The Boy Who Was Raised as a Dog (5 page)

 

OVER THE THREE YEARS I worked with Tina I was delighted and relieved by her apparent progress. There were no more reports of “inappropriate” behavior at school. She was doing her homework, going to class and no longer fighting with other children. Her speech had improved; most of her problems had been related to the fact that she was so soft spoken that teachers and even her mother often couldn't hear her well enough to understand her, let alone correct her pronunciation. As she learned to speak up and was spoken to more often, thereby receiving the repeated corrective feedback she needed, she caught up.

She had also rapidly become more attentive and less impulsive, so rapidly in fact that I didn't even discuss medication with my supervisors after that initial conversation with Dr. Stine.

Tina guided our play during our sessions, but I used every opportunity to teach her lessons that would help her feel more confident out in the world and help her behave more appropriately and rationally. We initially
learn impulse control and decision making from those around us, sometimes from explicit lessons, sometimes by example. Tina, however, lived in an environment where neither explicit or implicit lessons were taught. Everyone around her just reacted to what happened to them, and so that's what she did, too. Our meetings offered her the undivided attention she craved and our games taught her some of the lessons she had missed. For example, when I first began my work with Tina she hadn't understood the concept of taking turns. She couldn't wait to start things, she acted and reacted without thinking. In the simple games that we played I modeled more appropriate behavior and repeatedly taught her to pause before doing the first thing that popped into her head. Based on her excellent progress in school, I truly believed I'd helped her.

 

UNFORTUNATELY, HOWEVER, two weeks before I left the clinic to start a new job, now-ten-year-old Tina was caught performing fellatio on an older boy at school. What I'd taught her, it seemed, was not to change her behavior, but to better hide her sexualized activity and other problems from adults and to control her impulses in order to avoid getting in trouble. On the surface she could make others think she was behaving appropriately, but inside, she had not overcome her trauma.

 

I WAS DISAPPOINTED and confused upon hearing this news. I had tried so hard, and she had really seemed to be getting better. It was difficult to accept that what seemed to be a positive therapeutic effort had been so hollow. What had happened? Or more importantly, what didn't happen in our work to help change her?

I kept thinking about the effects Tina's early childhood trauma and her unstable home life could have had on her brain. And soon I realized that I needed to expand my view of clinical mental health work. The answers to my failed, inefficient treatment for Tina—and to the big questions in child psychiatry—were in how the brain works, how the brain develops, how the brain makes sense of and organizes the world. Not in the brain as it has been caricatured as a rigid, genetically, preset system that sometimes requires
medication to adjust “imbalances,” but in the brain in all its complexity. Not in the brain as a seething complex of unconscious “resistance” and “defiance,” but in the brain as it evolved to respond to a complex social world. A brain, in short, that had genetic predispositions that were shaped by evolution to be exquisitely sensitive to the people who surrounded it.

Tina did learn to better regulate her stress system; her improved impulse control seemed to be good evidence of this. But Tina's most troubling problems had to do with her distorted and unhealthy sexual behaviors. I realized that some of her symptoms could be fixed by changing her overreactive stress response, yet that would not erase her memory. I began to think that memory was what I needed to understand before I could do better.

So, what is memory, really? Most of us think about it in relation to names, faces, phone numbers, but it is much more than that. It is a basic property of biological systems. Memory is the capacity to carry forward in time some element of an experience. Even muscles have memory, as you can see by the changes in them that result from exercise. Most importantly, however, memory is what the brain does, how it composes us and allows our past to help determine our future. In no small part memory makes us who we are and in Tina's case, her memories of sexual abuse were a large part of what stood in her way.

Tina's precocious and oversexualized interactions with males clearly stemmed from her abuse. I began considering memory and how the brain creates “associations” when two patterns of neural activity occur simultaneously and repetitively. For example, if the neural activity caused by the visual image of a fire truck and that caused by the sound of a siren co-occur repetitively, these once separate neural chains (visual and sound related-neural networks) will create new synaptic connections and become a single, interconnected network. Once this new set of connections between visual and auditory networks is created, merely stimulating one part of the network (for example, hearing the siren) can actually activate the visual part of the chain and the person will almost automatically visualize a fire truck.

This powerful property of association is a universal feature of the brain. It is through association that we weave all of our incoming sensory signals together—sound, sight, touch, scent—to create the whole person, place, thing and action. Association allows and underlies both language and memory.

Our conscious memory is full of gaps, of course, which is actually a good thing. Our brains filter out the ordinary and expected, which is utterly necessary to allow us to function. When you drive, for example, you rely automatically on your previous experiences with cars and roads; if you had to focus on every aspect of what your senses are taking in, you'd be overwhelmed and would probably crash. As you learn anything, in fact, your brain is constantly checking current experience against stored templates—essentially memory—of previous, similar situations and sensations, asking “Is this new?” and “Is this something I need to attend to?”

So as you move down the road, your brain's motor vestibular system is telling you that you are in a certain position. But your brain is probably not making new memories about that. Your brain has stored in it previous sitting experiences in cars, and the pattern of neural activity associated with that doesn't need to change. There's nothing new. You've been there, done that, it's familiar. This is also why you can drive over large stretches of familiar highways without remembering almost anything at all that you did during the drive.

