by Torey Hayden
One of the advantages of being able to listen to a case presentation of one of my clients, rather than having to give it myself, was that it allowed me a small amount of distance from the case, such that I could examine the situation more objectively. Consequently, what occurred to me as Harry spoke was phobia. Genuine phobia, in its true psychological sense, as opposed to using the word as a casual behavioral description. Could Drake be actually phobic of the sound of his own voice? The sensation of vocalizing? Of saying words? I was well familiar with the connection between trauma, either physical mouth trauma or overwhelming psychological trauma, and elective mutism. Indeed, we commonly referred to types of elective mutism as a “phobic reaction to speech.” But could it be a real, true phobia that made the physical act of speaking so terrifying Drake couldn’t contemplate it but, as long as vocalization wasn’t involved, he felt calm enough to communicate in other ways? I had never encountered anything this extreme in my work with other elective mutes, but it seemed possible. I was also aware phobias could form around the most unusual things, and for the individual, they could be absolutely paralyzing.
So my mind took off running with these thoughts to the point that for that moment, I tuned out of the actual conference. I was thinking now in terms of desensitization and other common approaches to treatment of phobias. If this was the issue, how could I go about desensitizing Drake to the sound of his voice? Which, of course, immediately made me think of the tape he had made with his mother.
Hmmm, I was thinking. He had spoken with her. If he was so phobic as to refuse even the smallest sound with the rest of us, why would it be okay to speak at home? That didn’t make sense with what I knew of phobias otherwise. With true phobias, no matter how supportive the environment or the people, you can’t switch them on and off.
I glanced over at Lucia as I was considering these matters and experienced a small, unexpectedly lucid moment. All of a sudden, I saw her, sitting beside Mason Sloane. Sitting in the shadow of Mason Sloane in quite a literal sense there in the conference room. Arms wrapped around herself, she was slightly back from the table. The way she was seated gave the impression she was physically behind Mr. Sloane, although she couldn’t have been. I looked with more precision and, really, she couldn’t have been seated more than twelve or fifteen inches back from the table edge. Nonetheless, one got this sense of her being physically behind him because he was leaning forward over the table, making his point, whereas she was drawn in upon herself and inclined slightly toward him. I was struck by the fact that she was a genuinely beautiful woman. Her dark hair was shoulder length and cut stylishly. Her eyes were huge and dark. Soulful, doelike eyes, to use the cliché, was an accurate description in this instance because there was also that underlying wariness one always detects in the eyes of wild animals, even when they are at ease.
I was quite certain Lucia was anorexic. She was past being simply thin. Her skin was waxy looking in the fluorescent light, and she had about her that gaunt brittleness one sees in those photographs of prisoners of war crowded around the fence of some nameless camp. Caught off guard, unaware I was watching her, she also had that same kind of vacant desolation on her face as war prisoners had.
I was then jerked from my thoughts because Mason Sloane went nuclear.
“Sign language!” he shrieked in a horrified tone that would have made one think Harry had said we were using cocaine or leg irons on Drake with great results. “I will refuse permission for that boy to learn sign language. He is not deaf. I will not have you make a damned fool of him, learning miming. He did not come here to be taught how to act like a defective!”
And I thought, Well, here’s the explanation for Drake’s fearfulness in using sign language. I could just imagine Drake coming home from preschool and showing off a few signs, only to have his grandfather explode at seeing his grandson do what “defective” people did.
Sloane’s loathing of sign language was only the buildup, however, because what he really wanted to shout about was Harry’s implication that Drake was brain damaged. Because that’s what “neurologically based expressive disorder” meant, wasn’t it? And Mason Sloane wasn’t about to tolerate that kind of insult to the revered family name.
There followed a moment of very unpleasant confrontation between the two men, because Harry, mild-mannered as he was, was not a pushover. He pointed out that Drake had been sent to us for evaluation and intervention and in the process of that, it was our task as professionals to do whatever seemed best for Drake. This included evaluating his ability to communicate physiologically as well as psychologically, if that’s where the questions were. We’d be negligent otherwise, Harry explained. If a neurological disorder did exist, all the psychological intervention in the world was not going to make a difference.
This, of course, was definitely not the kind of directness Mason Sloane expected from, as he called us, “people he hired.” So he did what I’d been braced for all along.
Slam! Bang! He knocked all the papers across the table. Standing up, he banged his chair rudely, demanded Lucia follow him, and stormed out.
Harry, I, and the unit staff remained seated at the table. We exchanged exasperated glances.
Then Nancy Anderson shook her head and gave a mirthless little chuckle. “Mom must have been messing around. No kid nice as Drake could be carrying that jerk’s genes.”
Worse had happened, however. Our meeting had been held in the conference room, which was up in “Heaven,” the same area of the hospital as where the psychiatrists’ offices were, on the floor above the unit. When Nancy and I returned to the unit afterward, we found everyone there in an uproar. Mason Sloane had come raging straight down from the conference, stating he was not having his grandson stay a moment longer and insisting that Drake be released to them immediately. Because Drake was a voluntary admission and Lucia was there, Mason Sloane was within his rights to demand this. By the time Nancy and I had arrived, Drake was already gone.
