing
so.
“How am I to know if you are telling the truth?”
“You have only my word.”
“But, according to the letter, you may be telling me a lie.”
“That is presuming that I wrote it.”
“And you didn’t?”
“No.”
Pause. Then suddenly she stopped and faced him defiantly.
“I don’t believe you!” she snapped.
“Well——”
“Look here. You did write this thing. Tell the truth. Own up to it. It’s
very clever and all that, but it shouldn’t be kept up seriously like this.
I’m certain you wrote that letter.”
“You don’t take my word for it?”
“Not in this case.”
 “In other words, I’m a liar. Eh?”
“I suppose it comes to that.”
“Well, you’re very polite, I must say. Perhaps you’ve a few more
things you’d like to say about me?”
“Don’t try to be sarcastic. But there is one thing if you really want
to know.”
“What’s that?”
She paused, and then hurled it at him with terrible effect.
“I don’t love you a bit.... Not a tiny bit....”
She saw him whiten. It was thrilling to see how he kept his
emotion under control. She almost admired him in that moment.
“Is that so?” he said heavily.
“Yes.”
He bit his lip fiercely.
“Then our engagement, I presume, is—is dissolved?”
“Presumably.... Here’s your ring.”
Here occurred a touch of bathos. She tried to get the ring off her
finger, but it would not pass the first joint.
“Let me try,” he said humbly, and the episode became almost
farcical. It came off after a little coaxing. But the dramatic possibilities
of the incident had been ruined.
“Well,” he said stiffly, “I suppose that’s all. It’s your doing, not
mine. You’re breaking up our prospects without the least shadow of
reason.”
It did seem to her an incredibly wanton thing that she was doing.
And at this particular moment, if he had uttered her name slowly and
passionately she would have burst into tears and been reconciled to
him. But he missed the opportunity.
“I shall return your letters,” he continued coldly. (There were not
many of them, she reflected.)
 “Good-bye,” she said.
They shook hands. And she thought: “Fancy having been kissed
every night for months and months and suddenly turning to a
handshake!” That, more than anything, perhaps, indicated to her the
full significance of what had happened. That and the peculiar
sensation of chilliness round her finger where the ring had been.
As she turned into Gifford Road she asked herself seriously the
question: “What has come over me? Am I mad? ...”

§7
More than once during the next few weeks she wished for a
reconciliation with George. It was not so much a desire for him as a
sense of despair at being once more wholly alone and adrift. Now
she was back again where she was when she first came to Gifford
Road. With redoubled energy she laboured at her music, and soon
the idea of a recital in a London concert hall began to dance
attractively in her vision. She extended her reputation by playing in
other suburbs; she thought even of setting up as a private teacher of
the pianoforte. With the surplus earnings of a few months she bought
an upright piano of decent tone and installed it in the basement
sitting-room at Gifford Road.
George wrote to her once, a long letter of mingled pleading and
expostulation. He mentioned that he had not yet told his parents
what had happened, so that if she desired to change her mind it
would be easy to do so. He laid stress on the difficulty he should find
in giving Helen and his father and mother an adequate explanation
of their separation.
After the receipt of this letter Catherine ceased her vague
misgivings. She replied immediately in a letter, short by comparison
with his, whose every sentence was the result of careful
excogitation:
It is no good thinking of our ever becoming engaged again,
because if we did we should soon quarrel. We simply aren’t made for
one another, and however kind and sympathetic we try to be there’ll
always be something lacking that sooner or later we shan’t be able
to do without....
I am bound to confess that the idea of marriage with you always
struck me as fantastic and improbable. I never, I believe, considered
it seriously. I knew something would happen to put an end to our
plans....
... Of course I am in the wrong. You have been very kind to me
and from the ordinary point of view you would doubtless have made
a very good husband. You are quite entitled to consider yourself
shabbily treated. I am wholly in the wrong. But I am not going to
make myself everlastingly unhappy just to put myself in the right.
And whether you would have made me a good husband or not, I
should certainly have made you a bad wife. I am a peculiar person,
and I would never marry a man just because he would make a good
husband.... Surely you don’t imagine I am going to marry you just to
let you out of the difficulty of explaining things at home? ... A thing
like that proves at once the complete misunderstanding that exists
between us two.... You must tell your parents and Helen exactly what
has happened, viz. that I have jilted you. If you were a woman you
could claim a few hundred pounds damages for breach of promise....
Tell them I have jilted you because I could not bear the thought of
marrying you. Blame me entirely: I am heartless and a flirt, cruel,
treacherous and anything else you like. Only I am not such a fool as
to marry somebody I don’t want to marry....
Don’t imagine I am in love with somebody else. At present I am
not in love with anybody. At one time I thought I was in love with you,
but I am doubtful if it ever was so really. I think it was just that you
hypnotized me by being in love with me yourself. I mean, I was so
interested in your experience....
