by Torey Hayden
Understandably, Selma’s parents were not at all amused by this new development. They felt it was solely our fault Selma had been exposed to this kind of thing. They were also as terrified as the staff that someone who didn’t know what was going on would take Selma’s comments seriously, feeling there couldn’t be smoke without fire, and accuse an innocent adult of sexual abuse.
So the unit was in an uproar. Cassandra was strictly forbidden from interacting with Selma, and efforts were made to keep the two as much apart as possible, so that Cassandra couldn’t break this rule. This wasn’t easy. The unit wasn’t enormous and to enforce this separation, Cassandra’s movements had to be very controlled. Because of her endless accusations of sexual assault, we remained on a “paired supervision” order with her, meaning that every interaction required the attention of two adults.
All these restrictions made it virtually impossible to have any kind of normal dealings with Cassandra on the unit. Everything was necessarily defensive. We were containing her more than treating her, and it was difficult to know how else to go about it. It also greatly impeded my efforts to treat her psychological problems. While I now had a conceptual framework—that she was showing signs of early multiple personality disorder—it was still next to impossible to have any kind of continuation between sessions, as each day when I came for her, there was a new crisis to be confronted and resolved, and that took up most, if not all, of our time.
So there we were yet again that morning. Cassandra was back in lockdown, having been caught in Selma’s room, and, indeed, having been caught actively bullying Selma.
I paused a minute outside the seclusion room. The door had a small window, and I looked through. Cassandra was sitting cross-legged on the floor with her back to the door. I opened the door and went in.
She didn’t turn around.
“It would be more helpful if, when it was time for our session, you were on the ward and not in lockdown.”
She sat gloomily and didn’t answer.
“I don’t like losing our time together, but it isn’t really right that every time the staff puts you in lockdown, I then come and take you out.”
“It’s not my fault,” she muttered. “I didn’t do anything. I can’t even breathe around here. I hate it.”
“Well, come on.”
She got up sullenly and we left.
As with the previous session, however, by the time I closed the door to the therapy room Cassandra had recovered her spirits. “I want to do that feelings thing,” she said as cheerily as if nothing had happened out on the unit. “You know that one where we’re giving names to the feelings. Do you got that here? Where is it?”
“You seem much happier when you come in here,” I said. “On the unit, you always seem very angry. Once we are in here, it looks to me as if you have forgotten all about it.”
“Well, yeah. Wouldn’t you?” she asked in a condescending voice and went to the shelves to rummage around for the feelings drawings. “It sucks in seclusion. Of course, I’m glad to be out of it.”
“I find when I am very angry or upset, I can’t make those feelings go away just by walking into another room.”
“I can.”
“How?” I asked.
She shrugged. “I don’t know. I just do.”
“What kind of thoughts do you have when you are in the seclusion room?”
She shrugged again. Her back was to me, as she was still poking around in the papers on the shelves, and her shrug was casual and dismissive.
“What kind of thoughts were you having just then?” I asked again.
“I dunno.”
“Cassandra, turn around. Come here and sit down.”
“I want to do the feelings thing. I can’t find it.”
“I want to do that, too,” I said. “And we will. But first I want you to do this. Turn around, please, and sit down.”
“I want to do the feelings thing.”
“Okay, that’s fine. I’ve got it here in my box. But sit down first, please.”
Immediately she turned around and reached for my box.
I put my arm over it. “Sit down, please.”
There was a long moment’s hesitation, and then she slumped into the chair opposite me in a rather surly manner.
I opened the box and took out the list of feelings she had named and illustrated. As I laid it on the table, I kept my hand on it, as it was clear she intended to run the show herself.
“Okay, I’m going to demonstrate how we actually play this,” I said.
“I don’t want to play anything. I want to draw. I want to put names on the rest of the feelings. That’s what we’re supposed to do. That’s good psychology, huh?”
Which very nearly made me laugh. Or it would have, had she then not grabbed for the papers and said in an irritated voice, “So give me it.”
“No.”
“I want to draw.”
“No, that’s not what we’re doing today. We’re doing something different. We’re using the list today as a list, not as an art project. Remember the poker chips? Here.” I spilled a pile of red ones out.
“I want to draw.”
Why, WHY could we not just do things? I was so tired of fighting her every inch of the way. “Okay, here are the lists of feelings,” I said. There were three sheets of paper, each divided into five columns and twelve of the columns contained a feeling word—anger, love, disgust, and so on—most of which she had already illustrated and renamed as “baby feeling,” “dog puke feeling,” and so forth. I laid them out side by side and then pressed my right arm across the top of them so she couldn’t move them. “Okay, I’ll take my turn first and show you how this is played,” I said. “My cousin is coming to visit me. I haven’t seen him in a long, long time. In fact, not since he was twelve and I was eleven.
“Now, here is how this game works. I’m going to put poker chips under the different columns that show how I feel about my cousin coming to visit. For instance, I feel happy he’s coming, because even though it was a long time ago, he and I had a lot of fun together when I last saw him and I like my cousin. So I’m going to put some poker chips on ‘Happy.’ Maybe about five. But also, I feel worried, because it’s been such a long time since we met. Maybe he’s changed and I won’t like him now. But I’m not too worried, so I’m only going to put three poker chips on ‘Worried.’”