I couldn’t believe this. Standing in the middle of the empty dayroom, I groaned in pained frustration. How could he? How could this happen? There had to be some way we could stop him, that we could demand he continue treatment for Drake. This would be terrible for the boy, locked in his silence, trapped with a man who would not sanction sign language, who would not tolerate imperfection of any kind.
The rest of the staff were as distressed and disappointed as I was, and several of us gathered in the nurses’ station, venting our anger, searching desperately for solutions. Slowly, our talk tailed off into sadness. The plain truth was, children belong to their parents. While we might strongly disagree with the Sloanes’ decisions regarding treatment for Drake, all we could really do was record that in his case record. We had no rights to see things changed. Drake didn’t talk. He was otherwise, however, a well-adjusted child. We’d have a hard case proving he was better off here in an institutional setting, that we were providing him with crucial services that he couldn’t receive elsewhere. Indeed, only a short time before I’d been on the other side of this fence, fighting to keep him out of the unit, telling everyone that he did not need such major intervention and was better off at home.
Shit.
My mood was not greatly improved by the time I reached my office. Helen wasn’t in that day, so I was alone. Closing the door behind me, I flung my stuff on the desk and flopped into the chair. Staring at the miscellany of things on my bulletin board, I let my mind run.
I wasn’t ready to stop with Drake. The issue wasn’t so much that I had failed in my intervention; it was that I’d failed even to understand what I was intervening with. Something was wrong with him. Here was an intelligent, outgoing child, who, according to all the reports, was normal, was physically healthy, was generally well adjusted and he didn’t talk. That was not normal. People didn’t do that for no reason at all.
And he did talk at home with his mother. So, however well adjusted he may have appeared in Harry’s observations and Harry’s tests, Drake
was doing something that was really very maladaptive. He spoke there. He never spoke here. He never spoke at school. He never even spoke to his father. But he spoke to his mother. Poor cowering, defeated Lucia. He spoke to her. Was this because she was the only one he felt safe with? Were she and he a little island in what was really a very dysfunctional, abusive family and this was the source of his mutism? Knowing Mason Sloane and observing Lucia, it was not difficult to imagine this possibility.
These were not new thoughts. The whole abuse/dysfunctional family issue had occurred to me over and over, because that was a pattern I was familiar with, and it really was the only pattern that vaguely seemed to fit in all of this. But because Drake didn’t talk, there had been no way to investigate this at all. I had absolutely no proof.
Gloomily, I sat at my desk, knowing Drake was gone, knowing Drake had been returned to whatever was happening behind closed doors, and all this without our ever having established even the smallest thing that might at some point in the future throw him a lifeline.
Chapter
24
I lost that little boy,” I said. “The little one who was with me the other day.”
Gerda’s brow wrinkled.
“There is a lot of pressure in his family to be absolutely perfect. He doesn’t talk, and they wanted me to flick some kind of switch to make him start and that would be the end of it. They got very upset when we suggested there might be more to it and stormed off with him.” I looked over at her and sighed. “I’m really sad about it.”
Gerda reached out and patted the air, as if patting an invisible child’s head. She made an exaggerated frown.
I nodded. “Yeah. It’s awful. Something is wrong and no one is listening. No one is asking why he has this problem.”
I paused and reconsidered. “Not that I mean that in a nasty way. I don’t want to imply they’re neglecting his problems, because they’ve actually gone to quite a lot of trouble for him. Just that they’ve got their own agenda. Their emphasis is only on how the world sees them; that’s what’s important. How respectable he is, so that they will present a perfect face to the world. No one seems to be looking from the perspective of why this has happened, how it will impact his life, and what we can do to enable him to deal with it meaningfully.”
“I wanted blades for Christmas,” she said softly.
I looked over at her.
She was staring at the wall. “For my skates. Left blade was chinked. Fourteen that year. Louisa and I went skating every night. Done our chores. Went in the half-light. Went in the twilight. In the darkness because darkness came so early that time of year. So cold. Creek froze hard. Like a ribbon through the hills. And I put my skates on and I was a bird. So free. Gliding so fast over the ice. Down the creek. Through the hills. Fast as a swallow.
“But my blade had a chink. Left blade. Stopped me going fast. I said, ‘I want blades for Christmas.’”
She paused. “Blades aren’t expensive,” she said softly, quietly in what was almost a meditative tone. “Karl could do a sharp pair for me at the mill. I wanted it so much. Couldn’t go fast with a chink in the blade or I’d fall. And fourteen that year. Going fast mattered.”
Gerda turned her head and met my eyes, held my gaze a moment, and then looked away again.
“Come Christmas and I seen that long narrow package just for me. Knew it was blades. Seen it under the tree and I felt so happy. Felt happy for days.
“Then Christmas comes and I open it …”
She sighed. A pause intruded. She sighed a second time.
