The Devil You Know

by Gwen Adshead

From my limited research into Eritrea, I knew that the country had a significant Christian population. ‘Do you know that carol? Did you sing that at Christmas time, back home?’ ‘Nah,’ he said. ‘My mother – an angel voice.’ The image of an angel bending towards a young woman to give her the good news of a son formed in my inner vision, an angel who tells Mary, ‘Do not be afraid.’ I asked Gabriel if his mother sang. He gave a quick nod but didn’t say anything, and I didn’t want to push it. I was able to confirm that the church was where he had met the missionaries who helped him travel to the UK, but then he fell silent again. I felt frustrated, as if I had found a window onto something important that turned out to be nailed shut.

  ‘What was Christmas Day like for you, with your mother … and other family?’ He looked up, meeting my eyes. ‘Fear.’ I waited in silence, and he managed a little more. ‘My mother. My father … my sisters. Everyone has fear. No one sings after the soldiers come.’ I assumed he was referring to the Islamic militia I’d read about, who might have tried to shut down churches, but I didn’t ask. I would allow him to lead me wherever he wanted to go; I was there to follow. Given how little we had talked about his early life, this was such a remarkable exchange that I did not dare do anything but breathe, nod and pray he continued. I also realised that our allotted hour was nearly over, which was bad timing – especially since we were going to be separated after this over the Christmas break.

  The choir next door began to disperse. We listened to the scraping of chairs and chatter in the corridor outside, as I thought about how I could end this session. I considered the link between the absence of his mother and my absence from him and our work together for the next fortnight, but I decided not to go into that; I might come back to it in the new year. The carol had probably done enough emotional work for Gabriel for the day. I just thanked him for talking to me about his family and asked him if he could keep our conversation in mind so that we could return to it in the new year. As we parted, I wished him a happy Christmas. ‘Happy Christmas for you, Dr Gwen.’ A nod, a smile, a proper goodbye – it was progress. As I walked away, I held close the gift he’d given me; we never know what may cause someone to open up in therapy, and nobody should be discounted for treatment.

  *

  We met again in the first week of January. Waiting for him in the meeting room, I watched as a thin dusting of snow covered the paths and lawns outside the window. Out of the corner of my eye I caught sight of the brown beanie hat – Gabriel was at the nurses’ station, his familiar baritone greeting a staff member. To my ear, he was upbeat, but I couldn’t gauge his mood by sight – his face was impassive when he walked in. Before either of us said a word in greeting, he pulled out a photo and set it on the small table, right in the centre, then took his chair opposite me and folded his arms across his chest, awaiting a response.

  I was careful not to assume anything and asked if it was okay for me to look at it. He gestured for me to go ahead. The photograph was faded and crumpled with age. I wanted to touch it, to smooth it out with my hand, but felt I should not. Within a white border stood a handsome couple, a man and a woman who might have been any age between thirty and fifty, and whom I assumed to be African, possibly his parents. My eye was drawn to the woman’s hair, plaited in an elaborate arrangement across the top and around the sides of her head, then falling loose at her shoulders. Their dress was a mixture of Western and traditional: wide sashes of cotton cloth, decorated in intricate patterns, wrapped around their waists, and both in plain T-shirts. The man seemed to have a bandage or cast on his right calf, and he held a musical instrument in his left hand. They appeared to be standing on a city street, with cars and tall palm trees visible in the background.

  Instead of immediately asking about the people or the location, I asked, ‘Is that a guitar?’ Gabriel frowned, perhaps a little baffled as to why I had commented on that detail. ‘Kirar,’ he said. ‘S’like a guitar.’ I nodded thoughtfully and studied the photo a moment longer. ‘Can you say who they are, Gabriel? This seems important to you.’ With exquisite care, he picked it up and tucked it into the pocket of the hoodie he was wearing, then confirmed what I had guessed: they were his parents. When I asked where it was taken, he told me Asmara, the capital of ‘Ertra’, as he pronounced it. ‘Are you from Asmara?’ I asked. ‘Nah,’ he said curtly, not meeting my eye.

