The Boy Who Was Raised as a Dog (30 page)

“So who is reading minds now? You don't know how I feel.”

“Mmmm. I believe I said that I would
guess
that this feels pretty bad. Is my guess wrong?” She pulled her legs up underneath her and dipped her head to prevent me from seeing her tears. A tear dripped onto her black pants. I reached over and handed her a tissue. She took it from my hand.

“I hate this.” She said quietly. I let silence fill the room. I pulled my chair closer to hers and put a hand on her shoulder, leaving it there for a few moments. We sat.

“What part do you hate the most?”

“All of it. New school, new kids, new freak in town. I hate starting over all the time.”

“That must be hard.” I didn't want to invalidate her feelings by trying to put a positive spin on it. I knew that we would have time later to talk through some of the potential positive aspects of a new start. I just let her spill out her frustration and sadness. I listened.

The next week, she came in, announcing, “I can't wait to get out of this town.” She had already flipped to the “who cares?” mode. It is easier to leave people places if you “don't care” about them.

“So I guess all those tears last week were . . . ?” She looked at me, angry. I held her gaze and allowed her to read my face, my expression, which told her that I was sad and concerned about her, and her anger melted. We started the hard work of helping her with this transition.

During those last few weeks she struggled with how to present herself to her new school. Was she ready to “start over?” Did she need to always project anger, darkness? Did she always have to wear black? She was beginning to think that she might be able to be softer, more open and more inviting to new relationships. Our discussions about the animal world and how the brain works had seeped into her understanding of herself.

“I can't decide what to do. I don't know if I should try to start over and be myself, or to protect myself. I don't know what to do. I don't know how to be.”

“When the time comes, you will make the right choice.”

“What do you mean?”

“If
you
make the choice it will be right. Just don't let anyone else choose for you; don't let your mom, or your friends, or me, or . . .” I paused and caught her eye, “the ghost of Duane make the choice for you.”

“How does Duane have anything to do with this?”

“I think that the darkness is not your own. I think those things that worked when you were being abused—the disengaging, the fantasizing, the darkness you projected to the world—were forced on you by Duane.”

“No. I made that world.”

“Remember when you told me that when you first retreated to that world you wanted to be a songbird? A bluebird or a robin. And it didn't work?”

“Yeah.”

“Those beautiful, colorful songbirds were your first choice, Amber. Maybe they didn't work then because they were too vulnerable; and you needed something more powerful, dark, menacing to protect you.”

“Yeah.”

“Maybe you don't need that now, Amber. Maybe it would be ok to let the birds sing.”

“I don't know.”

“Me neither. But when the time is right, you will know. And when the time is right you will make good choices.”

Before the move, I tried to encourage her and her mother to see a new therapist in Austin. I gave Jill a list of names and reassured her that I often worked with colleagues from a distance. I told her that I would remain available by phone or for occasional consultation visits to track Amber's progress. But ideally, I hoped that she would find a primary therapist in Austin where she could continue the work we had started. Amber didn't like that idea.

“I don't need to see a shrink. I'm not crazy.”

“Have I been treating you like you are crazy?”

“No.” She was quiet. She knew her argument was ridiculous.

“Listen, it's up to you. My opinion is that it would help you if you take the time to find the right person. Meet with these folks and you can see who you might feel comfortable talking with.”

“OK.” She looked at me knowing that I knew she wouldn't really try.

“Well. Just make sure that whatever choice you make, it's truly yours.” And I reached my hand out to seal the deal. She shook my hand.

“Sure thing, Doc.”

 

WE DID HEAR from Amber's mother a few times in the first six months after they moved. She had taken her daughter to the first therapist on the list of referrals we'd provided, but Amber didn't like the woman. They hadn't gotten around to trying again. All too often when things seem OK, parents aren't motivated to follow through with the expense and inconvenience of therapy. Since Amber was “doing great” her mom didn't push it when Amber resisted finding a new therapist.

More than a year after Amber moved to Austin, I signed onto my email and saw a note from BlueRaven232. At first, I thought it was spam and almost deleted it. Then I saw the subject: “New Tattoo.” I read it:

 

I wrote back.

 

Later that day, she wrote back:

 

I smiled as I typed back:

 

Every now and again, I get email from Blue Raven. She is now a young adult. She went to college and graduated in four years. Like all of us, she has had her ups and downs. But from what I can tell she is a healthy, productive and caring young woman. She works with young children now and can't decide whether to go back to school to become a social worker, police officer or a teacher. I suspect, however, that she will make the right choice for her. And I know that because of what she's been through and what she learned about how trauma can shape a child's view of the world, in whatever capacity she works with children they will be very lucky to know her.

chapter 9

“Mom Is Lying. Mom Is Hurting Me. Please Call the Police.”

ONE OF THE hazards of running a clinic for maltreated and traumatized children is success: if you develop a reputation for being able to help these young people, you will inevitably be unable to keep up with the demand. It can be hard to increase staff and services and still maintain the high-quality, individualized, and time-intensive care the children need. This was why our working group ultimately decided to maximize our ability to get the best care to the most children by focusing on research and training. Our educational efforts target all of the adults who live and work with maltreated children—from psychiatrists to policy makers to police officers and parents. We continue to do clinical work with multiple service partners across the country, but back in 1998 most of this work was based at our large clinic in Houston. James, a six-year-old boy became one of our patients. Our work in his case was not therapy; I had been asked to provide expert input on his complex situation. James taught me a great deal about courage and determination, and reminded me how important it is to listen, paying close attention to the children themselves.

