The Boy Who Was Raised as a Dog (19 page)

So what could I tell the court about Leon, and what did I believe about his chances for rehabilitation? I would testify that the development of his brain had been skewed by what had happened to him as an infant. And I would confirm the diagnoses of attention deficit disorder and conduct disorder, which are mitigating factors, even if they do not absolve him of responsibility for his actions.

I would tell the court that his emotional, social and cognitive problems and neuropsychiatric diagnoses were related to his mother's unintentional neglect. His stress response systems had certainly received aberrant input: being left alone as an infant amped them up, and there was no one around at that critical time to teach him how to calm them down. And at the same time that these lower systems of the brain became overdeveloped, the higher, cortical regions surrounding them, the areas that modulate our responses to the world, our focus, and our self-control, were left underdeveloped.

I would also have to take into consideration the fact that Leon had been drinking when he committed his crime. Alcohol is disinhibiting; it reduces self-control and increases impulsiveness. Leon was already
prone to acting without thinking; alcohol only exacerbated this tendency, with deadly consequences for his victims. Would he have committed the crime had he not been drinking first? I suspect not. The alcohol released the already-overwhelmed and improperly developed brakes on his behavior, allowing his rage and lust to take over. Had he not been drunk, he might have stopped himself long before he killed or even assaulted the girls.

I ultimately testified about Leon's early childhood and its effects on his ability to maintain relationships, his impulse control and his attentiveness. I discussed how early neglect can predispose children to reduced empathy and violence. I included all the mitigating factors that I had found. It was all I could do: there was no case to be made that he was not legally responsible for his actions, and I could not deny that he was an ongoing danger to those around him.

During a break I happened to be near the defendant as he watched the victims' families cry and try to soothe each other. They were despondent, tears running down their cheeks, clinging to each other like survivors on a life raft. Leon said to me, “Why are they crying? I'm the one who's going to jail.” Again, his emptiness was chilling. He was emotionally blind.

Afterwards, when Leon had been removed as the jury retired to deliberate, Cherise's mother approached me. Her pain was visible in every step, in the slow movement of her hands, in her expression. “Doctor! Doctor!” she called to me, with great urgency, afraid I might leave before she could talk to me. I stopped, turned, and watched her slowly approach. Almost pleading, she asked, “Why did he do it? You talked to him. Why did he kill my baby? Please tell me. Why?”

I shook my head, acknowledging that, even with my expertise, I couldn't give her a satisfactory answer.

Crying and holding my arm, she asked again. “You know about these things. Why did he kill my baby?”

“Honestly, I just don't know for sure.” I said, feeling embarrassed at the inadequacy of my words. I sought out something to help this grieving
mother. “I think his heart is cold. Something in him is broken. He's not able to love like you can—like your daughter could. You hurt so much because you loved her so much. He doesn't feel things like you do—good things or bad.”

She was quiet for a moment. I could see her bring her daughter's image to mind with a fleeting smile, then more tears. She sighed and nodded. “Yes. He must be broken inside to kill such a beautiful child. She never hurt anyone.” I awkwardly hugged her for a moment and then she walked out toward the rest of her family. I thought of Maria and Alan and Frank. Our research is beginning to unlock the secrets of the brain and the causes of tragedies such as this one, but in that moment I was painfully aware of how much we still don't know.

chapter 6

The Boy Who Was Raised as a Dog

WHAT ALLOWS SOMEONE to make the right choice, even if he hasn't been given the optimal developmental opportunities he needs? What made Virginia continue to seek help for her baby, rather than simply abandoning her? What could we take from Mama P.'s book and prescribe for other children like Laura? Could the right treatment help prevent children like Leon from becoming a threat? Is there anything new I could say today to Cherise's mom—and to Frank, Alan and Maria—about why Leon had committed his terrible crimes?

Just as we only gradually came to understand how the sequential development of a child's brain is affected by trauma and neglect, it also only gradually dawned on us that this understanding could help us find possible treatments. These insights led us to develop what we came to call the neurosequential approach to therapeutic services for maltreated and traumatized children. One of the first children on whom we used this method had suffered neglect far, far worse than what had been done to Leon.

