At one point he mentioned my notebooks. ‘We read them,’ he said. We waited for some comment on all that work. ‘They were very interesting,’ he remarked.
The interview lasted only forty minutes. We were still trying to find the magic questions when it ended. But there was no more time. We had had it.
We walked slowly down the steps of the homelike building that had turned out to be a model of Kafka’s Castle. We had come prepared for bad news; we had expected to leave shaken and upset and drive back immediately. Instead we could only laugh helplessly, and went and spent a lovely afternoon in a museum. [12] It was only gradually that we began to feel angry and resentful, to react as intelligent adults, not as obedient children in the hands of those wiser than we. Our powers of indignation reawakened — indignation at this pleasant, passive, blandly inconsiderate institution, at their incredibly casual scheduling, which multiplied difficulties and intensified anxiety, at the attractive, softly smiling social worker whom the passage of time had made forget the number of my children, at the cloudy, gently evasive old man who would tell us nothing unless we surprised him into it. We fed information into that computer for ten days. And when finally we were allowed to press the button, the light didn’t even go on.
Yet we were not where we had been. Elly needed psychotherapy. We must try to get it for her. There was no children’s specialist near us, but there was a state child-guidance clinic in the next town. Should I contact them? The Institute definitely thought I should.
I did, prudently waiting a month (though every month counted) to allow the Institute to respond to my request to forward their report on Elly. I arrived for the intake interview; the clinic had received nothing. Two months later I made a progress report for Dr Blank, who had not seen Elly for a year. Of course, I remarked, this was only a supplement to the Institute’s report, which was by now in his hands. But it wasn’t, and for a very good reason. It wasn’t written yet. It was not put on paper until six months after Elly’s last interview, and then only after I appealed in desperation to the Institute’s director.
And yet when I compare our experience with others I see that again we were lucky. They treated us well, according to their lights. I was accused neither of rejecting my child nor of a symbiotic relationship. The director of a clinic for autistic children, part of a huge medical centre, has written that one of his greatest problems in treatment is the resistance parents make to the idea that they cause the disease. We might have gone there.
We got off easy. The professionals had neither praised nor blamed us and they had done their best to say nothing discouraging about Elly. They had said nothing terrible to us at all. Yet we emerged damaged, hurt, and frightened. We had gone in with expectations that, to those with no experience of the field, will not seem unreasonable. We expected to talk with wise and sympathetic people — wise because of a wide experience with sick children, sympathetic because it was their vocation to help those in trouble. We too had experience with a sick child, intense and prolonged if not wide, and we had been trying with every resource we possessed to help those in trouble — our baby, our normal children, ourselves. We were amateurs. They were professionals. But we had, we thought, a common task. Unconsciously we expected to be welcomed, not as patients, but as collaborators in the work of restoring this small, flawed spirit. We were doing something terribly hard, and we had been doing it quite alone. We had learned all we could from the biography of Annie Sullivan. We wanted information and techniques. We wanted sympathy — not the soppy kind; we were grown-up adults — but some evidence of fellow feeling, which ordinary doctors give readily enough. And — was it so unreasonable? — we wanted a little reassurance, a little recognition, a little praise. It never occurred to us that these expectations were naive, that the gulf between parent and ministering institution must deliberately be kept unbridgeable by any of the ordinary techniques of interpersonal relations. It should have been easy, after all, to say it: ‘Look, you’re a professional. I need references, I need to find out about play therapy, I need to know all I can about children like Elly, because whoever else may or may not work with her, her main psychotherapist is me.’
But of course it was not easy but impossible. Their system made it so. Autistic was not a word they used. They were wise to avoid it, it fitted them so closely. We knew that imperviousness, that terrible silence, those eyes that turn away. And this was the most frightening discovery of all: that we could make better progress against the walls around Elly than we could in reaching these people.
