How can parents learn? They can read, and they can watch and listen. Yet they find out fast that psychiatrists do not like them to read; display of the slightest knowledge of their child’s problem suggests exactly that cold intellectuality which many professionals expect to find. Even after I met psychiatrists who trusted me enough not to veto professional literature, they did not encourage reading, or suggest what it would help me to look at in this vast field with which I was almost completely unfamiliar. Even from my random reading I learned something-here was a child astonishingly like Elly, there a technique that seemed worth trying. How much more might I have learned from an intelligently selected bibliography, especially if I had been able to discuss what I read with a professional?
And if I learned from reading, how much more might I have learned from watching? Let parents into the therapy rooms and the special schools. The difficulties are obvious, but they can be overcome. An observer’s presence may disrupt the therapy, and children — especially other people’s children — cannot be made into guinea pigs. Fair enough. Use microphones then, and one-way glass. An untrained observer will not understand what she sees. Convert, then, the session with social worker or therapist into a question-and-answer training period. If the mother’s reactions need analysis, they will be better understood, by both her trainer and herself, in the mutually experienced context of the therapy room than when shakily reconstructed from memories and dreams. But the parent’s personality may be totally unsuited to this kind of work. Of course — in many cases it is bound to be so. But the radically unsuitable are less likely to wish for such training. If they should, they can be excluded after they have proved themselves so.
Severe mental illness in children is far too widespread for it to be possible to provide intensive professional treatment for every case. The answer must be to train nonprofessionals[17] — unless there is to be no answer at all. Above all, it must be to train parents to do with skill and effectiveness what they have got to do anyway. Mothers (and fathers who have time) will make ready pupils, as people do when they are learning what they have immediate need of. And it may happen that their training will pay social dividends beyond their own particular cases; such parents, if the time comes when their own child’s need is no longer paramount, may make use of what they have learned in helping others. The professionals may find that they have unwittingly created a corps of valuable assistants who will amply repay the time and effort that have gone into their training.
I have spoken so far of the special advantages of parents of abnormal children — those they possess by the very nature of their position, and how they might be enhanced by sympathetic training. I must not overlook, however, another advantage — not a special one, this one, but so commonplace that it is easy to forget it entirely or to doubt its relevance. This is the homely expertise already possessed by parents of normal children. I have often thought of the Institute psychiatrist’s musing words — ‘It’s hard — it’s very hard — even to bring up normal children.’ It is hard, perhaps, but it is something that millions of people have done. When viewed from the vantage point of the expert, conscious of the vast field of parental error, it may indeed seem miraculous that children ever grow up undamaged. Yet most of them do. Parents must not sell themselves short. Let them be conscious not only of how little they know, but how much. [18]
Without guidance, through Elly’s worst years, I brought up Elly as I had brought up my normal children, with no more knowledge of psychology than Dr Spock affords an unpractised mother. Perhaps I should not imply that that knowledge is a little thing, for Dr Spock is the premier example of a psychiatrist who is loving, wise, and good. His book was written for ordinary parents of normal children — it is not a handbook for the nurture of psychotics. Yet it is astonishing how much that one has learned from living with normal children is applicable also to the disturbed and defective.
I have come to see mental health and illness, soundness and defect, not as the separate entities the words seem to describe, but as a continuum. The needs of the defective and the sick are more imperious than those of the well, but they are not different in kind. Sick children need to be accepted, supported, comforted, corrected — like well ones. Above all, like all children — like all people — they need to be respected. Good parents have no magic key to dealing with children beyond this almost foolishly simple one: to try to imagine each situation from the child’s point of view. Some people do it by instinct, but it is a technique that one can learn — to turn in upon oneself at need and ask, ‘What would I feel like if?'
But the child is ill, its thought processes are incomplete, distorted? So are we ill, by turns and chances, and we are no strangers to distortion and incompleteness. Indeed since our children tend to be like us, we may have a special insight, based on our own self-knowledge. Our memories of our own childhood will guide us as we try to understand our children’s.
I remember a little girl, seven years old, shy to the point of incapacity and so tense that every social situation was liable to flood her in helpless nausea. I remember a father less known in daily familiarity than in arbitrary incursions and descents bringing with them fear and distrust the child could not acknowledge, since children learn only that it is customary to love one’s father. I remember a weekend of crisis so acute that the doctor had been called — the little girl had been able to keep nothing down for two days and the doctor and her mother had agreed that she should not be forced to eat, in hopes that the tension would abate of itself. I do not forget the unwonted apparition of the father in the kitchen, tall, handsome, intense. He would get the child to eat, these people knew nothing, it was all a matter of the right approach. He would make it with his own hands — a simple, tasty meal served in attractive circumstances. They would see that she would eat for him.
