Boy Who Could See Demons Page 3
“What was a social worker doing at a child psychiatry conference?” I turned toward the corridor that leads to my office.
“Psychiatry was my original discipline, after a spell studying for the priesthood.”
“The priesthood?”
“Family tradition. I liked your paper, by the way. ‘Addressing the Need for Psychosis Intervention in Northern Ireland,’ wasn’t that it? It struck me that you’re passionate about changing things around here.”
“Change is probably a bit ambitious,” I said. “But I’d like to see the way we handle younger cases of psychosis.”
“How so?”
I cleared my throat, feeling an old defensiveness rise up. “I think we’re missing too many signs of psychosis and even early-onset schizophrenia, allowing these kids to flail and even harm themselves when treatment could very easily help them live normal lives.” My voice started to wobble. I heard Poppy’s efforts on our piano in my head, her voice softly humming the melody she was trying to match on the keys. When I looked back at him I noticed he was staring at the scar on my face. I should have worn my hair long, I thought.
We reached the door to my office. I tried to remember my entry code, given to me the week before by Ursula’s secretary, Josh. After a few seconds I punched the gold number on the lock. I turned to see Michael looking up and down the corridor.
“You never been to MacNeice House before?”
“Yes. Too many times, I’m afraid.”
“You don’t like it?”
“I don’t believe in psychiatric institutions. Not for kids.”
I opened the door. “This isn’t a psychiatric institution, it’s an inpatient unit …”
“tomato, to-mah-to, eh?”
Inside, Michael remained standing until I gestured toward two soft-backed armchairs at a white coffee table and offered him a drink, which he declined. I poured myself an herbal tea and sat down in the smaller armchair opposite. Michael leaned back in his chair, paying rapt attention to a poster on the wall by my bookcase.
“Suspicion often creates what it suspects,” he said, reading the poster. There was a question in his tone.
“C. S. Lewis,” I said. “From The Screwtape Letters. Have you read—?”
“… yes, I know,” he said, his face twisting at the sight of my herbal tea. “I’m wondering why you framed a quote like that?”
“I guess it was one of those things that made sense at the time.”
He smiled. “I have the T-shirt for that one.”
There was a pause as he pulled out a file from his briefcase. The name on the label read ALEX CONNOLLY.
“Alex is ten years old,” Michael told me, his voice softening. “He lives in one of the poorest parts of Belfast with his mother, Cindy, who is a single parent in her midtwenties. Cindy has had a hard life herself, though that’s probably a conversation for another time.”
I nodded. “Where’s Alex’s father?”
“We don’t know. There’s no name on Alex’s birth certificate. Cindy’s never been married and refuses to talk about him. He didn’t seem to play any role in Alex’s life. What we do know is that Alex is deeply worried about his mother’s health. He acts fatherly toward her, exhibiting all the hallmarks of a child deep in the grip of the trauma of parental suicide.”
He spun a document around on the table to face me—a compilation of notes from Alex’s consultations with several different pediatric psychiatrists.
“Interviews with his mother and schoolteachers have flagged multiple psychotic episodes, including violence toward a schoolteacher.”
I looked up, startled. “Violence?”
Michael sighed, reluctant to divulge. “He lashed out during an outburst in the classroom. He claimed he was provoked by another child and the teacher didn’t wish to make a big deal out of it, but we still document these events.”
A quick scan of the notes told me that Alex had all the classic firstrank symptoms of mild high-functioning ASD—autism spectrum disorder—such as being intensely concrete in his thinking, prone to misunderstandings, violent outbursts, language that is slightly more sophisticated than his age, no friends, and eccentricity. I noticed a detail about his claiming to see demons. Then I saw that no medication or treatment had ever been prescribed, and for a moment I was lost for words. I had been warned repeatedly by colleagues in Scotland that things are different in Northern Ireland, “things” being the practice of psychiatric intervention. That warning rang in my ears as I scanned the file.
After a few moments I became aware that Michael was watching me. “So what brought you back to Northern Ireland?” he asked when I caught his gaze.
I sat back in my seat and clasped my hands. “Short answer, the job.”
“And the long answer?”
I hesitated. “An offhand remark from a PhD candidate doing a placement at the unit I worked at in Edinburgh. She mentioned that even those kids in Northern Ireland who have never experienced the Troubles, who have never been fished from a swimming pool and wrapped in tinfoil during a terrorist threat, who have never measured distance by the sound of a bomb, and who have never even seen a gun are experiencing psychological effects because of what the older generation has suffered.”
“Secondary impact, isn’t that what it’s called?”
I nodded. For a moment my memory heaved up the muffled thud of a bomb. From my bedroom window in Bangor—a coastal suburb on the outskirts of Belfast—I could hear the explosions; sickening, hollow. A memory I had never shaken.
“There’s a higher prevalence of psychological morbidity in the adult population here than anywhere else in the UK.”
“Well, that explains a lot about my job, then.” He rubbed his eyes, taking it in. “Did you ever get fished out of a swimming pool during a bomb hoax?”