I met Justin in 1995 when he was six years old. He was in the Pediatric Intensive Care Unit (PICU). I had been invited by the PICU staff to come and, using
that-psychiatric-voodoo-that-you-do-so-well,
try to stop him from throwing feces and food at the staff. The PICU was almost
always full and was typically busy 24/7. Nurses, physicians, aides and families crowded the unit. The noise from medical machines, phones, and conversations kept the large room filled with a nonstop buzz. There were always lights on, people were always moving around and, although each individual moved with purpose and each conversation was focused, the overall effect was chaos.

I walked unnoticed through the din to the nurses' station and studied the board to find the boy I'd been asked to see. Then, I heard him. A loud, odd shriek made me turn immediately to find a bony little child in a loose diaper sitting in a cage. Justin's crib had iron bars and a plywood panel wired to the top of it. It looked like a dog cage, which I was about to discover was terribly ironic. The little boy rocked back and forth, whimpering a primitive self-soothing lullaby. He was filthy with his own feces, there was food all over his face and his diaper was heavy, soaked with urine. He was being treated for severe pneumonia, but he resisted all procedures and had to be held down to draw blood. He tore out his IVs, he yelled and screamed at staff and he threw his food. The closest this hospital had to a psychiatric unit was the PICU (where the ratio of staff to patients was very high), so Justin had been transferred. There, they had jury-rigged his crib/cage arrangement. And once placed in the cage, the boy began to throw feces and anything else he could get his hands on. That's when they called psychiatry.

Over the years I had learned that it is not a good idea to take a child by surprise. Unpredictability and the unknown make everyone feel anxious and therefore less able to process information accurately. Also, and importantly for clinical evaluation, the more anxious someone is the harder it is for him to accurately recall and describe his feelings, thoughts and history. But most critically, when a child is anxious it is much more difficult to form a positive relationship, the true vehicle for all therapeutic change.

I had learned the power of first impressions, as well. I could get a much better sense of a child's prognosis if he had a favorable or at least a neutral first impression of me. So rather than just start asking questions
of an unsuspecting and usually frightened and disoriented child, I'd found it was best to give him a chance to meet me first. We'd have a brief humorous or engaging conversation, I'd let him size me up a little, provide a clear, simple explanation of what I wanted to learn from him, and then leave him alone for a while to process that information. I'd assure him that he was in control. The child didn't have to say anything if he didn't want to: if any topic came up that he didn't wish to share with me, I'd tell him to just let me know and I would change the subject. Any time he decided to stop, the conversation was over. Over the years I've only had one adolescent girl say that she did not want to talk. But later that week, she told the staff that the only person she would speak with was the “psychiatry guy with the curly hair.”

When I saw Justin I knew this case was going to be different. I needed to know more about him before I could approach him. I took his chart, went back to the nurses' station and read his old records, occasionally glancing over to watch him rock with his knees up by his chin, his arms around his legs. He was humming or moaning to himself, and every few minutes he would let out a loud angry-sounding shriek. The PICU staff had become used to this; no one even glanced his way anymore.

As I read through his records it became clear that Justin's early life had not been normal. Justin's mother was a fifteen-year-old girl who left him with her own mother permanently when he was two months old. Justin's grandmother, by all accounts, was a kindhearted, nurturing woman who adored her grandchild. Unfortunately, she was also morbidly obese and had related health problems that made her very ill. When Justin was about eleven months old, she was hospitalized and died several weeks later.

During her illness her live-in boyfriend, Arthur,* babysat for Justin. Baby Justin's behavior became difficult, surely a result of losing both his mother and his grandmother in such a short time. Arthur, still grieving himself, didn't know what to do with a crying, tantruming young child, and being in his late sixties, he wasn't physically or mentally prepared for such a challenge. He called child protective services, seeking a permanent
placement for the boy who, after all, was not even a relative. CPS apparently felt the boy was safe and asked if Arthur would keep Justin while they found alternate placement. He agreed. Arthur was a passive man, in general, and patient. He assumed that CPS would get around to finding a new home for Justin. But CPS is a reactive, crisis-focused agency and, with no one putting pressure on it to do so, it didn't act.

