The Boy Who Was Raised as a Dog (15 page)

As I began talking I tried to engage Mama and make her feel comfortable. I knew that people can “hear” and process information much more effectively if they feel calm. I wanted her to feel safe and respected. Thinking back now, I must have seemed very patronizing to her. I was too confident; I thought I knew what was going on with her foster child and the implicit message was, “I understand this child, and you don't.” She looked at me defiantly, her face unsmiling, her arms folded. I went
into long-winded and very likely unintelligible explanation of the biology of the stress response and how it could account for the boy's aggression and hyper-vigilance symptoms. I had not yet learned how to clearly explain the impact of trauma on a child.

“So what can you do to help my baby?” she asked. Her language struck me: why was she calling this seven-year-old child a baby? I wasn't sure what to make of it.

I suggested clonidine, the medication I'd used with Sandy and the boys at the center. She interrupted quietly but firmly, “You will not use drugs on my baby.”

I tried to explain that we were quite conservative with medications, but she wouldn't hear it. “No doctor is going to drug up my baby,” she said. At this point the child psychiatry fellow, Robert's primary clinician, who was sitting next to me, started to fidget. This was awkward. Mr. Bigshot Vice-Chairman and Chief of Psychiatry was making an ass of himself. I was alienating this mother and getting nowhere. I again tried to explain the biology of the stress response system, but she cut me off.

“Explain what you just told me to the school,” she said pointedly. “My baby does not need drugs. He needs people to be loving and kind to him. That school and all those teachers don't understand him.”

“OK. We can talk to the school.” I retreated.

And then I surrendered. “Mama P., how do you help him?” I asked, curious about why she didn't have the problems with his “rages” that had gotten him expelled from prior foster homes and schools.

“I just hold him and rock him. I just love him. At night when he wakes up scared and wanders the house, I just put him in bed next to me, rub his back and sing a little and he falls asleep.” The fellow was now stealing looks at me, clearly concerned: seven-year-olds should not sleep in bed with their caregivers. But I was intrigued and continued to listen.

“What seems to calm him down when he gets upset during the day?” I asked.

“Same thing. I just put everything down and hold him and rock in the chair. Doesn't take too long, poor thing.”

As she said this I recalled a recurring pattern in Robert's records. In every one of them, including the latest referral from the school, angry staff reported frustration with the boy's noncompliance and immature “baby-like” behaviors, and complained about his neediness and clinginess. I asked Mama P., “So when he acts like that, don't you ever get frustrated and angry?”

“Do you get angry with a baby when a baby fusses?” she asked. “No. That is what babies do. Babies do the best they can and we always forgive them if they mess, if they cry, if they spit up on us.”

“And Robert is your baby?”

“They are all my babies. It's just that Robert has been a baby for seven years.”

We ended the session and made another appointment for a week later. I promised to call the school. Mama P. looked at me as I walked with Robert down the clinic hall. I joked that Robert needed to come back to teach us more. At that, she finally smiled.

Over the years Mama P. continued to bring her foster children to our clinic. And we continued to learn from her. Mama P. discovered, long before we did, that many young victims of abuse and neglect need physical stimulation, like being rocked and gently held, comfort seemingly appropriate to far younger children. She knew that you don't interact with these children based on their age, but based on what they need, what they may have missed during “sensitive periods” of development. Almost all of the children sent to her had a tremendous need to be held and touched. Whenever my staff saw her in the waiting room holding and rocking these children, they expressed concern that she was infantilizing them.

But I came to understand why her overwhelmingly affectionate, physically nurturing style, which I'd initially worried might be stifling for older children, was often just what the doctor should order. These children had never received the repeated, patterned physical nurturing needed to develop a well-regulated and responsive stress response system. They had never learned that they were loved and safe; they didn't have the internal security needed to safely explore the world
and grow without fear. They were starving for touch—and Mama P. gave it to them.

 

NOW, A S ISAT with Laura and her mother, I knew that they both could benefit, not only from Mama P.'s wisdom about childrearing, but also from her own incredibly maternal and affectionate nature. I went back to the nurse's station, dug out her phone number, and called. I asked her if she'd be willing to have a mother and her child move in with her, so that Virginia could learn how to raise Laura. She immediately agreed. Fortunately, both families were involved in a privately funded program that allowed us to pay for this kind of care, which the foster care system is usually too inflexible to permit.

Now, I had to convince Virginia—and my colleagues. When I returned to the room where she was waiting, Virginia seemed anxious. My psychiatry colleague had given her one of the papers I had written that focused on our clinical work with abused children. Virginia assumed that I had deemed her an incompetent parent. Before I could even speak, she said, “If it will help make my baby better, please take her.” Virginia did love her baby—so much that she was willing to let her go if that's what it took for her to recover.

