by Bev Thomas
Still his tone is flat. There’s an absence of anger. When I go to speak, Dan isn’t even looking up. I can see he wants nothing from me.
‘They dragged me into the woods. Pinned me face down,’ he says, ‘I couldn’t move. I had one on each shoulder. They were heavy. Big blokes. I mean, I tried to wrestle free, but it was hopeless. I could hardly breathe,’ he says, ‘let alone move.’
He stops for a moment, and picks at his fingers.
‘The guy with the tattoo flicked a lighter, right by the side of my face. I thought—’ He falters, and looks down at his hands.
‘He held it close to my skin – then he just lit a cigarette. That smell—’ He shudders. ‘The lighter. The flame. Burning. I felt like I couldn’t breathe.’
He’s silent for a moment. I wait for him to continue.
‘That’s the flashback I keep seeing,’ he says quietly.
I nod. ‘Is it lots of images?’ I ask. ‘Like a camera shutter?’
He thinks about this. ‘It was at first. Now – just one. That moment. The feeling of being trapped. Held down. Now, I don’t always see it. It’s just a feeling …’
I probe gently. ‘A feeling of …?’
He looks up. ‘Being small and useless. Unable to do anything.’
His voice wavers an instant as he picks up the story again.
‘After that one had finished, it looked like the other guy was going to have a go too. Then there’s this rustling in the bushes. The sound of someone calling a dog. Trixie,’ he scoffs. ‘Can you fucking believe it? And then there it was, this small black dog, standing in the clearing, tongue hanging out and panting at my bare white arse.’
He stops for a moment, then looks up at me, ‘I hate fucking dogs,’ he says, ‘always have. But I’ve never been so happy to see a dog in my life. Then just like that,’ and he snaps his fingers, ‘they went. One of them stamped on my back and shoulders as he ran away. I got up and left. Never even saw the dog’s owner.’
He asks for water and I fill a glass from the jug on the table. He drains it quickly.
When I speak, my voice is careful, gentle.
‘I’m very sorry,’ I say, ‘that this happened to you.’
He waves a silencing hand through the air and tells me he went to the rape crisis centre. He had tests. Reviews. ‘A full MOT …’ He pauses. ‘It was an awful place,’ he says. ‘They were kind, but it was so clinical. I spent hours in a hospital gown, while they prodded and poked and did all sorts of tests.’ His voice drops down low. ‘It was humiliating. The whole thing was …’ he searches for the right word, ‘degrading. I felt ashamed. Like I’d done something wrong. Not them. Not the blokes that did it. But me – I was all wrong.’
He presses his fingertips each side of his temple. ‘Two weeks later I was offered an appointment with a counsellor,’ he mocks. ‘I didn’t go. It was shit. But hey – I was OK. Not great, but I was coping.’
At this moment, he falls into silence and absentmindedly twists a lock of hair around his finger. I feel a pull in my gut. That was Tom’s default gesture, the thing he’d do when he was worried, or deep in thought. I am suddenly back in my kitchen. Hours of late-night conversations with my son, watching him do the exact same thing. It was a habit that started in primary school when he was learning how to write. He’d sit with one hand gripped around the pencil, the other twisting round a strand of hair, his brow creased in concentration. As he got older, it became a comfort, helped him think, he said. It pained me when he shaved his hair just before he left. It felt like a punishment.
Dan is staring at me, and I realise I have drifted.
‘So, when exactly did this happen?’
‘About five months ago.’
‘In London?’
He shakes his head.
‘Bristol. I moved to London just a few weeks ago. For my film studies course.’
‘So things were OK,’ I ask, ‘immediately after the park?’
He nods. ‘I was OK. Eating … sleeping. I’d started my new course. Things were good. Then just a few weeks ago, all this stuff started to happen. My breathing. Dizzy spells. Feeling faint and spacey.’
I’m confused by the time lapse.
‘Was there any kind of trigger?’