“Perfume. In a fancy bottle. Fancy glass bottle so narrow and this high.” She measured with her hands. “With a long pointed glass stopper. Not blades at all. Perfume in a fancy bottle.
“Mama looks right at me. Says, ‘You thought it was blades, didn’t you?’ She said that. Then got so angry with me because I wasn’t grateful. I spoiled Christmas for everyone. Ruined everyone’s happiness, because there was a big fight. Because I cried when I should have been grateful. What’s wrong with you, they say. Perfume in a fancy bottle came from the city. It’s special. A gift any girl your age would want. And Mama and Papa went to so much trouble to get it.”
Gerda paused again
“But why did they get me perfume?” she said, her voice still querying after all these years. “I asked my sister Louisa. Said, if Mama knew I want blades so much, she could see the look in my eye, why’d she get me perfume? Perfume’s so much more expensive. Why did they spend so much money on something I never wanted? Why do that, if they knew all along what I did want? Why not give me blades?
“Louisa said I shouldn’t have spoiled everyone’s Christmas. Mama and Papa made a special effort, getting that. Should be grateful. It’s what normal girls want.”
One of the most challenging aspects of working with highly manipulative individuals such as Cassandra is the way they make the rest of us feel about ourselves when with them. Most people who go into psychology, psychiatry, and the other helping professions do so at least in part with hopes of alleviating some suffering in the world, of helping those less fortunate find a better life. When the person being helped does not get better, does not respond to efforts of help, it tends to bring up understandably unhappy feelings in the helper, be the helper a therapist, teacher, medical doctor, aid worker, drug counselor, or whomever. You often start to feel a kind of dread about working with the individual, a sort of hopeless, helpless frustration that makes it hard to like the individual and want to be in the situation, but at the same time it also generates an intense worry that if you don’t continue, things might get worse. It is easy to envision horrible and realistic scenarios, such as institutionalization, jail, or suicide, happening if you fail, and equally easy to feel if the failure happens, it’s your fault.
The manipulative person often feeds into these complex feelings in the helper in a way that creates a feeling of specialness. From what the person does and says, you begin to feel that only you can save this person. You are the one there on the front line with the clearest view of how bad things are, and you alone are all that stands between the individual and serious consequences. This specialness can feel almost like a sense of mission sometimes, and it makes it easy to believe that by trying harder you will succeed. And what “trying harder” usually means is crossing boundaries that have previously been in place—boundaries of time, touch, or situational structure, for instance—and if you do these things, this will prove to the person your commitment to help, will show him or her that you want to be there in such a meaningful way that this will make all the difference. You believe that if you only do this one more thing, you will finally connect with the person and he or she will start to get better.
This is actually a normal caring response. It isn’t unhealthy in itself, and in relationships with other normal and healthy individuals, these “caring” responses of feeling worried or guilty for not helping, of being willing to go the extra mile, actually do make a difference. The person in need responds to them by getting better. And that’s the important distinction.
The highly manipulative individual has a different reaction. Instead of improving, he or she uses these responses to perpetuate a destructive behavioral cycle and, in fact, actually manipulates people to provoke such reactions from them to feed this cycle. Consequently, the normal caring response has the opposite effect on these mentally ill individuals and actually perpetuates the problem rather than stopping it.
In most instances, this manipulation is not a conscious effort on the part of the mentally ill person. They do not set out purposefully to control other people in this manner. In most instances, they are genuinely trapped in a cycle of re-creating past troubled relationships and are unaware of using their manipulative behavior to make people in their current life feel and respond to them in the same way they experienced in this past relationship.
Because of the tendency for this kind of manipulative behavior to bring up such difficult feelings in the
person who is trying to help, a phenomenon that is called “countertransference” in psychiatric terminology, one has to be very aware when working with manipulative individuals, not only of what he or she is doing but also what it is doing inside oneself. This is the only way to avoid getting sucked into these responses and eventually the only way to help the individual recognize what is happening so that the destructive cycle can be broken.
With children, of course, it isn’t quite so straightforward. Developmentally, they are still very egocentric, which means they cannot think as objectively about themselves as people in later adolescence and adulthood can. Moreover, in Cassandra’s case, the issue of multiple personalities complicated things further. While on the ward or at the start of therapy sessions, she was often very manipulative and controlling, there were other moments when she seemed quite earnest. Were we connecting with a nascent alternate that did not manipulate? Or was it possible the whole multiple personality thing itself was a manipulation? This was unlikely, given Cassandra’s age, and would indicate a scary level of pathology; nonetheless, the possibility couldn’t be ruled out altogether. So I needed to keep an unusually alert and open mind. The personalities might provide a useful way of reaching Cassandra. At the same time, they might be there to control me.
Cassandra was yet again in lockdown when I came for her. I opened the seclusion room door and went in. I sat down on the padded floor beside Cassandra. She didn’t look at me.
“You know, every single time I’ve come for you recently, you’ve been here in the seclusion room.”