The Siege

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by Clara Clairborne Park


  Perhaps this would not be true if the professionals had access to a sure body of knowledge about psychotic or defective children, which they could have imparted to us. But they did not, nor did they pretend to. What they had was a body of observations, some of it crystallized into theory, on the behaviour of a large number of children and what appeared to affect it. These children were different from Elly and from each other; conclusions drawn from their problems or solutions were of doubtful applicability to this particular child. In the absence of sure knowledge in this case, these professionals did not substitute theory. They gave us instead the gift that amateurs and professionals alike can give — their sympathy, understanding, and support.

  Not that they withdrew from the attempt to apply what they did know, to place Elly within the categories they found meaningful. In this, as in other things, they were candid. The severity of her condition, which we had uncertainly divined from the gnomic generalities of the Institute, these people made quite plain. Up to this time we had had, as a guide to prognosis, only a small number of case histories that Kanner had got together some years before. [13] Its utility was doubtful, since very few of his cases had had time to grow to maturity, but such as it was it could be used to predict any kind of future for Elly. The cases showed a complete range of functioning, from quasi- vegetative existence in a state hospital to (one case only) apparent normality. But Hampstead, like the Institute, did not seem to find infantile autism a valuable category, and they did not encourage us in any vague hopes based on observation of it. The social worker emphasized that Elly had missed out on the most formative years of childhood, and that those lost years could never be made good. The psychiatrist discussed the difficulty children can experience in realizing the boundaries between themselves and others; his final report speculated that ‘the defect may lie in the integrative processes of the ego’. He brought forward the terms ‘childhood psychosis’ and ‘schizophrenia’, only to stress their extreme generality. The term childhood schizophrenia, he suggested, would in time be seen to cover a variety of conditions we could not as yet distinguish.

  Elly, as he spoke, was absorbed in play. Compulsively she turned on the taps in the playroom washbasin, filled it, and emptied it again. She was tense with excitement. This was a new fixation; in any building now she sought out sinks and tubs, screaming if she was prevented. The unexpected presence of a washbasin here made any contact impossible. Back in her citadel, she was incommunicado. The Institute psychiatrist, eight months before, had fared better than this.

  The whirr of running water made a background for the doc-tor’s words: ‘The prognosis is not good.’ When he said that she could not be expected to become an integrated personality, I knew that he was not thinking merely of a withdrawn woman who collects stamps and never marries.

  Yet it was the painless evasions of the Institute that hurt us, not this hard candour. We were grateful for much, but most of all for the fact that these people respected us enough to trust us with what they thought. It was, after all, that for which we had come.

  And if we could no longer strengthen our efforts with inchoate hopes of full recovery, we had been given another source of support. ‘A massive regression now appears unlikely.’ The wise and gentle professionals of the most famous children’s clinic in the world had given me the reassurance I could not give myself. They did not think that in my lonely and presumptuous work I had injured my child. They thought I had helped her. Their present recommendation was not that Elly begin analytic therapy, but that I continue to work with her as before, with one difference. I would now have professional guidance. One of their analysts was transferring her practice to the city where we were living. I could see her there.

  I saw her three times a week at first — a lot, it seemed to me, not enough, to her. The sessions, to my initial surprise, centred not on Elly but on me. It was not until much later that my husband told me the one thing that the Clinic had withheld; that they had thought that it was less with Elly’s emotions I would need help than with my own. We talked about me for several weeks, stirring up a good deal of mud and taking a good deal of time I didn’t have — the analyst the while cheering me on to find more time to myself, to read, to write, to meet the English, and generally encouraging me to feel talented, heroic. and unappreciated. It was a rather enjoyable process. The things she said were flattering and sympathetic; as no one else, she seemed to realize how hard my job was. But I grew uneasy. I was grateful for the support, but as time went on I feared the pleasure was self-defeating. The process seemed to breed self-absorption and self-pity, and at this juncture there was no use I could make of either.

  What happened then was a tribute to a good analyst’s perceptiveness and flexibility. We seemed to reach our conclusions almost simultaneously. Abruptly she shifted her approach. She came to see Elly at home. We talked, not about me, but about her problems. I came less often. The analyst became, and remained, a trained adviser, wise in the ways of children, giving me the benefit of her knowledge. But she was an adviser who now knew me well.

  I knew her too. She too became a friend. She tried not to, for it is contra-indicated in the training. She told me that; I had not known it. But we had too much in common. We could not inhibit our friendship, and it was as a friend that she helped me.