He nods. ‘It was just after the police got in touch. They asked me to come in and identify one of the guys. The guy with the tattoo. That’s when I found out he was on parole. That he’d attacked another bloke the week before. The parole officers had fucked up. Big time.’ His voice gets louder. ‘I blame the solicitors too. All this offender rehabilitation shit. What about the victims?’ He bunches his hand into a fist. ‘It’s me that’s suffering now. Dropping behind at college when I’m too panicky to leave the house. These so-called professionals should be held to account. My own solicitor said I should make a formal complaint. Thinks I’ve got a case.’
Why don’t people do their jobs properly?
‘So, after the police got in touch, you went to your GP and she told you it was panic attacks?’
He nods. ‘I had all the tests. Nothing physical. Gave me a leaflet on “how to manage your anxiety”,’ he snorts. ‘And then the flashbacks started.’
‘From the park?’
He hesitates. ‘First from the park – but then—’ he looks away, ‘other stuff.’
I wait for him to continue.
‘I can’t describe it. It’s a panic about feeling small. Being alone. When I went back to the doctor, she told me about this unit. I read up about it. Asked to be referred.’
It’s then that I hear the rhythm of his breathing starting to change: quick, laboured, like he’s supping at the air.
‘The thing is,’ he says, ‘last time I came, you talked about the randomness. How it can make things feel unsafe.’
And then all of a sudden, he stands up and starts moving from side to side.
‘The thing is – I don’t think it was.’
‘Don’t think it was what?’
‘I mean – I’d love it to have been a random thing. But I think there was more to it,’ and he picks at the edge of the chair.
‘What do you mean?’
‘Do you believe in karma?’ he asks, all of a sudden, looking at me wide-eyed and pale.
‘Karma?’
‘Maybe it happened for a reason. Because I’m bad. Deserved it …’
‘Why would you think you deserved it?’ I ask gently.
He’s now taking great gulps of air in between his words. He’s down in his chair. Then up on his feet again.
‘Karma. Perhaps they were sent. A punishment. Sent for me,’ he says quickly. He drags his hands through his hair.
I can see exactly what’s about to happen.
‘Dan,’ I say quietly.
He doesn’t hear me.
‘Dan,’ I say again, louder this time, ‘I need you to sit down.’
I repeat my request, but still he doesn’t respond.
His eyes are glazed and distracted. He’s sweating profusely. His forehead and neck are drenched.
‘It’s very important that you concentrate on your breathing,’ I say, my voice clear and firm. ‘I need you to come and sit down.’
I get up and guide him back into the chair.
‘—and your hoodie,’ I say, ‘you need to take it off.’
He doesn’t move. I repeat the instruction, then he lifts his arms in the air like a child, and I pull it over his head.
No sooner has he sat down, than he’s sprung up, unable to sit still. He is pulling at his face. His breathing is now erratic and laboured.
‘Dan,’ I say, a little louder, ‘look at me. You need to look – at – me.’
His eyes are wild, darting about the room, and for a while, he resists, unable to focus. Eventually, he seems to see me.
‘We are going to breathe together. You need to slow your breathing right down. Right now. Breathe in – two – three. Breathe out – two – three.’
I repeat this over an
d over, clearly and calmly, until eventually his breathing begins to slow down and then falls in line with mine.
It’s been a while since a patient has had a full-blown panic attack in a session; still I know the drill. Slow the breathing. Stop the influx of carbon dioxide. Prevent hyperventilation. I have dealt with many anxious patients during my career, but his reaction that afternoon is one of the more extreme manifestations of fear I have seen.
When he’s calm, I pass him the hoodie, and he slips it over his head. He knows I have seen the marks on his arm. The deep laddering of cuts from his wrist up to his forearm. A criss-cross of old white scars, several fresh ones that have recently scabbed over, leaving small spots of dried blood on his shirt sleeves.
Just as I’m about to mention them, he waves a hand about dramatically. ‘Woah. Sorry about that,’ he says, sitting back, ‘that was all a bit Billy Bibbit, wasn’t it?’