This is important because all of that previously stored experience has laid down the neural networks, the memory “template,” that you now use to make sense out of any new incoming information. These templates are formed throughout the brain at many different levels, and because information comes in first to the lower, more primitive areas, many are not even accessible to conscious awareness. For example, young Tina almost certainly wasn't aware of the template that guided her interactions with men, and shaped her behavior with me when we first met. Further, all of us have probably had the experience of physically jumping up before we even figured out what it was that startled us in the first place. This happens because our brain's stress-response systems
carry information about potential threats and are primed to respond to them as quickly as possible, which often means before the cortex can consider what action to take. If, like Tina, we have had highly stressful experiences, reminders of those situations can be similarly powerful and provoke reactions that are similarly driven by unconscious processes.

What this also means is that early experiences will necessarily have a far greater impact than later ones. The brain tries to make sense of the world by looking for patterns. When it links coherent, consistently connected patterns together again, it tags them as “normal” or “expected” and stops paying conscious attention. So, for example, the very first time you were placed in a sitting position as an infant, you did pay attention to the novel sensations emanating from your buttocks. Your brain learned to sense the pressure associated with sitting normally, you began to sense how to balance your weight to sit upright via your motor vestibular system and, eventually, you learned to sit. Now, when you sit, unless it's uncomfortable or the seat is unusually textured or shaped or you have some kind of balance disorder, you pay little attention to staying upright or the pressure the seat puts on your rear. When you are driving, it's something you rarely attend to at all.

What you do scan the road for is novelty, things that are out of place, such as a truck barreling down the wrong side of the freeway. This is why we offload perceptions of things we consider normal: so that we can rapidly react to things that are aberrant and require immediate attention. Neural systems have evolved to be especially sensitive to novelty, since new experiences usually signal either danger or opportunity.

One of the most important characteristics of both memory, neural tissue and of development, then, is that they all change with patterned, repetitive activity. So, the systems in your brain that get repeatedly activated will change and the systems in your brain that don't get activated won't change. This “use-dependent” development is one of the most important properties of neural tissue. It seems like a simple concept, but it has enormous and wide-ranging implications.

And understanding this concept, I came to believe, was key to understanding children like Tina. She had developed a very unfortunate set of associations because she was sexually abused so early in life. Her first experiences with men and her teenage male abuser were what shaped her conception of what men are and how to act toward them; early experiences with those around us mold all of our worldviews. Because of the enormous amount of information the brain is confronted with daily, we must use these patterns to predict what the world is like. If early experiences are aberrant, these predictions may guide our behavior in dysfunctional ways. In Tina's world males larger than she was were frightening, demanding creatures who forced her or her mother into sex. The scent, sight and sounds associated with them came together to compose a set of “memory templates” that she used to make sense of the world.

And so, when she came into my office that first time and was alone in the company of an adult male, it was perfectly natural for her to assume that sex was what I wanted as well. When she went to school and exposed herself or tried to engage in sex play with other children, she was modeling what she knew about how to behave. She didn't consciously think about it. It was just a set of behaviors that were part of her toxic associations, her twisted template for sexuality.

Unfortunately, with only an hour a week of therapy, it was almost impossible to undo that set of associations. I could model the behavior of a different kind of adult male, I could show her that there were situations where sexual activity was inappropriate and help her learn to resist impulses, but I couldn't, in such a small amount of time, replace the template that had been forged in the fresh tissue of her young brain, that had been burned in with patterned, repetitive early experience. I would need to integrate a lot more about how the human brain works, how the brain changes and the systems that interact in this learning into my treatments before I could even begin to do better for patients like Tina, patients whose lives and memories had been marred in multiple ways by early trauma.

chapter 2

For Your Own Good

“I NEED YOUR HELP.” The caller, Stan Walker,* was an attorney for the Public Guardian's office in Cook County, Illinois. I had completed my training in child psychiatry and was now an assistant professor at the University of Chicago, still working at the clinic and running my lab. It was 1990.

“I just inherited a case scheduled to go to trial next week,” he told me, explaining that it was a homicide. A three-year-old girl named Sandy had witnessed the murder of her own mother. Now, almost a year later, the prosecution wanted her to testify about it. “I'm concerned that this might be pretty overwhelming for her,” Stan went on, asking if I might be able to help prepare her for court.

“Pretty overwhelming?” I thought sarcastically to myself, “You think so?”

Stan was a Guardian-ad-litem, an attorney appointed by the court to represent children in the legal system. In Cook County (where Chicago is located), the Public Guardian's Office has a full-time staff to represent children in the child protective services (CPS) system. In almost all other communities this role is played by an appointed attorney who may or may not have experience and training in child law. Cook County had created the full-time positions in the noble hope that if the attorneys worked their cases full time, they could develop experience with children, learn about maltreatment and thus better serve those they represent. (Unfortunately,
like all other components of the child protective system, the volume of cases was overwhelming and the office was underfunded.)

“Who is her therapist?” I asked, thinking that, someone familiar to the child would be much better suited to help her prepare.

“She doesn't have one,” he said. This was disturbing news.

“No therapist? Where is she living?” I asked.

“We don't really know. She is in foster care but the prosecutor and the Department of Child and Family Services are keeping her location undisclosed because there have been threats against her life. She knew the suspect and identified him for the police. He is in a gang and there is a contract out on her.” This was sounding worse and worse.

“She gave a credible ID at age three?” I asked. I knew that eyewitness testimony is easily challenged in court because of the properties of narrative memory we noted earlier, especially its gaps and the way it tends to “fill in” the “expected.” And from a four-year-old about an event that occurred when she was three? If the prosecutors didn't have some help, a good defense attorney would easily make Sandy's testimony appear completely unreliable.