“What about ‘excited’?” Cassandra said. “I bet you feel excited, too, that he’s coming, because maybe you’ll do something exciting together.”
Pleased to see Cassandra clearly understood the exercise and was starting to join in what we were doing, I readily agreed and reached to put chips on “Excited.”
“Yeah, ’cause maybe he’s going to fuck you,” she added and then laughed.
I ignored the comment. “Okay, so now it’s your turn. Use this system to show me how you felt just now in seclusion.”
Cassandra surveyed the list. “I don’t see ‘Hate’ here.”
“No, I don’t either. Here.” I quickly wrote “Hate” at the head of one of the empty columns.
“Okay, so where are the other chips?” she asked. “Because they’re worth more, huh?”
Obviously she did have the concept of this. Indeed, to the point that I wondered if someone else had attempted to use a variation of this exercise with her. I grabbed the bag of blue chips and put them down.
“What about the white chips?” she asked.
“The white chips are worth less, not more.”
“Yeah, well, I need them, too.”
Yet again I could see this starting to turn into an exercise in control and manipulation. I grabbed the bag of white chips and flung it on the table, my exasperation perhaps not as well disguised as it should have been. “So. There are all the chips. Here are all the feelings. Show me how you were feeling in lockdown just now.”
She picked up a handful of blue chips, the ones worth the most, and began stacking them on “Hate.”
> “A lot of hate,” I said.
“Yeah. A lot of hate.”
“Anything else?”
“Nope,” she said, shaking her head. “That’s all.”
“Because quite often we actually have lots of feelings at once. One particular feeling might be the most powerful. It might seem like the only feeling we have, but quite often there are others, too.”
“Nope. Hate. I hate this place. I hate everybody here. I hate ’em so much I want to fuck them up the backside. I want to fuck this whole hospital.”
“Okay,” I said. “That’s clear.”
Cassandra reached over and picked up more blue chips, which she added to the pile already on “Hate.” The stack was about two inches high by this point.
“Yes, I can see you felt very hateful when you were in lockdown,” I said.
“If I had a million of these, it still wouldn’t be enough,” she replied.
“Yes, I can see that.”
My new concern was that she was going to attempt control of the exercise this way now, by stacking the blue chips on the paper, by insisting on stacking all the blue chips on the paper. Control, control, control. Whatever we did, a battle for control was always at the center.
“Okay, so you felt nothing but hate,” I said. “But let’s do it again. Let’s ask this time: what about Minister Snake? How did Minister Snake feel in lockdown?”
Her eyes narrowed and she looked at me.
“Yesterday you said Minister Snake was talking to you in lockdown. Could you feel Minister Snake when you were in the seclusion room today? Was Minister Snake there, too?”
She hesitated. Her eyes were still narrowed, still gazing at me in what felt like an assessing manner. Assessing what? I wondered. If I understood what was happening to her when she talked about Minister Snake and the others? If I was accepting of their perspective, too? Or was she simply assessing if this was an effective new manipulative technique and she could attack me anew? I had no way of knowing.
“Can you do the same thing for Minister Snake?” I asked. “Put the chips on the feelings Minister Snake was feeling then?”
Very slowly, she nodded. Then she said, “But there’s another feeling that’s not there. This list isn’t very complete.”
“That’s okay. We can add them as we go along. It’s hard to think of them all at once. So which other one is missing.”
“Feeling ashamed. Because Minister Snake was feeling ashamed of what I was doing. And mad. And …” There was the sense she was going to add something, but she didn’t.
I leaned over and wrote “Ashamed” on one of the papers. Unlike when I’d hastily written “Hate,” there wasn’t the sense now that she might snatch the paper away and divert the activity by trying to draw pictures or give additional names to the feelings. I was intrigued how, whenever we started to engage these other “friends,” these other components of her personality, Cassandra immediately settled down. She ceased her incredibly annoying efforts to control everything and responded much more earnestly to what we were doing.
“So, which chips?” I said. “Which ones for Minister Snake.”
She put a blue chip on “Ashamed” and a red chip on “Mad.” Then, picking up a white chip, for a long moment she studied the list. Finally she put it down under “Hate.” She took up a second white chip and added it to the “Hate” column, below the stack of blue chips. She put a third white chip under “Hate.” “That’s ’cause he hates me,” she said quietly. “He hates me when I act like that.”
“What about Cowboy Snake? Can you show me how Cowboy Snake felt in seclusion?”
Cassandra started to sweep away the chips already on the paper, but I put a hand up. “You can leave them there. We can put everybody’s feelings on at the same time.”
“No, I want to start over.”
“All right.”
She took up three blue chips and put them under “Worried.” Another blue chip went on “Sad.” Another one on “Lonely.” Two went down under “Scared.”
“He has quite a lot of feelings,” I said. “And I notice he’s got all blue chips. So he feels them quite strongly, doesn’t he?”