  That help took various forms. There were, for example, words I used which revealed certain presuppositions. Several times I had spoken of a ‘breakthrough’. Gently the analyst asked me what I meant by that word. ‘What arc you expecting?’ I saw then how much had been involved in it — how many romantic notions, fostered by how many accounts of cures that seemed like miracles but presumably were not to those who understood the dark mysteries of the unconscious. I had been told — though not by Hampstead — that Elly had no mental deficiency. Yet in all but a few areas of actual behaviour she was grossly defective. What could be the explanation, then, but some emotional blockage, some log jam of fears and repressions, which could be opened up and removed? We had already begun to remove them; with Jill, with the children, with her father, with me, was she not now often laughing and affectionate, more open than ever before? If she was healthy in body and had no mental deficiency, then her trouble must be all emotional. And was that not tantamount to saying that there was a normal child hiding inside her, and that if we could find the right things to do we could call it out?

  All that, I now saw, was inherent in my use of the word ‘breakthrough’. Though I had not been told so, I had unconsciously assumed that underlying the practice of psychiatry was this kind of optimism. I saw now that the wiser practitioners had too much experience to make such naive claims for their method. There were miracle recoveries, to be sure, and well-publicized ones — a recent book [14] tells the story of a child who could have been a stand-in for Elly, restored by play therapy to brilliance and affection. No doubt it happened. Miracles do. But I was in the presence of someone too wise to claim she could chart the processes to bring them about, or to allow herself or me the illusion that one was in preparation here.

  Sometimes we talked of words, more often of things. We began and ended with specifics. At the time our sessions began, I was in dire need of specific advice; Elly, whose toileting had never given any problems greater than those posed by minor clean-ups, abruptly began to withhold her bowel movement for days at a time. Controlled as she was, withholding was easy for her; what was hard was letting go. For months she had been urinating only two or three times a day, but that had bothered neither her nor us. She had defecated regularly every day or two, in pants by day, or diaper by night. (It had been years since we had put her on the pot.) But this changed suddenly when David and I, luxuriating in the freedom provided by the loving and intelligent girl who was now living with us, went to Paris for an unprecedented eleven-day trip. All went beautifully in our absence. Elly was cheerful all day, and some slight nighttime disturbances soon righted themselves. Everything was as usual, except that though she gorged herself on cann
ed pineapple and imported American apple juice, she had no movement all the time we were away. Even when we returned she could not let go. She suffered extraordinarily little discomfort, but clearly the situation could not continue indefinitely. It was no simple matter to find a cathartic that Elly would take; Elly as a rule allowed no unfamiliar substance to pass her lips. When she rejected Ex-Lax, however, I wondered if she were clairvoyant; never before had she refused chocolate. Finally she accepted syrup of figs, only to become frantic at the realization that her movement, now artificially liquefied, was out of her control. She would soil the diapers we now had to put her in and cry inconsolably, as never before.

  The analyst at this time was an invaluable support. She suggested that Elly’s withholding was a silent protest against our absence; she checked with paediatricians at her London hospital and found a less frightening cathartic, which prevented Elly from withholding her movement for more than four or five days at a time. Consulting the doctors, she was able to assure us that this could not harm her — an assurance we have had constant need of, for this was another of the sudden changes in Elly’s behaviour patterns that became permanent. We were lucky that this problem did not arise before we had help. It would have been hard indeed to ride it out alone. Modern parents have become so sensitive about toilet behaviour that it would have been nearly impossible for us to proceed with steadiness without the feeling of a professional behind us.

  Not that professional support gave us any remarkable solution, here or elsewhere; it merely helped us to adjust to a modus vivendi in which we avoided absences and trouble. The profit I got from my sessions with the analyst lay less in the recommendations she made for affecting Elly’s behaviour, or the occasional interpretations she made of it, than in the general atmosphere of her approach.

  She told me at the beginning that I should expect her to make mistakes. For that I respected her most of all. She gave much good advice. Mixed with it was much that turned out to be inapplicable or irrelevant, and some that was wrong. How should it be otherwise? If there is to be trial, one must expect error. In our common groping for a forward way, what reassured me was exactly this: to find pragmatic flexibility where I had anticipated dogmatism, allegiance to fact where I had expected applications of theory. I had thought I would be led among the verbal mazes of Freudian analysis, but ‘ego’, ‘id’, ‘complex’, and ‘libido’, are words that occur more often in the course of a New York cocktail party than they did in my months with the analyst. It is true that there was a bit of ‘oral’ and ‘anal’, but considering our particular problem that was not surprising. I soon found that it translated down to ‘let Elly play with stoves and refrigerators and let the bathtub and potty toys go’. That seemed good enough. Elly in fact paid lukewarm attention to cooking toys, none to potties, and there was no possibility of cooling her interest in tubs. I never did find out to what extent ‘oral’ and ‘anal’ applied. But my friend the analyst’s interest was clearly not in matters of theory. She brought forward few interpretations of her own and she was less than enthusiastic when we ourselves came up with ingenious hypotheses to explain the increasing complexity of Elly’s behaviour.