“Twice.”
“So you reckon every poor soul who’s been involved in the Troubles has a higher chance of a mental breakdown?”
“No one has any ability to estimate the impact of an experience on a person’s mental health. There’s too many other factors …”
He frowned. “Alex has never been involved in the Troubles.”
“No?”
“We’ve interviewed him and Cindy about things like that. I mean, yes, they live in a rough neighborhood, but Cindy has made it clear that it was the abuse she suffered at home as a child that impacted on her so greatly.”
Another form of secondary impact, I thought. “How long have you been involved with Alex’s case?”
Michael sighed. “I’ve had intermittent contact with him since he was seven. His family situation is very vulnerable, and his living conditions aren’t exactly ideal, either. The powers-that-be threatened to place him in foster care last time Cindy attempted suicide.”
It struck me that this might not have been as bad an idea as Michael clearly believed, though I figured I would give him the benefit of the doubt for the time being. I noticed his voice had hardened at the mention of foster care, his pale face beginning to flush red around his jaw.
I tapped the thick wad of notes on the table in front of me, thinking.
“What’s needed?” I asked quietly.
“A Statement of Special Needs, for a start.” He paused. “When I heard we had a new child psychiatrist in town … well, you can only imagine my relief.” He smiled, and suddenly I felt afraid of letting him down.
“Be specific, Michael. Please.”
He leaned forward, elbows dug into his knees, sliding a sliver ring up and down his index finger, deep in thought.
“The thing is, Dr. Molokova, I’m an advocate of Signs of Safety.”
I stared at him. He stopped sliding the ring.
“You know, the Australian model for child protection …?”
“… I know what Signs of Safety is,” I said flatly. It was in my interests to. Signs of Safety is a type of child protection plan based on working closely with families to build a system of safety and, ultimately, famil
y-centered treatment. Most of its advocates staunchly reject the types of intervention that form the basis of my job.
Michael seemed agitated. “Look, I need you to promise me you won’t separate this family. Trust me, these two need each other, not some bureaucratic, by-the-book, form-ticking procedure that lands this boy in care …”
“My only agenda is to find out what treatment the boy needs.” I said it clear and slow, hoping it would reassure him. If we were to work together on this case, we needed to sing from the same hymn sheet.
He eyed me with a degree of nervousness in his face, a hint of pleading. This boy meant a lot to him. Not just professionally, either—I saw that Michael had become personally involved in this case. I perceived he had a touch of the hero complex about him—that weathered, tired air was a result of his frustrations. After a long pause he broke into a smile, before pouring himself a mugful of my nettle tea and gulping it with a prolonged shudder of disgust.
I stood up to leave, noting our appointment with Alex was in twenty minutes’ time. Michael shuffled his notes and slid them neatly into his briefcase.
“You look tired,” he remarked, smiling to show the comment was born from empathy, not criticism. “Shall I drive?”
4
“WHO GAVE YOU THAT SCAR?”
ANYA
And so we headed off in Michael’s Volvo—which, oddly, bore a strong smell of fertilizer inside—to the pediatric unit of the Belfast city hospital.
It was crucial that my approach was gentle and provided Alex with a high degree of space and assurance. Before leaving MacNeice House I had instructed Michael to contact Alex about where he would like to meet with me, and to confirm that the time was suitable, so that my arrival did not cause anxiety. Alex had not been concerned about either; he simply wanted to know how his mother was doing and when he could see her at hospital. He had subsequently been promised a visit with her once she had been treated medically.
Michael entered the room first after a knuckled rat-a-tat-tat on the door. Children’s interview rooms in psychiatric units are always the same: a corner full of sensory toys and, invariably, a doll’s house. In this case the room held just a doll’s house, a child’s whiteboard on a stand, a sagging blue sofa, and a table with two chairs. Over Michael’s shoulder I spotted a boy on a chair behind the table, balancing on its hind legs.
“Hello, Alex,” Michael said lightly. At the sight of Michael the boy slammed the chair back down on all four and shouted, “Sorry!” Michael waved his hand in the air to indicate no harm done. Then he held both hands toward me as if presenting the prize on a quiz show.
“I’d like to introduce you to Dr. Molokova,” he told Alex, who nodded in my direction, smiling politely.
“Call me Anya,” I told Alex. “It’s nice to meet you.”
“An-ya,” he repeated, then grinned. I looked him over briefly. I noticed he had a touch of the street urchin about him: chocolate-brown hair in need of a haircut and a good wash; pale, Northern Irish skin; wide denim-blue eyes; a cheeky mushroom nose splattered with fat freckles. More striking was his dress sense: an oversized man’s shirt with brown stripes, buttoned up wrong; brown tweed trousers with thick cuffs at the hems, a man’s plaid tie, and black school shoes that had been carefully polished. I spotted a waistcoat and a blazer slung over the sofa. I wouldn’t have been surprised if I’d spotted a cane and pipe. Alex had clearly been independent for a long time, and was trying to be much older than his years. To support his mother, I guessed. I was anxious to determine whether this was a manifestation of another personality, or if he was just plain eccentric. The room was filled with the smell of onions.