Comfortable, well-educated members of the upper middle class ordinarily escape the experience of depersonalization, of utter helplessness in institutional hands, of reduction to the status of children to whom situations are mediated, not explained. Like so much that hurts, the experience is deeply educational. We know now in our skins that the most threatening of all attacks is the attack on the sense of personal worth, that the harshest of all deprivations is the deprivation of respect. We know now, I think, how the slum mother feels as the welfare worker comes round the corner. It takes, one would think, so little knowledge of psychology to put oneself in someone else’s place.
The failure of the Institute was not a failure of knowledge. Ultimately they produced, though not for our eyes, a reasonably detailed report, far fuller than the three oracular utterances they had trusted us to hear. Their failure was one of imagination. For all their silent attention they were not able to imagine the thoughts and feelings of my husband and me.
I think I can guess how we appeared to them — highly intellectual, cool, controlled, well-informed, prime examples of Kanner’s parents. We were controlled; we had no alternative. Refrigerator professionals create refrigerator parents, if the parents are strong enough to keep command of themselves at all. I had gone in in a highly emotional state, ready to tremble, to weep, to dissolve in gratitude. Received not even with reproaches but with no reaction at all, I of course dried up my emotions at once and met professionalism with professionalism. The type of personality Kanner observed, with its control, its reserve, its capacity for detachment, may seem invulnerable. A wise healer of souls will realize that it is for that very reason particularly vulnerable. In the light of my new experience I remembered the tale of the father who admitted he would not recognize his own children on the street, and I wondered if this classic reaction had not in fact been the irony of an unhappy man whose response was simply to shrug his shoulders and fall in with the hypothesis of the doctor who could misunderstand him so utterly as to dare ask him such a question.
A book should be a silent dialogue; the reader, I hope, is ready to burst out in exclamation (if he has not already done so): ‘But all psychiatrists aren’t like this!’
I know it. I have told this story in such detail because many are, and of these many are good ones. But such was our good fortune that before the next eight months were past we had found out that they need not be. When, in its place, I record our next experience with psychiatry, it will be in a very different tone. Elly’s next examination was in England, at the world-famous Hampstead Clinic. The Institute had suggested it as soon as they had learned we were going abroad. They had said they would send us the address, though they hadn’t done it. When we saw Dr Blank again we mentioned their suggestion. His face lighted. ‘Yes,’ he said. ‘Take her there. As a rule, as you know, I don’t have high expectations of psychotherapy. But Anna Freud is different. I’ll write her for you. Anna Freud — whatever language you speak, she will speak it too.’
10. To Retrieve the Past
Elly’s fourth birthday was as uneventful as all the rest, except that it took place in a household marshalling itself for a major removal. Two days later we were to fly to England.
For weeks trunks and suitcases had been accumulating in the hall. Elly played unconcernedly around them. Most of our conversation dealt with England and what we would find there. Elly did not hear it. Her father had been gone a month. Elly did not notice his absence. We m
ade no special effort to prepare her for the trip. I knew no way to do it, no words to do it in. Nor did it seem necessary. I had some minor misgivings about the effect of the move, but no more, really, than today’s mother, well schooled in up-to-date anxieties, has about the effect of a new house on any young child. Elly showed no unusual attachment to places, and she had been away before. We had never tried to shelter her or hide her. She had always come with us when we visited; we had stayed with her overnight, a week, ten days, in many different houses. No new surroundings had ever upset her. Why should they? Her strange imperviousness protected her. Only a very few aspects of the environment seemed important to Elly, after all. It was not hard to keep them constant. A few special foods, a few routines that could not bear changing — and everywhere she went, we made sure there was a crib, to become her new citadel. Recently, in one of her frequent shifts, in which overnight a new routine would become a settled habit, she had taken to wanting a spread draped over her bed. Enclosed on all four sides and above, it made a fine redoubt. Ordinarily I would have tried to limit or modify such a tangible symbol of withdrawal, but now I fostered it. It would be handy for the coming move, for converting the unfamiliar atmosphere of a new house and country into the unchanging ambience of Elly’s inner world.