She nodded. “He’s emotional,” she replied. This was an intriguing comment to me, not only because it was a oddly mature statement for a nine-year-old, but also because it showed unexpected awareness.
“And what about Fairy Snake?” I asked. “How did she feel in lockdown.”
“She wasn’t there. She’s too little.”
“I see.”
“’Cause she’d be scared. That would be her feeling. She’d be really scared, if she had to be in lockdown, because she wouldn’t understand what was going on. She’s just little. And I take care of her. I don’t let anything bad happen to her. So she wasn’t there.”
I nodded. “Anyone else?” I asked quietly. “Besides you. And Minister Snake and Cowboy Snake and Fairy Snake?”
“There’s the Sister Snakes. They’re twins. They’re thirteen, but they weren’t there. They’re named Becky and Bicky. But lots of times they’re not around. They have to be at school so they graduate.”
“I see. So, anyone else?”
“No,” she said softly. “That’s all of us.”
Chapter
23
A conference on Drake’s progress was held on Monday afternoon. Both his mother and his grandfather attended. Yet again, however, Drake’s father was absent. Thus far, none of us had met the man.
This was my first meeting with Lucia and Mason Sloane since that afternoon at the preschool in Quentin. I was dreading it simply because I had made absolutely no progress with Drake and I knew full well Mason Sloane would not be happy about this. For all the worry I’d had about being too hard on Drake, about being too goal oriented in my work with him, Mason Sloane would definitely think I hadn’t been goal oriented enough and, truth was, I felt a little afraid of him. This was exacerbated by the fact that I myself had expected to be much more successful with Drake, so even without Sloane’s pressure, I already felt like I was letting the side down.
The major difference between this meeting and the one in Quentin, however, was that I wasn’t going to have to go it alone. Indeed, Harry decided to chair the meeting himself, even though I was the one responsible for Drake’s therapy. Reckoning that the aggressive behavior was, in part, simply a power play, Harry hoped Sloane would be more cooperative in dealing with someone he perceived of higher rank.
Harry explained all the things we had done with Drake, including assessment tests, an IQ test, and various medical examinations, in addition to my therapy sessions. He said Drake showed every indication of being an intelligent, adaptable, well-balanced child. The only exception was speech.
“This is the big mystery,” Harry said. He laid the Mayo Clinic report the Sloanes had sent us on top of the other papers and sat back in his chair. “I want to be able to tell you we have made good progress in treating Drake,” he said. “This is really such an extraordinary case. To have such an intractable problem at such a young age, juxtaposed against an otherwise emotionally stable and well-adjusted child … I very much want to be able to give you a diagnosis and, even more importantly, a solution to this, but the truth is, at this stage …”
Harry lifted the Mayo report up again. “I do have enormous respect for this clinic. They are very good, arguably among the best, if not the best in the nation, so I also respect the fact you sought out this level of help for Drake. And I acknowledge that their findings here seem very thorough indeed. But … and this is a very big ‘but,’ what they say here does not add up with what we are seeing. This boy simply is not responding in line with these findings. So, before we go any further, I would like to put our own resources, including those of the medical hospital, to work on this case to help find a solution. This will mean replicating some of the Mayo investigations where necessary.”
Mason Sloane’s reaction was swift and fierce. “All you doctors are the same!” he com
plained. “Making money. That’s all you want to do. Test after test after test, repeating yourselves over and over again! Repeating everything every other doctor’s done. Telling us how important it is to do them and then you never get anywhere! You never help my grandson!”
And he didn’t stop there.
Mason Sloane launched into a red-faced tirade about how he had told us there was nothing psychologically wrong with Drake. He knew that. Did we think the Sloanes could have accomplished what they had—come west with the pioneers, cross the prairies in covered wagons, established the strongest group of banks in that part of the country, established Quentin itself, for God’s sake, because Quentin would never have grown into the important regional city it had without the strong blood of the Sloanes? How could we imply their blood was mentally unsound? No grandson of his was mental, for Christ’s sake. He had been class valedictorian. His son had been class valedictorian. Indeed, his son had gone to Harvard business school and graduated in the top of his class. Did we think his son’s son was capable of any less?
Harry gave me a little glance as all this was going on. It was just tiny, momentary eye contact. It said volumes.
Being shouted at wasn’t enough to deter Harry. Calm and unperturbed, he pointed out in a slow, calm voice, as if speaking to a particularly backward child, that he was casting no aspersion on the mental health of the Sloanes. What he was concerned about were underlying physical causes. In an effort to make his point clearer, Harry mentioned that during the previous week I had used American Sign Language with Drake and Drake had responded with remarkable aptitude, both in learning the signs and in using them appropriately to communicate. Harry went on to explain how psychologically based mutism usually inhibited all forms of communication. In contrast, Drake seemed eager to communicate but unable to, and this pointed to physical causation. Consequently, it was crucial we rule out such things as neurologically based expressive disorders; and yes, while it would be most unusual for the Mayo investigation to have missed something like this, it would be far worse to carry on treating Drake for the wrong problem.