The Boy Who Was Raised as a Dog (3 page)

Fortunately, I had another supervisor as well: a wise and wonderful man, a true giant in the field of psychiatry, Dr. Jarl Dyrud. Like me, he was from North Dakota, and we hit it off immediately. Like Dr. Stine, Dr. Dyrud was trained in the analytic method. Yet he also had years of real life experience trying to understand and help people. He had let that experience, not just Freud's theories, mold his perspective.

He listened carefully as I described Tina. When I finished, he smiled at me and said, “Did you enjoy coloring with her?”

I thought for a minute and said, “Yeah. I did.”

Dr. Dyrud said, “Very nice start. So tell me more.” I started to list Tina's symptoms, the complaints the adults had about her behaviors.

“No, no. Tell me about her. Not about her symptoms.”

“What do you mean?”

“Where does she live? What is her apartment like, when does she go to sleep, what does she do during the day? Tell me about her.”

I admitted that I didn't know any of that information. “Spend some time getting to know her—not her symptoms. Find out about her life,” he advised.

For the next few sessions, Tina and I spent time coloring or playing simple games and talking about what she liked to do. When I ask children like Tina what they want to be when they grow up, they often respond with “If I grow up,” because they've seen so much real-life death and violence at home and in their neighborhoods that reaching adulthood seems uncertain. In our conversations sometimes Tina would tell me that she wanted to be a teacher, and other times she said she wanted to be a hairdresser, all with the perfectly ordinary, rapidly changing desires of a girl of
her age. But as we discussed specifics of these various goals, it took some time before I was able to help her recognize that the future can be something you plan for, something you can predict and even change, rather than a series of unforeseen events that just happen to you.

I also talked to her mother about her behavior in school and at home and found out more about her life. There was, of course, the daily routine of school. After school, unfortunately, there were often several hours between the time Tina and her younger brother came home and the time Sara got off from work. Sara had her children call her to check in, and there were neighbors nearby they could contact in an emergency, but she didn't want to risk more caregiver abuse. So the children stayed home alone, usually watching TV. And sometimes, Sara admitted, because of what they'd both been through, there was sexualized play.

Sara was far from a neglectful mother, but working to feed three young children often left her exhausted, overwhelmed and demoralized. Any parent would have been hard-pressed to cope with the emotional needs of these traumatized children. The family had little time to play or just be together. As in many financially strapped homes, there was always some pressing need, an economic or medical or emotional emergency that required immediate attention to avoid complete disaster, such as homelessness or job loss or overwhelming debt.

 

A S MY WORK with Tina continued Sara always smiled when she first saw me. The hour that Tina had therapy was one time in her week when she didn't have to do anything more than be with her other children. Tina would run down to my office while I took a moment to goof with her little brother (he was in therapy as well, but with someone else at a different time) and smile at the baby. When I was sure they were settled in with something to occupy them in the waiting area, I'd rejoin Tina, who would be sitting at her little chair waiting for me.

“What should we do today?” she would ask, looking at the games, coloring books and toys she had pulled from my shelves and put on the table. I would pretend to think hard while she'd look at me with anticipation.
My eyes would fix on a game on the table and say, “Mmm. How about let's play Operation?” She would laugh, “Yes!” She guided our play. I slowly introduced new concepts, like waiting and thinking, before deciding what to do next. Occasionally she would spontaneously share some fact or some hope or some fear with me. I would ask questions to get some clarity. Then she would redirect the interaction back to play. And week by week, bit by bit, I got to know Tina.

Later that fall, however, Tina was late to therapy for several weeks in a row. Because appointments were only an hour, this sometimes meant we would only have twenty minutes for our sessions. I made the mistake of mentioning this to Dr. Stine during an update on the case. He raised his eyebrows and stared at me. He seemed disappointed.

“What do you think is going on here?”

“I'm not sure. I think the mom seems pretty overwhelmed.”

“You must interpret the resistance.”