The logistics of the trip were minutely worked out. Every stage was planned to minimize disruption, hesitation, delay — the normal hazards of travel. It had become second nature to think ahead, so that movement could be sure and firm, environment smooth and orderly. The reason that my husband had gone before us was to find and make ready a house for seven — the six of us and Jill, the young girl who was to help out; a house which, whatever chaos it might otherwise present, must provide in good order a separate room and a crib for Elly.
Kind friends drove us one hundred and eighty miles to meet the transatlantic plane. We flew alone; the girl was not expected for another month. The trip went well. Elly let no unfamiliar substance pass her lips, but it was possible this once to give her a pill, artfully concealed in a Hershey kiss, and under her spread, dramamined and doped, she accepted the unfamiliar bedding down beside me in the plane seat. The three older children rose to the occasion, cheerfully enjoyed their dinners, brought me what I needed so I never had to leave Elly’s side. No plans miscarried; no emergencies arose. David was at London Airport to meet us and decanted us into a rented car. Ten hours after we left Boston we arrived in the new English house, where Elly, exhausted like the rest of us from the strange night which had lasted only five hours as we flew against the earth’s rotation, settled serenely into the old white iron hospital crib that David had picked up secondhand. The slot was still there at the foot to hold the fever chart — for Elly, whose illness was so deep and who never had a fever.
The pink spread worked its magic. Nothing had changed. Elly settled in the new crib and began to rock, back and forth, back and forth. At home she had moved her crib all round the room with her rocking; finally we had nailed strips of wood on the floor and boxed it in. It made more noise here, very much more. The floor shook with the impact of the iron. Soon, however, Elly was asleep and the crashing stopped.
Things went well for the next week. There was the usual chaos of unpacking and settling in, and the beginning of a long apprenticeship in a difficult and unrewarding art — shopping in England. There was no one, as yet, to leave Elly with, so she came with me as she had at home. The new sights and sounds brought no visible reaction. She seemed undisturbed.
There were minor difficulties. The Danish Salami looked Italian but didn’t taste it, and Elly refused it. There were no hot dogs. She would not drink the delicious English apple juice. The foods Elly would taste were as rigidly self-limited as all the other elements of her world and the elimination of any of them was immediately felt. She had drunk no milk for months; with apple juice gone, she was down to water. But she had turned against foods before and it had passed. Lean, pale, she was tough and resistant, ineluctably healthy. Elly was adjusting to England at least as well as we were. We felt we had come off very well.
Then one day she was healthy no longer. Suddenly, without warning, she whimpered, vomited, relaxed, and in ten minutes vomited again. No one is surprised, though, when a small child throws up, especially after a change of food and water. I patted her, sat by her crib, and waited. Not long; almost at once she was gagging and coughing, her empty stomach convulsed, trying to bring up what was by now only saliva and a little bile. It passed and she lay down exhausted.
This went on for five days. Elly ate nothing and drank nothing. At first she played a little between attacks, but soon she was too weak for that. She had no reserves of fat. Her flesh melted before our eyes. Her new lightness as I lifted her took my breath away. Under her pale skin her ribs and joints showed like those of the children on famine posters. Oddly enough, she did not take refuge in her crib. It was, perhaps, her rigid sense of propriety that told her that she could not spend the day in a place reserved for sleep. Instead, like the old Prince Bolkonski, gathering her weakness for the effort, she would drag herself from one room to another, there to collapse on a bed or rug, passive until the fit seized her and she threw up again.