  After a bit, he continued. Halting and searching for words, he was able to explain that the photo was taken not long after they left their home village on the coast, ‘after the soldiers came’. The first part of that revelation felt easier to discuss. ‘Leaving home – that’s hard,’ I said, and he bobbed his head in fervent agreement. His eyes were shining. During the next hour, I learned more than I could ever have thought possible; for the first time, we were fully emotionally engaged. Using a combination of mime and his English, and prompted by occasional questions from me for clarification, Gabriel was able to communicate his story, despite the language barrier.

  First, he told me how brave his father had been in getting them out of danger. It sounded like the man had acted swiftly in the face of shocking violence. A few days before Christmas, Gabriel said, when he had just turned fourteen, the soldiers came from Ethiopia, arriving in their village at dawn. Screams woke them, and Gabriel ran outside, his father just behind him. Their neighbour and his wife were outside their house. I wasn’t clear about whether they were related in some way to Gabriel’s family, but I didn’t want to interrupt him to find out. The man was dead, lying in the dirt, his throat cut, ‘all his blood coming out’, and the woman was kneeling in front of two soldiers, begging for mercy.

  One of the soldiers brought the blade of a large knife down on her head and it split open ‘like a melon’, Gabriel said. His father grabbed him and pushed him into the undergrowth, and then they ran – here Gabriel whistled and gestured with his hand to indicate something whooshing past his ear, maybe a bullet, then another and another. His father fought off the soldiers, who nearly captured them, by the sound of it. They managed to get away just as the fields around them erupted into flames. ‘Fire in the sky,’ he told me, eyes raised to the ceiling. ‘Fire up to there.’ I didn’t move as he recounted this dreadful tale, still transfixed by that image of the woman and the melon. Such a terrible, horrifying thing.

  The family left behind their farm, losing all they had. Gabriel’s father had sustained a deep wound on his leg where a soldier had tried to slash at him with his big knife. Gabriel drew the weapon for me in the air, describing an impressive blade with his long fingers, then grasping the invisible handle in both hands and hacking at the space between us as if to clear a wide swathe through a cornfield. At first, I thought he must be exaggerating the size of the thing; then I imagined how huge a knife, or possibly a machete, might seem to a small boy in a state of terror.

  Somehow they were able to join his mother and sisters; how they did that wasn’t clear to me either, but I gathered that they all made it to the city, where people from their church gave them aid and shelter. They heard that there were no other survivors of the attack on their village and the surrounding area. I said something inadequate about loss, about the magnitude of it, and he nodded solemnly, holding eye contact for several seconds. ‘And then?’ I asked.

  They made a life in Asmara, but they struggled and didn’t have enough to eat. After a few years, ‘church people’ offered to get Gabriel out of the country, perhaps with his mother and little sisters. But she wouldn’t leave without his father. He didn’t explain how it came to be that he made the trip on his own, soon after he turned sixteen. The idea may have been that he would earn money abroad and send it home to help them, a common dream of the economic migrant. I perceived Gabriel more properly as a refugee from violence, running from rather than to anything. I wished he could tell me more, like how he travelled through North Africa and across Europe, and how long his journey took, but I didn’t want to be in interrogator mode. I had found over time that it’s really not necessa
ry to know every detail of people’s pasts in order to treat them. I was grateful and humbled to have as much as he’d been able to give me.

  I did ask if he’d ever been in contact with his family since he arrived in the UK. ‘Two times, maybe three or so. Long time ago.’ Some kind people had helped him to make phone calls back to Asmara not long after he first got to London, but in those days before cell phones it was difficult. When he did get through, he was told his father had gone back to the village some months after Gabriel had left, to try and salvage what he could from their home, but soldiers found him and killed him. His mother stayed on in the city with his little sisters, working in the church, he thought, but he couldn’t be sure because so many years had gone by and he had stopped calling them. He didn’t spell it out for me, but I understood that he felt terribly ashamed when he ended up on the streets and in trouble with drugs and the police; he hadn’t wanted to continue the contact.