“Ah. OK.” What the hell is he talking about? Is he suggesting that Tina doesn't want to come to therapy and is somehow forcing her mother to be late? “You mean Tina's resistance or the mom's?” I asked.

“The mother left these children in harm's way. She may be resentful that this child is getting your attention. She may want her to remain damaged,” he said.

“Oh,” I responded, not sure what to think. I knew that analysts often interpreted lateness to therapy as a sign of “resistance” to change, but that was beginning to seem absurd, especially in this case. The idea left no room for genuine happenstance and seemed to go out of its way to blame people like Tina's mom, who, as far as I could tell, did everything possible to get help for Tina. It was clearly difficult for her to get to the clinic. To get to the medical center, she had to take three different buses, which often ran late during the brutal Chicago winter; she had no childcare so she had to bring all her children; sometimes she had to borrow money for the bus fare. It seemed to me she was doing the best she could in an extremely difficult situation.

Shortly thereafter, as I left the building one frozen night, I saw Tina and her family waiting for the bus home. They were standing in the dark
and snow was slowly falling through the dim light of a nearby streetlight. Sara was holding the baby and Tina was sitting on the bench next to her brother under the heat lamp of the bus stop. The two siblings sat close to each other, holding hands and slowly rocking their legs back and forth. Their feet didn't reach the ground and they kept time with each other, in sync. It was 6:45. Icy cold. They would not be home for another hour at least. I pulled my car over, out of sight, and watched them, hoping the bus would come quickly.

I felt guilty watching them from my warm car. I thought I should give them a ride. But the field of psychiatry is very attentive to boundaries. There are supposed to be unbreachable walls between patient and doctor, strict borderlines that clearly define the relationship in lives that often otherwise lack such structure. The rule usually made sense to me, but like many therapeutic notions that had been developed in work with neurotic middle-class adults, it didn't seem to fit here.

Finally, the bus came. I felt relieved.

The next week, I waited a long time after our session before going to my car. I tried to tell myself that I was doing paperwork, but really I didn't want to see the family standing in the cold again. I couldn't stop wondering about what could be wrong with the simple humane act of giving someone a ride home when it was cold out. Could it really interfere with the therapeutic process? I went back and forth, but my heart kept coming down on the side of kindness. A sincere, kind act, it seemed to me, could have more therapeutic impact than any artificial, emotionally regulated stance that so often characterizes “therapy.”

It was full winter in Chicago now and bitterly, bitterly cold. I ultimately told myself that if I saw the family again, I'd give them a ride. It was the right thing to do. And one night in December as I left work and drove by the bus stop, there they were. I offered them a ride. Sara declined at first, saying she had to stop at the grocery store on her way. In for a penny in for a pound, I thought. I offered to drive them to the store. After some more hesitation, she agreed and they all piled into my Toyota Corolla.

Miles away from the medical center, Sara pointed to a corner store and I stopped there. Holding her sleeping baby, she looked at me, unsure whether to take all the children into the store with her.

“Here. I'll hold the baby. We'll wait here,” I said decisively.

She was in the store for about ten minutes. We listened to the radio. Tina sang along with the music. I was just praying the baby wouldn't wake up. I slowly rocked her, mimicking the rhythm that Tina's mother had used. Sara came out of the store with two heavy bags.

“Take these back there and don't touch anything,” she said to Tina, putting the bags on the back seat.

When we arrived at her building, I watched as Sara struggled to get out of the car and walk through the unshoveled snow on the sidewalk, juggling the baby, her purse and a bag of groceries. Tina tried to carry the other bag of groceries, but it was too heavy for her and she slipped in the snow. I opened my door and got out, taking one bag from Tina and the other one from Sara.

“No. We can manage,” she protested.

“I know you can. But tonight I can help.” She looked at me, not sure how to deal with this. I sensed her trying to understand if this was kindness or something sinister. She seemed embarrassed. I felt embarrassed. But it still seemed right to help.

