Supporting the survivor of bullying

Trigger Warning - bullying, suicide attempt content. 

Yesterday I saw a young boy in the clinic. Our clinical encounter last for roughly 20 minutes and it is strongly etched in my mind. I was disturbed for a long time even after I had come home last night. I am still thinking about him. My predominant thoughts when I think about this 15 year old boy studying 11th standard in the local school are helplessness, a gross feeling of insufficiency as an adult in the community and still not being clear how to help him. 

My colleague brought him to me so that we can see him together. The boy had repeated episodes of fainting and falling over the past 6 months. He had lost consciousness and fallen at different times which were totally sudden and unpredictable. Sometimes, he had fallen at home, sometimes in school. The mother said at those times he completely became cold and lay still like a log of wood. We spoke to him and got more details about these episodes. It was not making sense to me. I wanted to get to the depths of the problem. To give some context, we had just seen another young boy, of the same age, a few weeks ago in the clinic, who had sudden attacks of abnormal involuntary movements of the right hand and leg. On more detailed evaluation, we identified that he had hemichorea, a neurological condition that needs neurological evaluation and treatment. So our minds were at an alert high and we were keen on not missing some problem in the brain. 

Initially the narrative of the boy's fainting episodes sounded like a full loss of consciousness. But when he started narrating the events again, he said he would just 'feel dizzy' and fall. But he would be fully aware of what is happening around. If he was at school, he would note that the teachers are rushing towards him and helping him. If at home, his sister and mother would rush to help him. Within a few minutes he would feel better. This narrative was not consistent with either a loss of consciousness or a seizure attack. My colleague was suggesting that we look for postural hypotension, a fall in BP when someone suddenly gets up and stands from a prolonged sitting or lying posture. Postural hypotension in an otherwise healthy young boy is very rare. But it could be a possibility. But still something did not add up in my mind. I asked him, "what else? is there something else you want to tell me?" 

The boy went quiet and gave a broad smile. Throughout the clinical encounter thus far, the boy had a pleasant demeanour and had a smile on his face. At this precise moment of silence the boy's mother interjected and said, "Yes sir, something is happening. Four days ago, we found a letter typed in his mobile. He had taken my saree and tied a knot in it and kept it. His elder sister found the letter and read it. In that he had described some serious problems and had written that he is going to end his life" Saying this the mother broke down into tears. I looked at the boy and he still had the same smile on his face and when he caught my eye, he shrugged and the smile did not even fade a tiny bit. 

I understood that the boy was not ready to talk about it. I asked his mother to explain a bit more. She gathered herself up and said, "He had written in the letter that another boy in the class is bullying him in school and the only way to stop it is if he dies." and she once again broke down and started crying. I turned to the boy once again and he still had the same smile on his face. He held eye contact with me and kept smiling. It was like he was telling me, "Don't worry, I am fine" I did not believe the expression. I showed eye gesture to my colleague to leave the room which she understood immediately and left. I also sought permission from the mother to talk to her son alone for a few minutes. Then I asked our staff nurse to shut the room to the clinic and we were alone now. I looked at the boy and asked him, "nobody is listening now. do you want to tell me what happened" 

The broad smile on the boy's face slowly faded as he started speaking. "There is this boy in my class. He keeps telling me that I look beautiful...." he paused for a bit and hesitated. I realised he wanted to say more. But I did not say anything. I kept listening. "....he calls me 'sexy' and shows very inappropriate hand gestures to me." He went quiet. "Does it bother you when he does this?" I asked. "Other boys see him doing this to me and they call me bad names. That disturbs me a lot." I told him, "I understand.... How long has this been happening?" To this he said, "From the beginning of 11th standard this is happening." 

"Have you tried telling the boy that you don't like this and asking him to stop?" I was not sure if this was the right thing to ask. I did it anyways. "Yes, I have told him, I don't like what he is saying or doing. But he keeps saying I am sexy and keeps doing the same thing again and again..." The smile on his face had completely vanished by now. "What happened then? Did you tell your parents?" I asked. 

