No one can help me

Even the most solid blocks to progress can suddenly vanish, as John Pasture describes

Redeen was a small, dark, wiry man from the mountains of Iraq. He was not – he had made this very clear – Iraqi. He was a Kurd (he pronounced this ‘koord’), and he spoke Sorani – and English, Arabic, some Farsi, French and Russian. He was in his early 40s, with a fierce moustache, dark, intelligent eyes and a facial tic that made him look as though he was winking at something clever or funny that he had been told.

(By the way, Redeen is based on a real person, as is everyone mentioned in this article, but they have all been anonymised, and I am writing anonymously, so none of us are in any way identifiable.)

Language was our first misunderstanding. Not knowing that he was a Kurd, an Arabic interpreter had been booked for our first (assessment) session, and so we communicated with Redeen in Arabic. The referral letter from the GP was fairly economical in detail (‘Dear colleague, I would be most grateful if you would see this pleasant man who seems to be suffering from post-traumatic stress disorder’). So, I asked Redeen if he felt able to explain what brought him to see me. He found this question baffling; he had come to see me because his doctor had told him to. Yes, but why had the doctor told him to see a counsellor? ‘Because I am very sad.’

Clearly, Redeen’s attitude to counselling was not dissimilar to Nigel Slater’s attitude to pot noodles. This was not going to be easy.

I asked if Redeen had been prescribed medication for his sadness. He said that he had, but he had thrown the tablets away – ‘I took one and it did not help.’

I tried to explain that sometimes people find it helpful to talk about the things that are troubling them, and this is especially true for people who have been forced to leave their country, family, friends and colleagues. Deprived of their customary support network, they are obliged to keep their thoughts unspoken. Counselling is an opportunity to say things in a safe environment to someone who has some understanding of their history and situation.

Redeen nodded thoughtfully and then said: ‘I am not going to talk about the past. It hurts me too much to think of these things, and it will not help me or anyone else to say anything about what has happened to me.’

He sat for some minutes, glowering and twisting his moustache. It seemed he was not going to say anything else of significance.

At the end of the session, the interpreter left, and Redeen followed behind him down the corridor. As the interpreter went out through the front door, Redeen turned and trotted back to me. Then, in impeccable English, he gave me a lecture on the misfortunes of the Kurds in Iraq and his loathing of Arabic. We should, he said, book a Sorani speaking interpreter for the next session. Which, of course, we did.

However, the next session, the first treatment session, was a fiasco: someone in the admin team misread the instructions and, thinking that Sorani was a country, booked another Arabic-speaking interpreter. Redeen did a lot of moustache twirling and glowering, but refused to have the session, either with the Arabic interpreter or without an interpreter and the two of us speaking English. There were no further options that I could offer. I explained that we did know what had happened, and assured Redeen that it would not happen again.

‘I am not going to talk about the past. It hurts me too much to think of these things, and it will not help me or anyone else to say anything about what has happened to me’

The next appointment was a couple of weeks later, and Nadya, a Sorani interpreter, arrived on time. At last we could begin properly. But Redeen did not appear. His mobile was either not working or switched off, so I left a message saying I hoped he was OK and asking him to give us a call so that we could rebook his appointment. The following day a member of the admin team called me. Redeen had been in touch. He had been sick. He knew that he had an appointment and had called in to cancel and reschedule it. However, all he got was a recorded message telling him that all of the staff were busy and his call would be answered as soon as possible. With limited credit on his phone, he did not want to wait. So, he had turned off his phone and gone back to sleep.

What is the point?

The following week, Nadya again arrived on time, as did Redeen. I made the introductions and he smiled and appeared to be content: the arrangements were to his liking. But when I asked him what he would like to discuss in this session, he looked puzzled. He told me he would answer any questions that he was asked. I tried to explain that this was his opportunity to talk about anything that was troubling him, but he asked, confrontationally: ‘What is the point of that?’

He then spent the rest of the session telling me his life story.