Michael pulled a chair close to the door and sat down, careful not to intrude on my meeting with Alex. I walked toward the table.
“Very cozy in here, isn’t it?”
Alex watched me, visibly nervous. “Is my mum okay?” he asked. I glanced back at Michael, who nodded.
“I believe she’s safe and sound, Alex,” I said, choosing my words carefully. It is always my utmost resolve to be honest with my patients, but when it comes to young children, tact is highly important. Alex had seen me hesitate and glance at Michael, and the smile he offered back was fractured with worry. This was not surprising, given what he had been through. It is rare for me to work with children who have had pleasant childhoods, yet despite the catalog of traumatic life stories I’ve racked up so far it’s still upsetting to find myself part of yet another narrative that is marred by so much harm at such a young age. Too many times I know the ending, and I can never erase the faces of those children from my eyes. I find myself mulling over their life experiences in my sleep.
But Alex did not appear what we in the psychiatry field call “flat.” His eyes were lively, questioning, and haunted.
A psychiatry consultation is a little like an interview with a celebrity: It moves in inward-bound spirals, circling the crucial issue throughout a series of related topics. The only difference is that a psychiatry consultation needs to achieve that by allowing the interviewee to steer the conversation. I looked for cues. On the whiteboard beside the doll’s house a picture of a house had been sketched in blue marker with noticeable care. I pointed at it.
“What a beautiful drawing. Is this your house?”
Alex shook his head adamantly.
“Is it a house you’ve seen before?”
He got up from his seat and walked carefully toward the whiteboard.
“It’s the house I’d buy my mum if I had enough money,” he explained, rubbing a stray line around the carefully arched front door. “It’s got a yellow roof, and there’s flowers in the front garden and lots of bedrooms.”
I was keen to pursue this topic. “How many bedrooms?” I asked.
“I’m not sure.” He picked up his blue marker and continued adding to the house with surprising artistic skill—a cockerel-shaped weather vane on the roof, two small bay trees beside the front door, a dog running up the garden path. I watched, saying nothing, mentally taking notes.
He drew a small circle in the front garden of the house and filled it with dots—a strawberry patch, he said, because his granny used to grow strawberries to make jam. His final addition to the drawing was a huge set of wings at the top of the picture in the sky above the house.
“What’s that?” I asked.
“An angel,” he replied. “To protect us from bad things. Though I’ve never seen an angel.” As soon as he said it he appeared to shut down, withdrawing eye contact and raising a hand to his mouth, as if he was afraid he’d given something away.
I asked Alex if it would be okay for me to open a window. I find an open window often acts as a reassurance to patients that they are not trapped, that there’s a physical exit, should they require it, even though it would take a set of ladders and a Spider-Man dexterity to climb out these windows. He nodded and took a deep breath. Already, he was relaxing. Step one.
I sat cross-legged on the multicolored floor tiles and pulled out a notebook and pen from my satchel. Alex fidgeted a bit, glancing at Michael sitting on the other side of the room. Eventually, Alex sat down opposite me.
“Do you mind if I take notes during our conversation, Alex?”
He made himself comfortable, crossing his legs and holding on to his ankles. He nodded. “I write stuff down, too.”
“You write?” I asked. “Stories? Poems? A diary?”
At my third suggestion, his eyes lit up.
“Me too. I find writing things down helps me clarify things,” I said, holding up my notebook, but he was staring at the corner, deep in thought.
“How did you get that?” he said when he spotted my facial scar.
“It’s nothing,” I answered, touching the jagged groove on my cheek, reminding myself to keep my emotions in check. “Have you ever fallen off your bike?”
“I cut my knee once.” A long pause while he reflected on this. Then: “Why are you wearing a bottle top for a necklace?”
He repeated the words anaphylactic shock. “What is that?”
“I’m allergic to nuts.”
His blue eyes widened. “Even peanuts?”
“Yep.”
He considered this. “And peanut butter?”
“That too.”
He cocked his head. “Why?”
“My body doesn’t like them.”
He held me more firmly in his gaze now, inspecting me like I might explode at any moment or grow a second head.
“So what would happen if you ate like a Snickers or something?”
I would probably stop breathing, I thought, but instead I said: “I would fall straight to sleep.”
His eyes widened. “Do you snore?”
I laughed out loud. “Michael tells me you’ve got some great jokes. I love jokes. Can you tell me your favorite?”
He studied me and, after a moment of contemplation, shook his head slowly. “I can’t,” he said, very seriously. “I’ve too many favorites.”
I gave him a minute to think, then: “Shall I tell you one of my favorites?”
“No, I’ve got one,” he said, and cleared his throat. “Statistically, six out of seven dwarves aren’t Happy.”
It took me a second or two to get it, but when I did, I laughed so hard that Alex’s face lit up like a Chinese lantern.
“I didn’t write that one,” he said quickly.