And she did eat, while he stood over her; she ate everything down to the last bit of apple-sauce, fighting back nausea with every mouthful. She thought that this would be the way to satisfy him, to give him what he wanted so that he would leave her alone and she would never have to eat again unless she was able. She could not guess that he would take her gift as proof that what she had done then she could do always, and that a genuine and terrifying disability (which has followed her all her life) was merely a spoiled child’s malingering. That memory is also part of my education. It taught me, when my own children came, not to confuse gallantry with strength. Respect must grow out of knowledge — knowledge of what a child can do, and what is at present and perhaps for ever beyond its power. When Elly came I at last formulated what I had learned so long before — that a result that has been achieved once because of some unusual motivation may have taken every ounce of strength a child possesses, and that it must never be construed to commit the child to that level of performance.
Every parent has been a child — more likely than not a child in some way like this child of his. Every parent has incidents he can remember and learn from, from which he can assess his children’s vulnerability or strength. The bringing up of children is an exercise in self-knowledge and in the respect for others that grows out of it. The millions of families that function in comparative happiness are evidence that ordinary parents have intuitive knowledge of this principle of respect. They are expert in many things, but penetrating and modifying everything they do is their expertness in the application of that golden rule which governs all personal relationships. Family life is the first school in which we learn the techniques of love, and if it is not perfect, still I know no better.
I have not dared to set down in my list of advantages a parent’s love for the child. Love is not only not enough — we have almost been persuaded to admit that it is a disadvantage. Yet I cannot think that we are disqualified for working with our child because we love her. Detachment and objectivity are techniques too and can be learned. Psychiatrists themselves work by love — in their strange language it is called transference. It is usually understood as the love the patient feels f
or the person who is helping him, but psychiatrists have learned from their master Freud that it works both ways and that they love whom they help. It is in fact to prevent their being consumed by the power of reverse transference that they have learned to set limits to the therapeutic relationship — and this knowledge is part of what they can give to parents. They have learned, too, the dangers of a love that uses the creature that it loves to satisfy its own needs. It is quite true that parents can exploit children to build up their own egos. Teachers can exploit students, ministers parishioners, psychiatrists patients. ‘Love seeketh only self to please,/To bind another to its delight’ — the love that builds a hell in heaven’s despite is one we must all recognize. Most of us learn to recognize it in the school of family life, from the childhood of others if we have been lucky, from our own if we have not. We learn it from reading, watching, listening — in as many ways as we are able, for it is the single indispensable lesson. Never to make Elly feel guilty for having taken so much of our time — never to voice the words ‘the best years of our life’-always to remember that though she may have needed what we gave her, she never asked us for it, that we gave of our free choice what must remain a gift and not a claim — luckily these are not recondite principles. We must remind ourselves of them continually; no expert can do it for us. Though others may help us to it, such analysis as we make must be our own.
So it is that we must be aware of the ways to go wrong in loving, ways that help not the person we love but ourselves. But our consciousness of these should not be too acute, lest it immobilize us for the work to be done. We need to learn the lesson, but not to be made afraid by it. Insight, overdone, becomes cliche; if there is a cliche more widespread than that of the rejecting parent it is that of the possessive mother.
Physicians of the soul do the thousands of afflicted children no service if they undermine the confidence of their parents in what they can accomplish by intelligent love. Intelligence and love are not natural enemies. Nothing sharpens one’s wits for the hints and shadows of another’s thinking as love does — as anyone who has been in love can testify. Blake’s poem describes as well another kind of love — the love that ‘seeketh not itself to please,/Nor for itself hath any care,/But for another gives its ease,/And builds a Heaven in Hell’s despair’. There are millions of parents — as well as teachers, and social workers, and doctors, and ministers, and psychiatrists, and ordinary men and women-who practise this love daily, knowing that love is a technique as well as an emotion.
Ordinary men and women. The point needs emphasis; the special advantages of parents are not unusual but widespread. It is some time since I myself have felt shut out by professionals. Those with whom I have lately come in contact treat me almost as if I were on the inside. But their amiability has a corollary; they seem to think, as some readers may think, that I have done something extraordinary, something that few parents would have been able to do. I do not believe that. I learned from my Cockney cleaning woman that an uneducated mother of six can have a delicacy of touch in dealing with a psychotic child that few can match who are trained to the business. Of all the types of success, the most widespread is successful parenthood; the species survives because this is so. It is also the most inconspicuous; it is precisely those millions of parents who successfully pilot their children through illness and crisis who never come to a psychiatrist’s attention. No one, professional or amateur, should underestimate the immense fund of goodness, knowledge, and resourcefulness possessed by ordinary parents. Let it be understood that I am no miracle worker. I am not ‘good with children’ or particularly fond of them. I knew none before my own, and even now I would never voluntarily seek a small child’s company. Such qualified success as I have had must not be thought of as unique.