  As this narrative emerged, finding its shape through fluttering hand gestures and delivered in simple English that was remarkably free of expletives, I thought about the immensity of what was happening in the room. This was the psychotic man who had delusions about strange persecutions by the night staff, the furious patient who had pushed me to the floor in a rage just a few months earlier. Despite his life’s many ruptures, this same man had taken a chance by trusting me with his story.

  Perhaps this was the first time that he had been able to share so much with another person. It was possible that before this day, other professionals he had encountered had tried to draw him out – missionaries, social workers and the like – but he had been too unwell. They had probably not had the same time and space to create an alliance with him, and had seen only the foreignness and the paranoia. I didn’t blame them; after all, I’d had a first-hand glimpse of the ‘deranged’ man who had terrified people in a north London café when he pushed me over that day. In order to get to this place of trust and attention, he’d had to go out and commit an act of near-fatal violence; this sorry irony is something I will return to again and again in the stories that follow. I considered myself lucky that I’d had the chance to restart therapy with Gabriel after that ‘attack’ on me and go deeper with him, not as if nothing had happened, but as though everything he did mattered. I felt a sense of privilege to be sitting with him.

  The words of a colleague of mine came to mind, a man who speaks of the ‘strange and terrible beauty’ of our work and of the honour it is to bear witness to our patients. Gabriel was not the anonymous ‘nutter’ his victim had described; he was a man whose name had special meaning, who was strong. He had been a boy with a mother, a father and two little sisters, with a home and a past and hopes for a future. I explained carefully to him that I would like to share what he had told me with his clinical team, to make all of us better able to help him, and with his approval I did so at our next team meeting.

  Everyone was visibly moved, especially Trevor, who mused aloud whether there was any chance that the mother was still alive. What if we could find her somehow? He looked around the room for encouragement. The social worker nodded: they could look into it. I’d known them to be successful in tracing family members, having seen it with other patients from other countries, yet I felt I had to share my genuine uncertainty about this. I said it could help Gabriel in his recovery, but renewed contact or a failure to find his family could also be so painful that it undid his progress and triggered his psychosis. Ultimately, it would have to be Gabriel’s call; this was not something that we could decide for him. As a team, we decided that Trevor and the social worker should pursue it with him.

  I have to own up to some anxiety when I heard he had agreed. The wheels ground into motion, creaking through various institutional processes and agencies, with slow responses from Eritrea. While we were waiting for news, Gabriel and I continued to meet. When we didn’t hear anything, he began to fret, telling me that finding her was probably ‘impossible’ – a new word for him. I reminded him of the time we had heard that Christmas hymn together, and the pride he took in the strong angel he was named for. He stared at me as if he didn’t remember what I was talking about, but it seemed to calm him a little.

  Sometimes we just sat in silence together or had conversations that were as banal as they had been in the early days, talking about the lunch menu or the weather. It may seem surprising that after such a profound shift in one session we could lapse like this, but as all of the examples in this book show, the truth of the therapy process is that it ebbs and flows, and gains are usually followed by long, mundane plateaus. We continued to be hampered by language constraints too, but over time it seemed to me that Gabriel’s English was improving, and he was more coherent than before. I’m sure this was because as he felt more secure, he became less hostile and paranoid.

  I thought he might now be capable of some reflection on his journey into violence, and I gently led him into a conversation about this by suggesting that he bring images of what he feared into our meetings, perhaps torn from magazines. I’ve worked with some wonderful art therapists who have used this technique, and while I wasn’t specifically trained in this type of therapy, I thought it could be a useful avenue for Gabriel to go down, partly because it surmounted the language barrier. He willingly did so, which allowed us to talk about his fear as an image and how that felt in his body. We used visual ideas to explore the different ways that people experience fear. He would draw a lightning bolt to the head, or a body with a dark scribble on the throat, stomach or heart.