We all walked up three flights of stairs to their apartment. Tina's mother got out her keys and opened three locks all without disturbing her sleeping baby. How difficult this mother's life was, I thought, all alone caring for three children, no money, only episodic and often tedious work, no extended family nearby. I stood at the threshold of the door with the bags in my arms, not wanting to intrude.

“You can just put those on the table,” Sara said as she walked to the back of the one-room apartment to put the baby down on a mattress against the wall. In two steps I was at the kitchen table. I put the bags down and glanced around the room. There was one couch facing a color television and a small coffee table with a few cups and dirty dishes on it. On a small table with three unmatched chairs near the kitchenette, there was a
loaf of Wonderbread and a jar of peanut butter. One double mattress sat on the floor, with blankets and pillows neatly folded at one end. Clothes and newspapers were scattered around. A picture of Martin Luther King Jr. hung on the wall, and next to it on either side were brightly colored school portraits of Tina and her brother. On another wall hung a picture of Sara and the baby, slightly crooked. The apartment was warm.

Sara stood and awkwardly said, “Thanks again for the ride.” and I assured her it had been no trouble. The moment was very uncomfortable.

As I walked out the door and said, “See you all next week,” Tina waved. She and her toddler brother were putting the groceries away. They were better behaved than many children I'd seen in much better circumstances; it seemed to me that they had to be.

The drive home took me through some of the poorest neighborhoods in Chicago. I felt guilty. Guilty about the luck, the opportunities, the resources and the gifts I had been given, guilty about all of the times I had complained about working too much, or not getting credit for something I had done. I also felt I knew much more about Tina. She had grown up in a world so very different from mine. And somehow that had to be related to the problems that brought her to see me. I didn't know exactly what it was, but I knew there was something important about how the world she grew up and lived in had shaped her emotional, behavioral, social and physical health.

 

AFTERWARDS, OF COURSE, I was afraid to tell anyone what I'd done, that I'd driven a patient and her family home. Worse yet, that I had stopped at the store on the way and helped bring in some groceries. But part of me didn't care. I knew I'd done the right thing. You just don't let a young mother with two young children and a baby stand in the cold like that.

I waited two weeks and then, when I next met with Dr. Dyrud, I told him. “I saw them waiting for a bus and it was cold. So I gave them a ride home,” I said nervously, scanning his face for his reaction, just like Tina had done with me. He laughed as I slowly told him about the extent of my transgression.

When I'd finished, he clapped his hands together, saying, “Great! We should do a home visit with all of our patients.” He smiled and sat back. “Tell me all about it.”

I was shocked. In an instant Dr. Dyrud's smile and the delight on his face released me from two weeks of nagging guilt. When he asked what I'd learned I told him that one moment in that tiny apartment had told me more about the challenges facing Tina and her family than I could ever have learned from any on-site session or interview.

Later in that first year of my child psychiatry fellowship Sara and her family moved to an apartment closer to the medical center, one twenty-minute bus ride away. The lateness ceased. No more “resistance.” We continued to meet once a week.

 

DR. DYRUD'S WISDOM and mentorship continued to be liberating for me. Like other teachers, clinicians and researchers who had inspired me, he encouraged exploration, curiosity and reflection, but, most importantly, gave me the courage to challenge existing beliefs. Taking bits and pieces from each of my mentors, I began to develop a therapeutic approach that sought to explain emotional and behavioral problems as symptoms of dysfunction within the brain.

In 1987 child psychiatry had not yet embraced the neurosciences. In fact, the vast expansion of research on the brain and brain development that began in the 1980s and exploded in the 1990s (“the decade of the brain”) had yet to occur, let alone influence clinical practice. Instead, there was active opposition by many psychologists and psychiatrists to taking a biological perspective on human behavior. Such an approach was considered mechanistic and dehumanizing, as though reducing behavior to biological correlates automatically meant that everything was caused by genes, leaving no room for free will and creativity, and no way to consider environmental factors like poverty. Evolutionary ideas were seen as even worse, as backwards racist and sexist theories that rationalized the status quo and reduced human action to animal drives.