Once, in an access of mingled self-congratulation and self-pity, I was describing all I had done with Elly to a friend, herself a mother of three. When my torrent of words had ceased she replied with healing matter-of-factness, ‘Well, you couldn’t have done anything else, could you?’ Of course not. She did not have to tell me that she would have done the same.
Psychotic children are a congregation of mysteries. So little is as yet understood about them that the distinction between amateur and professional has hardly begun to acquire a meaning. There are many parents who, like us, have had no choice but to make themselves experts in their child’s abnormality. I have met some of them. They should not have to work alone.
13. Towards Speech:. A long, slow chapter
I have described Elly’s first four years in almost complete detail. To describe her second four as minutely would be impossible, even in a much longer book. Not only has her behaviour become more complex, but as her withdrawal has lessened and helpers and teachers have been able to contribute more and more to her development, I have not, as in her first years, been aware of everything she said and did. I have been aware of most of it, though, and it is a measure of her progress that at length I have more data than I can record. Elly has gradually begun to live a richer life than can be got between the covers of my notebooks.
On our return to America, Elly was five years and two months old. The devoted intelligence of the English teachers had socialized her to the point where she was able to enter a small private school in the community. Here she adapted to the school routine and enjoyed the minimal stimulations of the nursery class — clay, paint, music, and dance. She remained two years in the nursery and then went into the kindergarten. She was older than the other children, but it did not matter much. Socially she was far less mature than the youngest of them, and though she coexisted in the same classroom, she interacted with them hardly at all. The children tried to talk to her at first, but receiving no answer gave up the attempt. Only the most aggressive of them could make a contact — I remember a small boy taking hold of her sash and pulling her around the room while she laughed in pleasure. But such things did not happen often. Most little children are too shy and too self-absorbed to function as therapists. Elly responded to the kind and gentle teachers, not to the children who should have been her companions. It helped her to be in the same room with them, doing the things they did — that we took on faith. Quiet still, and docile, she did not disturb the group though she contributed nothing to it. She was at least kept constructively occupied while she learned to respond to simple spoken communications of adults outside her own family circle.
For as she grew, the problem of her speech took precedence over all the others. It was through speech that she must join the human race. Kanner had found no better indicator of future development than speech. Five was his year of decision. By her fifth birthday, Elly had in fact begun to develop communicative speech.
The reader will recall that, according to the count made the month she turned four, Elly had in her life spoken thirty-one different words, fewer than half of which were then in current use. In the course of a week she would speak no more than five or six. She responded to a number of routine commands. That was all.
This situation began to improve that year, the year we spent abroad. There was no sudden change; it happened gradually. Four months after her fourth birthday the word count had reached thirty-eight. More important, when I counted the different words she had spoken in a single week, I found twenty- one. Two months later, although only three new words had been added and she was still using about twenty words a week, they were by and large the same ones. Instead of the frustrating come-and-go of her earlier vocabulary, she was acquiring a core of speech on which we could depend.
Along with this came a new interest in getting us to name things — the letters in her alphabet set, the fruits and vegetables on the pretty curtain I had found for her to darken her bedroom and give us a little more sleep. She would try herself to say ‘strawberry’ or ‘celery’ — the barrier against imitation was at last breaking down. But she mouthed them so clumsily that they were nearly unintelligible even at the time, and totally unrecognizable out of context; they did no
t get included in the word- count.
All Elly’s speech was indistinct; only those who knew her well understood anything she said. She never pronounced a final consonant, and often the initial consonants were ambiguous or wrong. Words of more than one syllable were rare, and tended to turn into Polynesian, so that Becky’s name would come out Beh-Beh, recognizable only because Elly would perhaps be looking at her sister’s picture. In this indistinctness, as in so much else, there seemed a queer deliberateness. The first time I ever heard her say ‘all gone’ she said it distinctly; I could even hear the terminal ‘n’. I remembered the clear ‘scissors’ she spoke before she was two; I remembered her limpid ‘El-ly’. I smiled; she smiled back mischievously and said the words again, less distinctly. ‘Ah-gah.’ It was ‘ah-gah’ for years after that. Her pronunciation did not improve as she began to acquire words more easily; it grew worse. It was as if (as if) now she was beginning to talk she had still to maintain her reputation for unintelligibility, to obscure — to herself? to us? — the significance of her entry into the world. At this same time began a new phenomenon which, though unconnected with speech, seemed comparable to her verbal indistinctness. Often, now, she would squint up her eyes, sometimes to the point of actually walking around blind. This would last a few seconds — at most a minute. Her face would have a little smile on it. The action seemed to express a kind of separateness, now she was becoming one of us, and yet it was a game of withdrawal rather than withdrawal itself. She kept it up, with decreasing frequency, over the years — a teasing game which denies withdrawal while affirming it, since it is done with our reaction in mind. We suspect — we cannot know — that the indistinctness of her speech has been similarly functional.
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