"I told my mother one day. She told me to ignore it and go to school. But I hate going to school now. He is in my class and I have to see him everyday. He keeps doing this to me daily and so I hate going to school. I like studying. I want to finish school and then go to college and then take a job and earn money. But I hate going to this school because of this boy. I asked my mother if we can change school. She ignored my request." He said. But throughout this he was calm and composed.

"Did you approach your father?" I asked. "My father is an alcoholic and he beats my mother. I always have many arguments with my father and fight with him when he beats my mother. So we are not in good terms. But my mother told this to my father. To that my father came and shook me by my collar and said that I should stop behaving like a girl. He said, I am worse than my sister. Not only that he used some bad words to scold me and mocked the way I walk, the way I talk. It hurt me very bad" By now the pain that was hidden deep inside this young child's heart started surfacing and I could see the corners of his mouth quivering. 

"What happened on the day you wrote that letter that your mother told me about? Do you want to talk about it?" I asked. "Nothing happened. It was a silly decision. All of a sudden I felt very much alone and did not know what to do. Nobody was understanding me. I did not know what to do. I now understand it was a silly decision. I will never end my life." The smile was back on his face now. I started realising the deep internal struggle inside this young boy's mind. He was putting up a brave front. 

"Here, please take my phone number. I am just a phone call away. you can call me any time when you feel like you need to talk to someone. You are not alone. You are going through an age where you are exploring your identity and your sexuality. The same is true for the other boy in your class who is doing this. He is either feeling attracted to you or confused about what he is feeling about you. I will talk to your mother now." I said and called his mother inside. 

"Just like how a young woman is teased and harassed sexually, young boys can also go through the same by other boys. It can be equally distressing for the boy. So please go to the school, lodge a complaint and make sure that your son gets a peaceful learning environment in school. Talk to his father and ask him to not be so hard on his son." I told her. "Yes doctor, I have already gone and spoken to his class teacher. The class teacher has said she will warn the other boy in a sensitive manner. My husband is a drunk man. There is no use in talking to him." She said. The young boy was watching, the same broad smile on his face now. "Don't worry, I don't bother much about my father. He wont change." he said. I also gave them an appointment to meet the psychiatrist who visits our clinic on a monthly basis so that he can be evaluated and treated if required. 

Long after this clinical encounter was over, the smile on the young boy's face, his pleasant demeanour in the face of such adversity, and his composure disturbed me. There is some discourse on the social pressures on young boys based on the norms associated with masculinity. The way society expects adolescent boys to be 'brave', 'macho', 'not cry' and engage in aggressive behaviours and the way the same society labels him 'sissy', or 'not man enough' for doing the exact opposite are being spoken about. These norms are slowly changing . But in the hinterlands, especially in suburban areas like the one where we work, the gender norms are still strongly operational. The boys who do not adhere to these norms are termed effeminate and mocked, ridiculed and bullied. Intolerance to people who are different is the root cause for this bullying and harassment. It is a universal phenomenon, but the toll it takes on the mental health of the ones who experience it is immeasurable. I have met this boy only once so far. I still don't know him well. But I understand that he might be exploring his own gender and sexuality. For most youngsters such a conscious reflection of one's gender and sexuality never happens. Many never feel the need to reflect on it because the majority fit into the cisgendered, heterosexual normative pattern. But for the small minority who don't fit into this pattern, the society doesn't create a safe space for such a reflection. 

When I was a teacher in a medical college I have had some students from various colleges, who have come out to me about their gender and sexuality. In such situations, I have never been sure if my response was appropriate. I have tried never to judge and have tried to be sensitive. I don't know if I have done it right. I need to ask them about it. We are still friends and the fact that I have not lost them as friends could indicate either I have been sensitive, or they have forgiven me for my insensitivity. I need to figure out which of these? As a clinician, this is the first time, I have the potential opportunity to provide such a space where the boy can safely reflect on his gender and sexuality. Since this is the first time, I felt completely unprepared for this. In fact, yesterday when I was talking to this boy, I had to think hard before saying every word that I uttered. I was not prepared for this session and I did not want to hurt someone who was already being judged and harassed by the society. In MBBS they teach us that we must be ready to be life long learners. This young boy and this experience has taught me the meaning of that one more time. I look forward to working and traveling with this young boy and supporting him through this traumatic period into a beautiful life and future.