He came from a poor family. His father was a shepherd, and Redeen, the oldest child (he had two sisters), was expected to be a shepherd too. As soon as he was old enough, he had to take a flock of sheep high into the mountains to graze. It was a very tough and lonely life. The weather was harsh – hot in the summer, freezing in the winter. There were predators always looking to pick off a lamb, and there was no excuse for losing an animal: if that happened, Redeen would get a beating from his father. In pursuit of stragglers over slippery rocks, there was the risk of falling to his death.

Aged 16, Redeen ran away from home. He had relatives in the city, his mother’s cousins, and he went to them and asked if he could live with them. Redeen then missed out a lot of his history. He talked about being successful – he had a car, a job and a good life; he was married and had two children and a nice house. He was also political – and this is where things began to go wrong. He was holding meetings at his workplace, and someone informed someone; leaflets were found and he was arrested. He was imprisoned and tortured but, after six months, he was released. His mother’s cousins had paid ransoms, and then paid bribes to have him officially recorded as dead. Then he was helped (more money was paid to people for false documents, and more money to traffickers) to escape the country, and he came to the UK. Like most asylum seekers, he was very sparing with the details. The knowledge that naming anything or anyone would put others at risk was too deeply ingrained. He was unable to give anything more than the most basic facts. Not that this mattered to me: I wasn’t collecting evidence or assembling a case. This was, as I had said to him, just an opportunity to talk about what was on his mind.

What was really on his mind were his wife and children. It sounded as though there had been, and continued to be, a huge rift between Redeen and his father, who had never forgiven him for deserting the family and his inheritance – the flock of sheep. Whether his father had actually taken some kind of action as revenge or punishment, Redeen did not know. He did believe that his father was involved in some way, and he was very bitter about this. How it had happened and who was involved was not clear. What was certain was that Redeen’s wife and children had vanished. No one knew anything; no one could help. And this was the heart of it, the core of his pain. His freedom and safety meant nothing, because he had lost his wife and children. He did not know what had happened to them, but he knew very well what the options were, and he was, understandably, inconsolable. His survivor’s guilt was crippling him. His inability to see a future made him hostile, despairing and antagonistic to anything that anyone might try to do for him – which, in his eyes, was precisely nothing.

A door opens

He was very late for the next session. He said something about buses and it was clear that he was generating a cover story on the spot. For all his lack of psychology mindedness, he knew as well as I did that he was acting out his ambivalence. He did the glowering and moustache twisting for a bit. Then he asked if he could go. I said of course, that he was not attending the session under any duress from anyone, and whether he came at all, or left early, was entirely up to him. He said, challengingly: ‘So, I can do what I like?’ My response was: ‘No, Redeen, that is not what I said. There are some things that cannot happen. For example, you missed half an hour of your session today. You cannot have an extra half hour at the end.’ To my surprise, he laughed, a genuine, hearty laugh. He said: ‘In Erbil I was the boss of a graphic design company. When one of my employees was half an hour late in the morning, they had to stay one hour extra after work.’ Then he got up and left.

Redeen had not mentioned his work before, and I was reminded of it some days later when I came across an exhibition of graphic design put on to showcase local companies. One company in particular attracted my attention. Looking back, six months later, I am not sure what generated that connection for me. Probably it was subliminal. What I do know is that I was moved to write an email to the company, as follows:

Dear Angel Graphics,

I would like to make what you might feel is an odd request. If, for whatever reason, you are not able to help, please do say.

I would like to know if you would be willing to meet with one of my patients. He is an asylum seeker, a Kurd from Iraq. He is struggling and could do with some mental stimulation. He used to be a  graphic designer. Here, in the UK, if he were allowed to work at all (he is not), his qualifications would not be recognised. However, it might cheer him up to meet someone in his (former) profession – even for 30 minutes.

Of course, if you are not able to help, that is fine. If you know someone else that I might contact, I would be grateful if you would let me have their contact details.

Many thanks.

I was not expecting a positive response (actually, I was not expecting any reply at all), so I was surprised when, just the following day, I received an email from the studio manager at Angel Graphics, Stephen Smith:

Hello John,

Thank you for your email.

