“Hello.”

“Hi.”

“So… you came back…. we will be allowed to meet here for every session….obviously, we don’t know how many there will be. You’re not compelled to see me… we can stop this when ever you please…. I need to be sure you are aware of that…it’s important.”

“I know I don’t have to come… I know I can walk out whenever… but let’s not pretend I can walk out of here and that would be the end of it…. if it frigs me off I’ll stop…. you need to be aware of that… but I know what the consequences could be if I chuck it in.”

“Hm… well, let’s not jump too far ahead of ourselves I have no real say in what ‘might’ be….I’d like to think we’ll make real progress….. but I can’t make you see me….and I can’t make you talk….. I don’t subscribe to coercion…. okay?”

“The elderly gentleman and young girl were seated in a delightful little nook at Table 42 and 3/4; it was going to be their quiet place where they could have people close by but not be heard. He had known she would like it away from hospital offices and the formality of checking in with his secretary - not to mention disturbed patients arguing with nurses, each other and people who were the products of a delusional mind - not actually there. It was the quiet time, a sliver of calm before the bustle of day became the energy of night. A few people dotted up and down talked almost in whispers in deference to hush as light drained from the sky.

“You told me last time that it would be easier for you if I opened the conversation.”

“Did I?”

“Yes, you were quite adamant about it. Have you changed your mind….. would you like to begin….. something troubling you more than usual?”

“No.”

“No you haven’t changed your mind or…..?

“Just start! Okay… start… ask me something… you want to know stuff… you know what you want to hear…. fire away, ask!”

“Hm….. what do I want to hear?  I don’t believe there is anything I “want to hear”  …..  what do you want to tell me… other than not really wanting to tell me anything.”

“If I am admitted to hospital again I’ll be sectioned… you know that don’t you… it’s not like I jumped up and down saying please let me have a new shrink…. it’s not like we had a cozy meeting and I begged them to let me do this - again…..  I am not going to let them section me…. not ever! So pick up a thread from last time and… and…. let’s see where it takes us.”

“You don’t like the ‘jargon’ do you…..  although I have to say you’ve learned it well…. you fairly spit the words out…”

“The jargon has been poured into me for years! I would have had to be brain dead not to pick it up - and let’s face it…. they tried brain death so please, pick a topic, any topic …. I really don’t care!”

“You appear to be agitated…… “

“Agitated… appear…. would you like to swap places? Would you like to be in my position … you’re going to interrogate me for God’s sake…. it’s incredible that you can say that! It’s funny! ….. do you think the Spanish Inquisition looked at their victims and said ‘ah ah signorina, yous appears to be aghhitated’…. how would you like me to appear… how, how…. come on, give me a clue!”

“Your hands are clenched again… do you want to lash out? ….. do you want to hit me with your fists?…..”

She jumped to her feet and glared at the elderly doctor almost unable to contain herself, shaking with rage and exasperation, twisting her fingers in knots, tugging her hair, knocking the table legs which rattled cups, saucers and cutlery so much they could have danced a conga before leaping to a violent death on the stone floor…. he sat back and watched the child explode in front of him, fuming, furious, desperate….anguished.

“Let’s start again…. I’m sorry, I’ve distressed you…. I’ll get you a drink…. please…. I know this is hard but you need to relax your body, be calm….”

Within a minute there was milk, coffee, bread, cake, bits and pieces, ‘nibbles’ - placed in the centre of the table by someone who virtually ghosted in and out with the tray. There was quiet for a while, he sipped coffee, she gulped down milk and toyed with the food.

“You told me last time about your fear of choking. Do you remember how that started…. had you experienced choking when you were younger?”

“No…I don’t remember any choking.”

“What happens when people choke?  If you never had an experience of choking what is there about it that would make you so frightened?”

“You can’t breathe…. when you choke… you can’t breathe…. your head wants to explode like it’s swelling up into a giant ball and… there’s no air.”

“Hm….. you told me some things were more ‘dangerous ‘ than others… sharp things…. why sharp things….what makes them special…….. ?”