Seeing the confusion on my face, he adds, ‘The film? One Flew Over the Cuckoo’s Nest?’ Before I have the chance to speak, he’s asking if that’s happened with any of my other patients.
‘What about that girl,’ he asks, ‘the one who comes before me? Why does she come? Does she get panicky?’
When I tell him I’m not at liberty to discuss other patients, he looks around distractedly, as if wanting to find something else, something new to focus on.
‘Your plants are dead,’ he says, nodding towards the window sill. ‘What would Freud say about a therapist who can’t keep her plants alive?’ He shakes his head. His tone is light, jokey. ‘Hope you do better with your patients.’
He turns back towards me. ‘Perhaps I should make a complaint?’ he says.
I feel muddled, wrong-footed.
‘The parole officers?’ he says. ‘What do you think?’
I know he wants me to collude with his view of the world as an unjust place. A place that let him down. The police. The legal system. The justice system. They’ve all conspired against him. By agreeing with him, I am being called to set myself apart from these other professionals, and to ally myself with him.
I want to say something about my confusion. About how his anger is with ‘people not doing their job properly’, rather than the men who attacked him. I want to comment on the fact that his making a complaint feels like some kind of warning. That perhaps I won’t do my job properly. Somehow, in my uncertainty about what belongs to me and what belongs to him, I can’t find the words for any of this. He’s speaking very quickly. And I feel left behind somewhere – running to catch up.
I look up. He’s still talking. ‘—and then I re-read the letter about the six sessions. This is my second,’ he says, ‘six simply won’t be enough. I mean, how can it after what has happened to me?’
His tone has changed. The panic has gone. He sits tall in his chair. He looks full of confidence and charged with a glorious sense of entitlement. Something, in my experience, that often goes hand in hand with a sense of deprivation. I think about the sort of unimaginable experiences people have had when they come to see us. I think about Mr Begum, Matt Johnson and other patients whose images and events still haunt me to this day, although I know this is irrelevant. What’s relevant is that everyone, no matter what they’ve experienced, is offered the same six sessions. It doesn’t mean they then can’t be offered more, but the principle is that everyone is offered the same, at the outset. Boundaries. Containment. It’s what we always do.
I blink back at him. The clock behind his head tells me it’s time. That we must finish. And when I do reply, it’s as if the words come out of my mouth, without any thought at all.
‘You can have as many as you need,’ I say.
Satisfied, he nods, then gets up and leaves, before I have the chance to draw the session to a close.
Four
‘Why not?’ she says. ‘It’s my neighbour’s stuff. It’s practically brand new.’ Before I have time to speak, Stephanie is reeling off a list: ‘A kid’s bed, loads of clothes, toys, a high chair. I mean, Samira really needs them.’
We’re in my office, the Monday after my session with Dan, and Stephanie’s telling me a little about Samira: her refugee status, how she left Somalia and the fact that her husband and older child were murdered in the village by militants. She’s talking very fast and her face flushes with anger as she speaks.
‘She’s got nothing. Her daughter comes in wearing this dirty vest and skirt. When I volunteered at the camps in Calais,’ she continues, ‘the donations made a massive difference. We could transform people’s lives,’
For a moment, I feel bewildered. I could simply tell her the Trust has a policy about giving gifts to patients, but I know that wouldn’t teach her anything.
‘The thing is,’ and then I stop, because I don’t know where to start.
She’s sitting neat and upright, pen in hand, like an interviewer. She looks back at me expectantly.
‘Do you remember how we talked about our approach, here at the unit?’
Again, there’s enthusiastic nodding, but her face is blank. There is no lightbulb moment.
‘Yes – but I’m not sure what—’
‘Our work has a focus on boundaries; the fifty-minute appointments, the lack of self-revelation and the offer of six sessions,’ I say. ‘Six sessions,’ I repeat. And as I speak, I can hear the firmness in my voice – as if I am somehow reprimanding myself, in the wake of my own deviation with Dan. I tell her that when people come to us in chaos, ‘it’s these very boundaries, rules, if you like, that enable you to do the work. The frame,’ I say, ‘around a very messy picture.’