I have discussed this with one of our directors and Nick would be happy to meet with your patient. If he wished to, he could come to our studio to look around and chat with Nick.

Redeen was clearly not in a good mood when he and Nadya, the interpreter, arrived for the next session a couple of weeks later. He did a lot of moustache twisting, and complained bitterly and at length about the Home Office, the Jobcentre, the local council housing department, the weather, the Red Cross, his GP, and various agencies and organisations that had failed to meet his expectations. Although I had been excited by the potential, I knew Redeen would not see the offer of a visit to Angel Graphics as an answer. This was a concept that one of my line managers, a very wise person, had taught me: ‘John, your suggestions are not solutions.’ Even if I had something to offer, it was probably not going to get a rapturous response.

The door closes

I was right. ‘That is the past. I am not a graphic designer. I am nothing, I am no one. Nobody is interested in me, nobody cares about me, nobody does anything for me.’ My reaction to this was mixed. In part, I felt hurt. It is not uncommon for many people with whom I work (or many of my patients) to say in a session that no one cares for them, no one is interested in them, no one listens to them and no one is able to do anything for them, even when they are sitting in a room with a counsellor and an interpreter who are both there to hear what they want to say. I also felt chagrin; my presumptuousness had been revealed.

However, I was not quite ready to abandon my idea. I asked Redeen if he might just give the idea some thought before our next session. He did not have to go, of course, but, on the other hand, would it be a bad thing to think about, I asked? I could see Nadya almost literally biting her tongue, trying not to add her encouragement to mine. Grudgingly, Redeen concurred that giving the idea some thought might be OK, but that did not mean that he would go.

Later that day, just to make sure that Angel Graphics had not changed their mind about meeting Redeen, I emailed them again, and Stephen replied promptly:

It’s good to hear from you. He is welcome to come into our studio for the meeting to see us work etc. Nick is a director at Angel Graphics and he will chat to Redeen. He is visiting Iraq at the end of the month. Would it be appropriate to chat to Redeen about that?

In the following session, Redeen was more cheerful. He had been in contact with some friends living in Manchester, and he had allowed them to persuade him to visit for a couple of weeks. So, he told me, the interpreter and his counselling needed to be cancelled for the next two weeks. I said we would do that, of course. However, had he come to any conclusion about Angel Graphics? They had suggested a couple of dates, but if he did not want to take up the offer, that was fine, of course;

I was asking him because it would be courteous to let them know.

I worked on refining my reproachful reaction, reducing it to a mildly hurt (not angry with him, but affected by him) tone of voice. Guilt is not helpful, but I wondered if a gentle challenge would help Redeen move forward in a more adult way

 No, he said, he was OK about visiting them, and OK too about talking to Nick about Iraq. He put this as though he would be doing me a favour. And, to underscore his assertion of control, he chose the day and time that conflicted with his counselling session. However, everyone would have to wait until he returned from his visit to Manchester.

I was fairly sure that, if there was a way of sabotaging the studio visit, Redeen would find it. The obvious way out was to invoke, as he often did, his poor memory, damaged as it was by post-traumatic stress disorder. To anticipate that, I sent him a reminder text a couple of days before the visit was due to take place.

On the morning of the scheduled visit, Stephen emailed me to ask if Redeen was still coming. Of course, I could not say; I had not had any contact with Redeen for several weeks. I fully expected a further email from Stephen regretting Redeen’s non-appearance, and maybe offering to make another appointment.

Sure enough, at the end of the day, there was an email waiting for me from Stephen.

In the millisecond before opening it, I pondered how I would address the matter with Redeen at his next session. I worked on refining my reproachful reaction, reducing it to a mildly hurt (not angry with him, but affected by him) tone of voice. Guilt is not helpful, but I wondered if a gentle challenge would help Redeen move forward in a more adult way.

And then I opened the email:

Hello John,

Just to let you know Redeen came over today and met with Nick. It was an absolute pleasure to meet him and chat about his passion for graphic design. We have exchanged numbers and would be very happy to support him further. Thank you for giving us this opportunity to meet such a wonderful man.

This article was first published in Therapy Today March 2017.