“They’re pointed… sharp things are pointed….. that’s why they are more dangerous. You can swallow a long, pointed sharp thing… it’s possible…. you are terrified… you can’t breathe….your air passage is blocked.”

“Hm ….. is that how scissors are on your list… even though they can be large and clumsy? You mentioned wasps and bees….  you thought they might pass your face and you would swallow them….. have I got that right?”

“Yes… they have stings, the stings are sharp and pointed…. it would be very dangerous to swallow one… I hate them near me.”

“It wouldn’t be nice to swallow a bee or a wasp…. wouldn’t you be in more danger of being stung….  most people are afraid of being stung… wouldn’t you know if one flew into your mouth? Is there a way maybe that you could prevent that from happening?”

“Yes…. I can keep my mouth covered… but…. it doesn’t work. If I panic and I’ve heard them buzzing I get convinced I’ve swallowed one…  convinced…. it doesn’t sound logical does it… it sounds weird.”

“It sounds distressing.”

“When a wasp or a bee flies near me I have to count…. you know… like I told you last time…1 to 6 and back and on and on…. if I panic I can tell myself I didn’t swallow a wasp because I counted…. it’s tiring…. a nuisance…. it never stops.”

“What happens when you panic? Can you describe it to me……take your time.”

“I know it’s going to be bad when I get a sensation of anxiety…. I feel my body going weak and then I start to shake…. it’s like an electric shock going through me and that’s so scary becuase I panic more and lose the feeling in my fingers and toes…. like I’m going numb all over. It makes me feel like I can’t breathe so I have to breathe faster and that makes my head swim as though I’ll faint. I’ve read books about it, I know now why it happens - I can’t always stop it from happening but I do know about it.”

“And that happens … how much? How often?”

“Every day, I don’t know how many times per day, I don’t keep track…. as many as 5 or 6 times…. in a bad day.”

“You say when these attacks happen you feel like you can’t breathe…. what’s that like?”

“It’s terrifying, I fret constantly about the chances of me fainting or being unconscious… it’s a vicious circle…the more frightened you feel the things happening to your body get worse, when they’re worse the panic increases. You’re supposed to get a paper bag, scrunch it up, hold it over your mouth and breathe out so that you can ‘breathe in what you breathed out.’ I tried it …it never worked.”

Why’s that do you think… it sounds sensible…. I’ve had patients who’ve used the technique successfully….. why doesn’t it help you?

“Well it wouldn’t help me would it….. I fail at everything…. I probably don’t do it right…. I’m thick…  stupid… useless!”

“I wouldn’t say that … you’re being a bit harsh on yourself… there can be numerous reasons for why some things don’t live up to the theories behind them.”

“Really….”

“Are there other things you can choke on besides sharp ones?”

“Yes… everything can choke me… except breakfast… I never get frightened at breakfast…I don’t know why breakfast is safe so let’s not analyse it.”

“Hm…. okay…. we’ll leave this for now… perhaps we’ll come back to it another time.”

“Anne… what came first… the fear of choking or the counting…. can you remember?”

“Counting…. counting…I’m sure.”

“Do you know how old you were…. why you counted?”

“No…. I’m not certain……before I was 9….number 6 was important years before then…. it turned into complicated 6’s when I was eleven….. the numbers had to be earlier…I needed the safety.”

“The safety…. when did you start to feel unsafe…. do you recall that… do you remember why you weren’t safe?”

“The counting ….. I think it mixed with the dream…. maybe… probably.”

“And the safety…. do you know why you didn’t feel safe… what was so frightening you couldn’t tell anyone? Children who are frightened usually rush to mum or dad so they can be reassured, they don’t normally keep it inside them….. why didn’t you tell anyone?”

“Why? I don’t know…. I have an idea… I don’t….I’m not…. “

“I think you probably do know….. what made you so frightened? So scared you had to count and have recurring dreams…. I think you can remember, tell me.”

“My parents… for different reasons… my parents, I love my mam… I hate saying this, it’s like a betrayal, I love her to bits….. but….she scared me, she hit me…. a lot. I didn’t love my father then, I don’t love him now….I hate him. I’m tired now… please… let me go … I’ve said enough.”

Jan