By Firas A. Nakshabandi, M.D.
Children were running and screaming down the hallway as the behavioral code was being called on the child psychiatric in-patient unit. Some were cowering in a corner, others were pointing in terror at the wall on which one of the kids was smearing blood he had drawn scratching at his face, tracing out a pentagram to “open a portal to hell”.
Sammy was eleven, and he was a Devil Worshipper. He refused to eat so that his cheek bones would become more prominent. He researched occult spells online, and dreamed of getting plastic surgery to acquire fangs and red eyes. But perhaps most troubling was the fact that he would drink his own blood in hopes of transforming into a demon.
I had been working with Sammy for about a month. From our first encounter I was both deeply intrigued and deeply moved by him, and the more his story unfolded the more it became clear to me that this was a child who desperately needed to believe again; both in himself and in the world.
Sammy grew up with a bipolar mother and a schizophrenic father. His father was in jail for assault & battery against his mother, and she in turn lost custody of Sammy after inciting him to burn their furniture. Despite growing up with an unstable mother who would do things like feed him flour, he missed her deeply. He also hated her. She would frequently call him things like “retarded” and “stupid”, and it seemed like his life with his current guardian; his cousin, was not much easier.
His cousin’s boyfriend beat him when he was drunk, to the point where he would curl up in a ball waiting for the punches and kicks to stop. The only support he ever got from his guardian was her insistence that he abandon his sinful “foolishness” and “return to Jesus”.
Outwardly, it appeared as though Sammy’s obsession with demons was driven by a need for power; to control that which he simply had no control over. “Demons are strong, mortals are weak” he explained. He also hoped somehow this would help him gain friends.
Much like the ambivalence he felt towards a mother who did not know how to nurture, he both yearned for friendship and despised those around him for not accepting him as he was. He had decided he was a Devil Worshipper, and to hell with anyone who did not embrace his ideals. He would often tell me how he was being bullied at school for what he saw as religious beliefs he was entitled to. On the unit, he hissed and bared his teeth at the other kids. On the other hand he was desperately lonely; constantly requesting a roommate. Unfortunately, his behavior ensured the staff would never feel comfortable granting him that wish.
As our relationship progressed and I dug deeper, he finally confided “I used to believe in God, but He never answered my prayers. Now I believe in the Devil”. This statement shook me to my core.
For the first few days I was never certain of his diagnosis. Some days he would complain of constant headaches, trouble sleeping and terrifying voices malevolently whispering “join us”. On others, however, he seemed to be just a boy pretending to be a demon; because that was preferable to what his current reality was. What seemed abundantly clear was that he needed medications, to which his guardian only finally consented after Child Protective Services threatened action for concerns of medical neglect.
Dishearteningly, it seemed the medications only made him worse. He was becoming more irritable, and when he was particularly upset he would scratch at himself until he bled. I was at a loss until I noticed a rather peculiar interaction.
A new patient came into my care; a six year old girl. I suspected a history of trauma in her as well; she had very low frustration tolerance and, like him, also resorted to self-injurious behavior when she was overwhelmed with emotions. As I colored alongside her, Sammy walked over and asked her name. For some reason they were drawn to one another, and it occurred to me to employ this interaction in service of something we had been working on for weeks: his conviction that he was evil.
In his mind Sammy’s “evil” made perfect sense: He was a demon after all, and demons were evil. He also heard confirmation of this from everyone around him: “bad”, “sinful”, “retarded”. I had been working hard on improving his self-esteem by holding a mirror to him of what I saw: he really was very smart, artistic and caring. I took every opportunity to show how impressed I was by him, to teach him other kinds of magic like card tricks, and to use his fascination with the occult for hypnotherapy oriented work to help him deescalate when he was in crisis. I modeled using humor as a coping strategy. But this interaction with a younger girl intrigued me. “She reminds me of my sister” he admitted.
“Well, why don’t you be her big brother then?” I encouraged him to watch over her, teach her how to calm down when she was upset, and pass our work on to her.
He embraced the role whole heartedly. Finally, a cure to his loneliness! Someone who did not judge him! And most importantly, it seemed to me, he found someone he could relate to. The more his empathy was “stimulated”, the more convinced he became that he was not evil after all.
It seemed to me all three of us resonated with each other on various levels, and the relationships formed between Sammy, the girl and myself helped all of us in different ways: I was even more motivated to help because of how moved I was by their suffering, the girl found support and a caring figure to guide her in Sammy, and Sammy found a new purpose and a new identity to work from.
An altruistic drive had awakened within him, and he would often convey that he wanted to model how to act when the girl felt like injuring herself. Being a role model for her played an enormous role in his acceptance of himself as being in fact “good”, and for the duration of his stay thereafter he no longer cried and scratched at himself when he was overwhelmed, as he did when he was trying to escape through that portal to hell, moments after hanging up the phone on his castigating, withholding mother.
My experience with Sammy sent me down a rabbit hole of research into mirror neurons, oxytocin, yawn contagion and trauma. I became convinced that if there was ever anything we as Child & Adolescent Psychiatrists must target, it should be empathy. Problems with empathy can be traced to the root of everything from antisocial and borderline personality disorders to PTSD and autism. In a world of cycles of aggression, hate and dehumanization my question felt more urgent: Might there be a way to teach children empathy? The research in this field is ongoing, but it seemed like my intervention was a success: “Thank you Dr. N., you really helped me a lot” were the last words Sammy spoke to me before he was finally discharged.