Arthur was not malicious, but he was ignorant about the needs of children. He made a living as a dog breeder and, sadly, applied that knowledge to the care of the baby. He began keeping Justin in a dog cage. He made sure the baby was fed and changed, but he rarely spoke to him, played with him or did any of the other normal things parents do to nurture their children. Justin lived in that cage for five years, spending most of his days with only dogs as his companions.

If we could witness a child's moments of comfort, curiosity, exploration and reward—and his moments of terror, humiliation and deprivation—we would know so much more about him, who he is and who he is likely to become. The brain is an historical organ, a reflection of our personal histories. Our genetic gifts will only manifest themselves if we get the proper types of developmental experience, appropriately timed. Early in life these experiences are controlled primarily by the adults around us.

As I read through Justin's chart I began to imagine his life as it unfolded. At the age of two Justin had been given a diagnosis of “static encephalopathy,” meaning that he had severe brain damage of unknown origin that was unlikely to improve. He had been taken to the doctor because he was severely developmentally delayed: he was unable to walk or say even a few words by the time most children are actively exploring toddlers who have begun to speak in sentences. Tragically, when Arthur had brought Justin in for medical check-ups, no one inquired about his living situation. And no one took a good developmental history. The boy had been tested for various physical ailments, and his brain had been scanned, revealing atrophy (shrinkage) of the cerebral cortex and enlargement of the fluid-filled ventricles in the center of the brain. In fact,
his brain looked like that of someone with advanced Alzheimer's disease; his head circumference was so small that he was below the second percentile for children his age.

Back then, many doctors were still unaware of the damage that neglect alone can do to the brain. They assumed that something so clearly visible on scans had to be evidence of a genetic defect or intrauterine insult, such as exposure to toxins or disease; they couldn't imagine that early environment alone could have such profound physical effects. But studies done by our group and others later found that orphans who were left to languish in institutional settings without receiving enough affection and individual attention do indeed have visibly smaller head sizes and tinier brains. The brains show obvious abnormalities, virtually identical to those seen in Justin.

Unfortunately, as in Laura's case, Justin's problems were exacerbated by a fragmented medical system. Over the years, even though he'd been given tests as complicated as high-tech brain scans and chromosomal analysis to look for genetic problems, he rarely saw the same doctor twice. No one followed his case over time or learned about his living situation. By age five a repeat screening showed he had made minimal progress in fine and large motor, behavioral, cognitive or speech and language capabilities. He still couldn't walk or talk. To the doctors, who didn't know about the deprivation the child was experiencing, it appeared as if most of his brain-mediated capabilities just did not work properly. They assumed that Justin's “static encephalopathy” was due to some, as of yet unknown and untreatable, birth defect. The unspoken conclusion with children exhibiting this kind of severe brain damage is that they do not respond to therapeutic interventions. In essence, the doctors had told Arthur that the boy was permanently brain damaged and might never be able to care for himself, so he wasn't given any incentive to seek further help.

Whether because of this medical pessimism or because of his irregular care, Justin was never provided any speech therapy, physical therapy, or occupational therapy, and no in-home social services were
offered to his elderly caregiver. Left to his own devices Arthur made caregiving decisions that fit his understanding of child rearing. He'd never had children of his own and had been a loner for most of his life. He was very limited himself, probably with mild mental retardation. He raised Justin as he raised his other animals: giving him food, shelter, discipline and episodic direct compassion. Arthur wasn't intentionally cruel: he'd take both Justin and the dogs out of their cages daily for regular play and affection. But he didn't understand that Justin acted like an animal because he'd been treated as one, and so when the boy “didn't obey,” back into the cage he went. Most of the time, Justin was simply neglected.