  After that I felt able to explore with him his dislike of the African night nurses and suggested that they might unwittingly remind him of the soldiers who had terrorised him as a boy. It was a bit of a leap to make and I wasn’t sure if Gabriel fully understood the idea of this kind of projection, but the team did report that his complaints about the two night nurses were less frequent in the weeks that followed our discussion, and everyone hoped that if he were able to make contact with his mother soon, we would see more substantial progress.

  As winter turned into spring, we all became excited when our social worker colleagues announced that they had found her, having made contact with the same Christian group that had helped Gabriel come to Britain long ago. A long-distance call was arranged between mother and son. Trevor and Dave would sit with him to provide support and feedback.

  In a movie – perhaps the Broadmoor version of It’s a Wonderful Life – this would be the moment when the string section took their cue and raised their bows, a choir of angels singing out as Gabriel and his mother were reunited before a shimmering tree. But Broadmoor is the antithesis of Hollywood, and that’s not how it went at all. Gabriel’s consultant called me the next day to say that our patient had been deeply distressed by the phone call. The line hadn’t been great, but the real problem was that he couldn’t understand his mother; it was as though he had lost his ability to follow her local dialect. I felt for him, trapped in a linguistic no-man’s-land, and my heart sank.

  Apparently, Gabriel’s mother was terribly upset about him being ill, which was all she’d been told in advance of the telephone call. Gabriel indicated to Dave and Trevor that he couldn’t tell her the truth about his time in prison and his struggles with violence, and certainly not about the attack on the man in the café or the fact that he was locked up in a secure hospital. Broadmoor is a difficult enough place to describe to the English, so how was he to find the words and surmount the shame he felt in order to reveal the truth of his situation to her in far-off Eritrea? He only confirmed to his mother that yes, he was in a hospital. Then she barraged him with questions. Did he have cancer? Was he in pain? Before long, he ended the conversation.

  In the first twenty-four hours afterwards, he reverted to being paranoid and hostile, accusing the two African night nurses of poisoning his mother against him by contacting her before the call and telling her lies about him. He became psychotic, railing that ‘that old woman’ with the quavering voice could
not have been his mother, who had a voice ‘beautiful like a bell’. He decided the nurses he hated had bewitched her. Over the next few days his paranoia gave way to tears, and he began weeping and wailing incoherently.

  Everyone was disturbed by this turn of events, professionals and the other patients alike. I think we all – me included – felt painfully deprived of the dream that a mother’s love might bring some peace, if not a magic cure. All doctors – and, indeed, serious professionals in any field – have to live with a certain amount of disappointment and frustration during the course of their work, and Gabriel was one of my teachers in this regard. He was instrumental in helping me to understand that I had to take such setbacks in my stride and accept that they are as transitory as our successes. Like the hero of Kipling’s poem ‘If’, I needed to try and treat those two imposters triumph and disaster just the same.

  Our next few sessions after that disappointing call were not comfortable to sit through. He would spend the whole session crying quietly, telling me how hurtful it was that his mother seemed like a stranger and how sad he felt about his father being dead. What a transformation from the early days of our work together, I thought, when he could not even articulate what he felt about daily life in the hospital. As I had experienced with other patients, I became a fellow mourner. His pain got into my mind and brought silent tears that wet my cheeks. I have a therapist colleague who uses a beautiful phrase – ‘judicious self-disclosure’ – as a way to speak about the value of choosing to share our human emotional response with a patient. Such connection is the essence of therapy, but it has to be different from the sharing a professional will do with friends and family because the mutuality is different. With a patient, the therapist is sharing something real about themselves in order to help the patient accept something real. It requires mindful control, which is why most therapists spend a lengthy period in therapy themselves. We can then appreciate the difference between our minds and the minds of others from the patient’s perspective, as well as the boundary between disclosure and self-exposure. When he first noticed my tears, Gabriel shook his head furiously, saying, ‘You don’t cry, you don’t cry, Doctor!’ He was worried that he had hurt me in some way, and I could see he was anxious that this was similar to the time he pushed me. I explained that wasn’t the case, and that therapists want to take pain away and feel sad when we can’t do that for someone. ‘Do you understand, Gabriel?’ I could see that he did.