Imagine driving down a deserted midnight road, certain that you are going to hell. That, if you do not turn back and return to the abusive, violent relationship you have suffered for your entire life, your soul will be damned. And, with visions of Satan flashing up at every mile marker, imagine summoning the will to keep driving.

This is the experience of the few escapees of the Westboro Baptist Church, the infamous who actively picket funerals, awards ceremonies and anywhere else they can gain attention with signs reading ‘God hates fags’.

Speaking in London on 13 October 2014, Nate Phelps, son of the now-deceased Westboro leader Fred Phelps, relayed his experience with frank, candid simplicity. Nate escaped on his 18th birthday (the first day he was legally an adult and could not be forced back), but the experience of abuse still haunts him.

His talk, as part of a critical thinking lecture series at Conway Hall, relayed the childhood abuse he suffered. The nights he, as a 12-year-old was sent to sell candy in strip clubs to fund the church; the baseball bat implements used to beat the children; the culture of paranoia and distrust sown into the family, with the threat of hellfire and damnation if they did not comply. The Westboro Baptist Church was a tyranny of fear, believing a Calvinist doctrine that God has already decided who is saved and who is damned, and that only the Westboro family will see heaven. “When you live in a place of violence,” Nate explained, “there doesn’t have to be violence all the time. The threat of violence is enough.”

Beyond this culture of abuse, once free, the thoughts stayed with him. Nate lived in fear that he was damned for years. He could not understand what love was, and was petrified of marrying his now-wife because she had been divorced before, and would therefore condemn him to the pit. He cried as his children asked about religion, and the thoughts in his mind were tainted with the Westboro poison. It took years of therapy to help him come to terms with the abuse he experienced, and the post-traumatic distress he suffered.

This is a powerful reminder of two inescapable facts. The first is that we never know what our patients, and friends, experience or have experienced behind closed doors. In our lives we will know people who have faced child abuse, alcoholics, homophobia, misogyny, rape and violence. As healthcare professionals, there is a duty to create a safe, confidential space for all; this does not mean forcing help where it is not wanted, but does mean providing it when asked.

The second is that traumatic events have ripples that often go unseen. Escaping a traumatic situation does not close the book, it merely moves to the next chapter. Conditions such as post-traumatic stress disorder or borderline personality disorder affect patients for years. These mental scars are as important – and as debilitating – as any physical wound. And these conditions must be afforded the same respect, and the same high-level of care.

Most of us are lucky enough to never know how it feels to escape a climate of hate and fear. But we all need to be there, if we are wanted, for those who do.