I don’t ask you to forgive me. Because forgiving won’t make any
difference. I may have done right or I may have done wrong, but I
have done what I would do over again if I had to. There is no
repentance in me. It is idle to pretend I am sorry. I am extraordinarily
glad to have got out of a difficult position....
 This letter, by the way, is the first sincere letter I have ever written
to you. I do not mean that the others were all insincere: I mean that,
compared with this one for truth and sincerity, the others were simply
—nothing....
As to my present attitude towards you I will be offensively
straightforward. I do not like you. That ought to convince you finally
of the uselessness of answering this letter....

§8
A cold May day, so chilly that a fire seemed the most welcome
thing on earth. Seven in the evening, and it was the last lesson of the
quarter. When she reached “Claremont,” Verreker was not there. He
had been up to the City, and a slight accident outside Liverpool
Street Station had delayed the trains. The maid showed her into the
music-room and left her alone. She sat in one of the big chairs by the
fire and felt astonishingly miserable. The room had regained its
normal condition; the surplus furniture, the books, papers, writing-
desk, etc., had been taken away: but a grandfather clock that had
not originally been there now occupied a permanent position in the
corner. The embers were burning low, and shadows were darkening
all around: the black and white vista of piano keys straggled
obscurely in the background; the clock was ticking sleepily away. Far
into the dim distance of the ceiling loomed the polished splendour of
the raised sound-board....
Why did she feel miserable?
It was something in her soul.
She got up and sat down at the piano.
With no discoverable motive she commenced to play the piece
that she now knew was Chopin’s Black Note Etude (in G flat). It was
the one she had heard years ago when she stood in the scented
dusk of the Ridgeway in front of the house with the corner bay-
window. Since then she had learned it thoroughly and played it many
times on concert platforms. But as she played it now it sounded new,
or rather, it sounded as if she had heard it only once before, and that
was many years ago in the summer twilight. All between was a gap,
a void which only the Chopin Etude could bridge....
(In her strange mood she was playing it most abominably, by the
way.)
She paused in the middle. Her eyes were like dark gems amidst
the red glory of her hair.
“I’m not in love with any person,” she told herself with incredible
calmness. “I’m not in love with anybody in the world. But I’m in love
with Something. Some Thing! Very deeply, very passionately, I am.
And I don’t know what it is.... I keep finding it and losing it again. But
it’s in this”—she started the first few bars of the Chopin piece—“it’s
all everywhere in that. I knew it was there when I stood and listened
to it years ago. Oh, it’s there. And I’ve heard and seen it in other
places, too. But as yet it’s been only a thing.... But some day, maybe,
I’ll tack it on to somebody living, and then ... God help me! ...”
Her fingers flew over the keys, and the great octaves began to
sing out in the left hand.
“I’ll have to be careful,” she went on in thought—“careful, or else
some day I’ll go mad.... But it’s there, whatever it is.... Something
that’s in that and that’s in me as well, and they’re nearly tearing me
to shreds to get closer to one another. That’s how it feels.... And I
told him I wasn’t in love with anybody ... But if I should catch a
glimpse of this something in any living being! Nothing should ever
keep us apart! Nothing could! Neither life nor death—nor miles—nor
anything.”
She let her hands fall down the keyboard in a great culminating
Niagara of octaves. Two chords like the blare of trumpets, and ...
The door opened and Verreker entered.
She paused with her hands poised on the keys.
“Well,” he began cheerily, “it’s the last lesson of the quarter, isn’t
it?”
“Yes,” she said quietly.
 He was warming his hands in front of the fire.
“Confoundedly cold for May,” he remarked parenthetically.
“You’ve been taking lessons of me for a year now, haven’t you?”
“Just over a year.”
He stood with his back to the fire.
“Well,” he continued, “you’ve not done badly. In fact, you’ve—
you’ve improved—er—quite—er—beyond my expectations. I admit
that.”
It was the biggest compliment he had ever paid her. Pleasure
surged in her blood. She flushed.
“And,” he went on, “I don’t want to go on taking your money when
you’re no longer likely to benefit much. As a matter of fact, you’ve
come to a point at which my lessons are no longer worth three
guineas each to you. You can teach yourself as well as I can teach
you. I’ve led you out to the open sea, and now the time’s come for—
for dropping the pilot. See?”
She nodded.
“So I don’t recommend you to have another quarter with me. I
think it would be money wasted.”
She nodded.
“Of course I shall be glad to help you in any way I can if you need
it.”
She nodded.
“And if you ever wish me to give you advice on any point of
theory or technique I shall be pleased to do so.”
She nodded.
Pause.
“... I’ve just been up to town to get some new music in manuscript
from a new author. It’s quite good stuff and very modern. I’ll run it
over if you’d care to hear it.”