Strangers in a strange land, we didn’t even have our National Health cards. But though we as yet had no official existence, the doctor came an hour after we called him. In blessed England, the land of socialized medicine and impersonal bureaucratic care, the doctor came daily, unasked, as a matter of course. But the affliction was as mysterious to him as to us. Elly had no fever, no looseness of the bowels, no signs of infection — only the continued, meaningless revolt of the empty stomach, preceded by the same whimpering and followed by the exhausted resignation of the mute. The doctor feared dehydration, but she would not lick the sweets he gave her and refused the water. Without words there was no way to explain to her that she was sick, that water would make her better. A child without speech is as unreachable as a sick animal. I forced a spoonful of water down to be vomited up again, and waited. These were quiet days and I could work on the house. Elly made no demands and there was nothing to do for her.
On the sixth day the vomiting stopped. Elly drank half a glass of water and ate a lollipop. (It hadn’t been easy to find it. Later on she ate British sweets readily enough, but at first they were the wrong shape. ) She sat up. Next day we carried her downstairs to the kitchen. Shakily but without hesitation she led me to the refrigerator. She took my hand and put it on the door handle. When I had opened the door she took my wrist with her firm, feathery touch and moved it to take out an egg.
Elly had not had an egg for more than two years — half her lifetime. Eggs were not on her list of edible substances. As far as I knew she knew nothing about them, for cooking, like so much else that was human, did not interest her — she watched it, if at all, with unseeing eyes. I took out the egg in some astonishment. To the innocent eye it is by no means obvious that an egg is food; someone who had never seen one would find it scarcely more promising than an oyster. But Elly, it developed, knew all about this egg, including how she wanted it cooked (scrambled) and what pan to use, all of which she indicated with her delicate light grip. She requested six eggs in the hour, and she spent the next week sitting in the kitchen,eating eggs by dozens. She couldn’t, of course, have chosen a better convalescent food. In a week she was well.
But she was curiously changed. There was, for one thing, no more need to worry about how to muffle the crashing of her crib. For years that rhythmic rocking had been a part of Elly; in a life of limited activities it was, if nothing else, one of the few things she did. She had been too weak to rock during her illness. She never rocked again.
She was cheerful enough inside. But though at home she had ranged the neighbourhood, barefoot through the roughest brush, now she would not voluntarily set foot outside the house. Active as ever indoors, her movements out of doors were no longer free and open; she did not run or jump, but squatted in one place and dug in the sand or played
with pebbles — and that only as long as someone stayed with her. She would no longer walk with us on our small excursions round the neighbourhood. We would coax her along a few steps — only a few, for she would whimper and then, if we persisted, cry. We would carry her for twenty feet or so, put her down, and coax a few more steps out of her, and thus, picking her up and putting her down, maintain the fiction of a walk. It was only a fiction. But we dared not let her seem to herself to succeed in regressing to her babyhood.
These changes were permanent. Although we were able, with tact and care and many weeks, to get her to walk normally again, not once while we were in England did she step over the threshold of her own accord, and even since we have returned to her familiar ranging-grounds here at home, she has not moved alone out of sight of the house.
We began to wonder about the meaning of that sudden illness that had no ascertainable cause, only consequences. Could this be what a traumatic experience was — mysterious phrase, plucked out of the sophisticated air we breathe, not really understood? Was the trip a psychic trauma, unexpressed and for Elly inexpressible, internalized, and manifesting itself the only way it could, in physical symptoms? Elly had seemed to take the move serenely. But we had failed to imagine what it must be like for a child of four to leave her home behind without a word of explanation. For a week or so it seems a visit like any other. But as the days pass and there is no return, it becomes plain that home has simply disappeared — been annihilated, swallowed up and gone. Without speech, the child can ask no questions, give no form to anxiety. No explanation can reach her, even if one should be offered. She has no hint that home still exists, that it was abandoned for a reason, that one day she will return there. A single inexplicable convulsion has overnight abolished her physical world. For, lacking words, remote from people, her world was above all the physically known — toys, furniture, houses, streets. When these disappeared, for all she knew for ever, who can know how much seemed to disappear with them? To what degree was her own frail selfhood locked into those vanished rooms? Did they express in space, in the only way she could appreciate, the sense of time, the continuity of personality, the past?
The Siege Page 15