  One of these concerned Elly’s new ability to count. Naturally, this delighted us. Yet it had queer liabilities. Instead of expanding, as a normal child’s will, so that the child learns to count higher and higher, it hardened into a fixation. She had to have four washcloths in the bathroom, four cookies on the floor. She had to have them; they were so important to her that we called them her status symbols. We knew that intuitively she could subtract, because if one or two were missing she would reject any but the right amount required to make up the number. This was a gratifying display of intelligence, but awkward if the Co-op ran out of the proper biscuits so that lost or broken ones could not be replaced; it was then almost impossible to comfort her.

  Focusing on this behaviour, as perforce we all had to, we noticed that the week after Jill came to us Elly added one cookie-and one washcloth. A short time later, she added two more — chocolate biscuits this time, somewhat larger than the others. Then, on our Paris trip when Jill and the children were left alone, the two chocolate cookies disappeared and four Ritz crackers took their place. A total of nine, grouped as five and four, was now indispensable.

  Psychology is a game any number can play. Our Cockney cleaning woman, who was extraordinarily good with Elly, had suggested already that the four biscuits represented the four children, raised to five at Jill’s arrival. From then on the interpretation burgeoned. Jill put her fine young mind to work; the exigencies of replacing cookies which got lost or stepped on kept the problem in the forefront of everyone’s attention. Might not the two chocolate cookies represent the two parents? When they left the family circle, the five were retained, but the original four were now added to represent the confusion in Jill’s status, since it was no longer clear whether she was functioning as a child or a surrogate parent.

  This hypothesis afforded us all a certain intellectual satisfaction. Myself a gingerly theorist, I had had no part in it, but I thought it a handsome attempt and reported it in one of my sessions. It had the air of some of the things I had read in the psychology books, and I thought it was the sort of thing the analyst would like.

  She didn’t care for it, however. She cautioned me ‘not to make constructs’. I was surprised; I had thought applied psychology to be more than the method of trial and error I had been pursuing, cautious, hesitant, guided more by action and reaction than by overarching explanations. I was startled and pleased to find professional sanction for playing it by ear, especially since it was the only way I knew how to play. Her caution against constructs helped me, not to reject constructs altogether, but to feel free to judge them by their correspondence with the facts and not by the glories of their internal consistency. There were few constructs indeed, however probable, that made much difference to what I actually did with Elly. I could refrain from flushing out dirty diapers in her presence, as the analyst had told me to do, because the bowel movement is ‘the child’s first gift to its mother’. But since she continued to pay the process no attention, whether the change in routine reassured her or hastened toilet training I could not see that I would ever know. ‘Constructs’, whether our own or the work of professionals, were certainly interesting. In other cases, their applicability might be verified by the child’s positive response to changes in routine which they suggested. In this case, if there were such constructs we did not light on them. The only construct working here was one so obvious and so deeply shared that we did not need to talk about it: that all children, sick and well, feed on love, and that the job of the lover is to love, not in ways satisfying to herself, but in ways the child can accept and use to grow.

  So we were back to specifics again: what to do with Elly, how to fill her empty days, how to encourage such spontaneous play as she originated, how to supply new and usable experiences where she originated none. As before, I learned best by watching. Twice the analyst came to our house — further evidence of her flexibility, for many children are treated by people who never see them at home. She was thus able to check out some ideas of her own in a direct way that would otherwise have been impossible. She could satisfy herself that Elly’s fastidiousness did not reflect compulsive orderliness at home (one look at the living room took care of that!), and that her low performance was not a reaction to the inappropriately high standards of a middle-class family. And while she observed, I was able to watch her play with Elly. It was an impressive sight, for she was one of those people who could involve her in action without making demands on her. Most people tried to talk to Elly. This therapist, though highly articulate, was an expert in nonverbal communication. She played the piano for Elly. She got out the cups and saucers she had brought and got her to play tea- party. She sat down on the floor beside her to paint. Elly, used to my drawing sessions, tried to get her to do the drawing herself. She did not refuse, but kept her markings as crude as
Elly’s own, so they could set no unattainable standard. A year before, when I had begun drawing with Elly, I had deliberately made my drawings as realistic as I could to aid her uncertain recognition. The technique had had considerable effectiveness,but I could now see its drawbacks. Elly was more likely to draw for someone else than for me.

  The analyst had brought a flower pot. She tried to interest Elly in filling it with earth. She had little success beyond satisfying herself that Elly could take dirt or leave it, but I saw something that might be usable later. As I watched the therapist I had the impression of an enormous reservoir of skills, most of them as yet inapplicable to this very simple system, yet still something I could learn from for the future. I wished I could watch her with other children. That was impossible, but she was willing to tell me about some of them. The children she described seemed much less severely afflicted than Elly; even those who didn’t talk had shown that they could. I tried to imagine Elly playing, like the little girl I was hearing about, with the contents of my pocketbook, and in the process revealing tensions and hostilities invisible on the surface. I couldn’t. If I gave her my pocketbook what would she do but ignore it, or at best lay the objects out in rows? I put the idea away for the future. One day, I hoped, she would reach that degree of complexity.

 

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