James was referred to us by a judge who had received so many different opinions about the boy's situation that he hoped we could clarify what was going on. A children's legal advocacy organization was worried that he was being abused by his adoptive parents. Numerous therapists and Child Protective Services, however, believed that he was such a troublemaker that his adoptive family had needed a break from him. Teachers reported unexplained bruises and scratches. The boy had been adopted before his first birthday by a couple who had also taken in three other children and had one biological child. James was the second oldest. When we met him, his oldest sibling was eight and the youngest, a girl, was an infant.

According to his mother, Merle,* James was incorrigible and uncontrollable. He frequently ran away from home, he tried to jump out of moving cars, he attempted suicide and wet his bed. By age six he had been hospitalized numerous times, once after jumping from a second story balcony. He lied constantly, especially about his parents, and seemed to enjoy defying them. He was being prescribed antidepressants and other medications for impulsivity and attention problems. He'd seen numerous therapists, psychiatrists, counselors and social workers. His mother said he was so unmanageable that she called Child Protective Services on herself, pretending to be a neighbor concerned that his mother could not handle him and that he was a danger to himself and his siblings. The last straw was an overdose of medication he'd taken that had landed him in an intensive care unit. He was so close to death that he had to be flown to the hospital in a helicopter for rapid treatment. Now he'd been taken to a residential treatment center to give his mother a “respite.” The judge had been asked to determine what should happen next.

CPS caseworkers and several therapists believed he had Reactive Attachment Disorder (RAD), a diagnosis frequently given to children who have suffered severe early neglect and/or trauma. Leon, who ultimately killed two girls, may have had this disorder: it is marked by a lack of empathy and an inability to connect with others, often accompanied by manipulative
and antisocial behavior. RAD can occur when infants don't receive enough rocking, cuddling and other nurturing physical and emotional attention. The regions of their brains that help them form relationships and decode social cues do not develop properly, and they grow up with faulty relational neurobiology, including an inability to derive pleasure from healthy human interactions.

RAD symptoms can include the “failure to thrive” and stunted growth we saw in Laura's case. The disorder is often seen in people like Laura's mother Virginia, who was moved to a new foster home every six months and not allowed to develop a lasting early attachment with one or two primary caregivers. Children raised in institutions like orphanages are also at risk, as are children like Justin and Connor. In addition to being unresponsive to people they know, many children with RAD are inappropriately affectionate with strangers: they seem to see people as interchangeable because they were not given the chance to make a primary, lasting connection with a parent or parent-substitute from birth. These indiscriminately affectionate behaviors are not really an attempt to connect with others, however, but rather they are more accurately understood as “submission” behaviors, which send signals to the dominant and powerful adults that you will be obedient, submissive and no threat. RAD children have learned that affectionate behaviors can neutralize potentially threatening adults, but they don't seem to engage in them as a way to form lasting, emotional ties.

Fortunately, RAD is rare. Unfortunately, many parents and mental health workers have latched onto it as an explanation for a wide range of misbehavior, especially in adopted and foster children. Treatments like “holding,” which were so harmful to the Gilmer, Texas, children, are pitched as “cures” for RAD, as are other coercive and potentially abusive treatments that involve emotional attacks and heavy-handed discipline. James's therapist, for example, had recommended that his mother lock him in a closet when his behavior got too wild.

The therapist and the mother's description of James's behavior did seem to fit the diagnosis. But there was something decidedly odd about
James's records. When he was in the hospital or in a residential treatment center, he was well behaved. He didn't try to run away, didn't threaten suicide. His behavior in school was unremarkable aside from some minor aggression toward other boys, nothing like the out-of-control demon his mother consistently complained about. And there was something else, too: his adoptive parents' behavior was unusual. They would show up for his appointments with us (he was living in a treatment center at the time) when they had explicitly been told not to do so; one time his father came with a gift for him and waited around for hours. When one of our staff interviewed James's mother, she seemed entirely focused on herself and her own problems, repeatedly expressing her distress about being separated from him, but not any concern about what he might be going through.

When I met James, I instantly liked him. He was a bit small for his age, with curly blond hair. He was engaging, behaved appropriately and reciprocated eye contact and smiles. In fact, he laughed and joked with me and seemed to like my company. Stephanie, his primary clinician on our interdisciplinary team, felt the same way about him. After four sessions we had planned to stop seeing him because we felt we had enough information for our evaluation.

At our clinic we coordinate and discuss a patient's care in staff meetings, where everyone involved in a particular child's case comes together to “staff” the child. We thoroughly discuss each person's interactions with the patient and their impressions of him or her. In the staffing for James, Stephanie became emotional; she'd liked the boy and was sad that she wouldn't be working with him any more. When I saw her near tears, my perspective on the case shifted.

If a child has RAD, the lack of connection and attachment goes both ways. There is a reciprocal neurobiology to human relationships—our “mirror neurons” create this. As a result, these children are difficult to work with because their lack of interest in other people and their inability to empathize makes them hard to like. Interacting with them feels
empty, not engaging. Stephanie shouldn't have been so upset at disconnecting from a child with RAD; there should have been no loss of relational contact to miss. Therapists are as human as anyone else, and the lack of rewarding interactions with RAD children tends to make working with them feel like a burden, not a joy. The anger and despair that their coldness and unpleasant behavior can provoke may be the reason why so many parents are attracted to therapies for it that are harsh and punitive and why therapists so often converge on these harmful techniques. Most therapists feel relieved if the therapy ends. But James had endeared himself to Stephanie and me and, as we discussed him, I realized that he could not have genuine RAD.