The sound of silence

It was early on a Saturday morning in February at half past seven and  the peaceful silence of my lay in was disturbed by a low throbbing hum that increased  and made the whole house vibrate as it passed overhead. It’s not the lawn mowers that wake you up round here but the helicopters.

Later after breakfast a couple of jets roared low in the sky as they returned to the airbase This happens  several times a day, they have presumably the same destination as the helicopters and are a reminder of a major news story that is not very far away. I won't speak of that now, you can look it up for yourselves.

As the sound of the planes died away, I entered the emergency room to see a boy,  a silent echo from the same events.

I thought I knew the story already from a nurse who had come to the house earlier on. The boy had been bought in by his father, he hadn’t spoken or indeed done anything for four days but apparently he was still eating and drinking what was put in front of him and going to the toilet; but nothing else, just laying down. He had been carried to the hospital. His pulse temperature and blood pressure were all normal. So he had been waiting to see me for an hour or so, triage category important enough to see the doctor but not urgent, as I said to the nurse whilst cooking the eggs for our family breakfast.
 

The boy was laid immobile on the bed eyes open starring into space, about 7 years old. I said hello and asked his name, no reply. So I sat him up and gave him a quick physical check. He looked normal to me,  and now  he was looking at me, watching me carefully but he wouldn’t talk. I asked a few questions of his father,

Had there been any bad news or shocks at home? ‘No’,

Had he been fighting or arguing with anyone? ‘No’

Had he problems at school? I am his school master and there are no problems.

Where are his father and mother?  His family lives up by Lake Chad but they have sent him to my religious school.

I remembered, how could I forget, that a village on Lake Chad had been attacked a few days before, could  this the cause of the behaviour?  No, he is sick.

 

The response of the powerless and weak is often silence round here. How to give them a voice?

I agreed that  he was sick and suggested that the master  step outside so that I could try to find out the cause.  In the quiet I spoke to the boy  again and this time asked him if he was worried about his parents. Perhaps it was the surprise being addressed by a white man, or perhaps just that someone understood? Tears welled in his eyes and rolled down his cheeks and he said yes. He told me his name, Moussa, that his mother had died a couple of years ago, he hadn’t seen his father for 18 months since he came to school. His father is a fisherman on Lake Chad and he agreed he was worried for his safety. I prayed for him, his father and for peace.

The nurse was surprised to see the change and suggested that the master would now beat him for wasting time. Not an ideal solution, and hopefully simply the prejudiced view of a Christian nurse of a Muslim family, but who knows?  Anyway the master, who seemed to really care for Moussa, (why else had he come to the hospital?),  was invited back.  I explained to him that  Moussa had a bad shock with the news from his home area that made him unable to speak. The best solution would be to get Moussa to talk to his father on the phone. That won’t be difficult he said I have his number he is my brother. As often happens the phones wouldn’t connect so he said he would try again later and they went home. Moussa walked out by himself.  I hope it all went well.

This case was, in my experience, unusual; in that a child was involved and he was male. Much more commonly, at least two or three times a month, we see young women who come in mute, laying stiff in a wheelchair and looking unconscious. With experience it is relatively easy to distinguish this psychiatric syndrome from physical disease. Sometimes there is a minor physical illness and they have excessive fear, death can comes surprisingly quickly here. More often there is a history of family trauma, arguments with husband, mother in law, a death in the family or the arrival of a second wife. Difficult situations for women in a society where they have little right to speak for themselves. We try and get people talking to each other so that the issues can be addressed and if necessary can act as place of safety for a cooling off period.

Conversion disorders used to be termed hysteria and were often considered a disease of females. Even the name, hysteria, comes from the Greek for uterus which was supposed to move and cause the disturbance. Of course this is not the true cause and it’s not just down to the hormones either, but it is true that  in my practice women are more frequently affected. I think that these phenomena, and especially psychological mutism has much more to do with a sense of powerlessness and being in a low position where you aren’t usually heard than with gender. Typically in patriarchal societies it is the women, especially the young who find themselves in this situation but  It is interesting to note that it was common amongst the ordinary soldiers in WW1. Unable to endure the horrors of the trenches they became mute and withdrawn. Interestingly  it was uncommon amongst officers who had different physical manifestations of post-traumatic stress disorder (shell shock), such as unexplained paralysis. Perhaps the ordinary infantryman couldn’t find the words to describe so numbed by events he spoke no more. The voiceless lose the power of speech, but remember  it is  not a choice ,they simply cannot speak.

Changes in our society in the UK have meant that the typical reactions that I see in Chad are much less frequent than they were a century ago. People, especially women are better educated, and have learnt to have a voice. The change for the better, but there are still problems. Theoretically people, women and even children, are used to expressing themselves but sometimes they can’t find the words. Instead of becoming passive and withdrawn there is a still a desire to express themselves to cry out and so there is an often hidden epidemic of self-harm seen in NHS Emergency Departments most nights of the week; the taking an overdose of tablets or cutting of the skin.  

So it was a surprise to me when last month when I was called to a young women had swallowed petrol. That is not a normal response to stress in Chad, but then no rule is absolute. She felt trapped in an arranged marriage where she suffered verbal and sometimes physical abuse. Earlier in the week had taken refuge with her parents. She was due to return to her husband,  her father was to take her  that morning, and saw the petrol as the solution even accepting death if necessary. After a period of observation it was clear she was in no medical danger but stayed with us a couple of days as a way forward was worked out.

Our societies differ and people use different ways to cry out, sometimes with a silent cry and other times with acts against themselves. These people, especially the powerless young women unhappy, abused and exploited in all our societies, need help the world over.  Let us all see what we can do to help on this International Women’s Day.