She makes a note in her book, but she looks unconvinced. She has no idea what any of this has to do with baby clothes.
It reminds me of my own initiation into the psychodynamic approach. A placement in North London where I was astonished by how long the staff spent on their own feelings in staff meetings, rolling my eyes at what I thought was self-indulgence. At first, along with a fellow trainee, we railed against the model. Together, we mocked the strict boundaries. ‘Detached. Pedantic. What difference does it make?’ Two weeks later, I was accompanying my supervisor on a home visit. We were seeing a teenage girl with an eating disorder. ‘What should I do in the session?’ I wanted to know as she was parking the car. My supervisor was a small slight woman with a fierce work ethic. ‘Just observe,’ she said briskly, ‘and focus on yourself.’ Myself?
‘Use your emotions as data,’ she said, as we walked up the driveway of a neat semi-detached house.
The girl had a pale gaunt face and wore a baggy pink tracksuit. As my supervisor sat and talked with her on the sofa, I felt consumed by a powerful sense of exclusion. Of being on the outside. And the more I felt it, the more anxious I became. The more I tried to find a way back in, the more detached I felt. I tried to listen – A family that had moved three times in four years … a father in the military … difficulties settling into school … no friends – but my sense of alienation only grew. My head ached. I couldn’t concentrate. I felt useless and superfluous. Emotions as data. Then something opened in my chest.
All of a sudden, I saw beyond the meticulous weighing of food, and the punishing exercise regime, and I knew I was feeling something of what it was like to be this young girl: anxious, out of control, and trying to make herself smaller, to fit into a life that didn’t feel like her own. While I didn’t know the theory, it was strangely familiar, like threading my arms into a much-loved coat. I’d spent my childhood creating small boundaries, little frames around the chaos. Mundane and pointless tasks that became a way to manage my anxiety; counting a particular alphabet letter on the back of a cereal packet, studying the weave on the arm of a sofa, keeping a neat and tidy room. After that home visit, something shifted. I read the books, then signed up for two specialist psychodynamic placements. A frame around the mess? I felt like I was coming home.
Now, I look at Stephanie in her neat buttoned-up cardigan. I take in the colour-coded ring binder perched on her la
p. I imagine her on previous placements. Her joy in being able to help patients. Her comfort in the clear treatment objectives, and the use of patient rating scales to map out progress and measure her own efficacy. It’s seductive, all that structure and certainty. I often feel jealous of it myself.
Gently, I remind Stephanie of the importance of the blank canvas. ‘An empty space to be filled with whatever picture they bring. The less they know about us, the more possible that is.’
I pause for a moment.
‘This approach might feel difficult,’ I venture, ‘after the orientation of your other placements.’ It’s like a hand outstretched. An opportunity for her to talk. But when I look back at her, there’s nothing. No snag of uncertainty, no hint that she might be finding the concepts tricky. Her face is impenetrable. A mask of competence. In that moment, I am reminded of my daughter. How her own competence is a defence against vulnerability and how sometimes I see a look of uncertainty flit across her face, but whenever I try to catch it, it slips away, butterfly-like, from underneath my fingers.
‘What impact do you think these gifts might have on the counter-transference?’ I ask.
‘The counter-transference?’ she repeats. She stares down at her binder for inspiration.
All of a sudden, I feel frustrated by her impenetrability. Her refusal to be vulnerable enough to learn. Then I realise that it goes further than frustration. I feel the nudge of something cruel. I fight the urge to sit and wait it out while she looks for answers she won’t find in her file. To watch her stumble through the humiliation of not knowing.
‘It’s the feelings that we are filled up with in the session,’ I explain. ‘Clues, if you like, as to what the patient might be feeling.’
She nods.
‘We all repeat things that are familiar to us,’ I say, ‘and patients do the same. The therapy room can be a place where they can act out all sorts of messy feelings about the past.’
‘Yes, of course. I remember now,’ she says breezily. ‘That’s really helpful.’