I explained what I wanted to do instead, that I wanted her to live with Mama P. She, too, assented right away, saying she would do anything to help Laura.

My pediatric colleagues, however, were still extremely concerned about Laura's nutritional needs. She was so underweight that they were afraid that she would not take in enough calories without medical support. After all, she was currently being fed through a tube. I told the other doctors that we would strictly monitor her diet to be sure she was getting enough calories, and it turned out to be a good thing that we did. We could then document her remarkable progress. For the first month with Mama P., Laura consumed the exact same number of calories she had in the prior month in the hospital, during which her weight had barely been maintained at twenty-six pounds. In Mama P's nurturing
environment, however, Laura gained ten pounds in one month, growing from twenty-six to thirty-six pounds! Her weight increased by 35 percent on the same number of calories that had previously not been enough to prevent weight loss, because she was now receiving the physical nurturing her brain needed to release the appropriate hormones required for growth.

By observing Mama P. and by receiving the physical affection Mama showered on everyone around her, Virginia began to learn what Laura needed and how to provide it for her. Before Mama P., meals had been robotic or filled with conflict: the constantly changing dietary instructions and advice given by various doctors and hospitals who were trying to help just added to the confused hollow experience of eating for Laura. Also, because of Virginia's lack of understanding of her child's needs, she'd swing from being affectionate to being tough and punitive to simply ignoring her daughter. Without the rewards that nurturing normally provides both mother and child, Virginia had been especially prone to frustration. Parenting is difficult. Without the neurobiological capacity to feel the joys of parenting, irritations and annoyances loom especially large.

Mama P.'s sense of humor, her warmth and her hugs allowed Virginia to get some of the mothering she'd missed. And by watching how Mama P. responded to her other children and to Laura, Virginia began to pick up on Laura's cues. Now she could better read when Laura was hungry, when she wanted to play, when she needed a nap. The four-year-old had seemed stuck in the defiant stage of the “terrible twos,” but now she began to mature, both emotionally and physically. As Laura grew, the tension between mother and daughter during mealtimes ended. Virginia relaxed and was able to discipline with more patience and consistency.

Virginia and Laura lived with Mama P. for about a year. Afterwards, the two women remained tight friends, and Virginia moved into Mama's neighborhood so that she could remain in close touch. Laura became a bright little girl, similar to her mother in that she tended to be emotionally distant, but with a powerful moral compass; they both had strong
positive values. When Virginia had a second child, she knew how to care for him appropriately, right from the start, and he suffered no growth problems. Virginia went on to college and both of her children are doing well in school. They have friends, an invested church community and, of course, Mama P. just down the street.

Both Laura and Virginia still bear scars from their early childhoods, however. If you were to secretly observe either mother or daughter, you might find her facial expression vacant, or even sad. Once she became aware of your presence, she would put on her social persona and respond appropriately to you, but if you paid close attention to your “gut” you would sense something awkward or unnatural in your interactions. Both can mimic many of the normal social interactive cues, but neither feels naturally pulled to be social, to spontaneously smile or to express warm nurturing physical behaviors such as a hug.

Though we all “perform” for others to some extent, the mask slips easily for those who have suffered early neglect. On a “higher” more cognitive level both mother and daughter are very good people. They have learned to use moral rules and a strong belief system to tame their fears and desires. But in the relational and social communication systems of their brain, the source of emotional connections to others, there are shadows of the disrupted nurturing of their early childhoods. The nature and timing of our developmental experiences shape us. Like people who learn a foreign language late in life, Virginia and Laura will never speak the language of love without an accent.

chapter 5

The Coldest Heart

ENTERING A MAXIMUM-SECURITY prison is always daunting: after the extensive identity check at the gate, you have to hand over your keys, wallet, phone and anything else that could possibly be stolen or used as a weapon. Everything that identifies you, except your clothing, is confiscated. One of the first locked doors you pass through is marked by a sign saying, in effect, that if you are taken hostage past this point, you're on your own. The policy is ostensibly to prevent visitors from pretending to be held captive by prisoners and enabling their escape, but it also immediately instills an unsettling feeling. There are at least three or four double sets of thick metal doors, with many layers of human and electronic security between them, which slam solidly behind you before you can meet with the kind of prisoner I had been brought in to examine. Leon, at age sixteen, had sadistically murdered two teenage girls, and then raped their dead bodies.

Virginia and Laura demonstrated one way that neglect in early childhood can disrupt the development of the areas in the brain that control empathy and the ability to engage in healthy relationships—a loss that often leaves people awkward, lonely and socially inept. Emotional deprivation in the first years of life, however, can also predispose people to malice or misanthropy. In the mother's and the daughter's cases, fortunately, despite their underdeveloped capacity for empathy, both became highly moral people; their early childhood experiences had left them
emotionally crippled and often oblivious to social cues, but not filled with rage and hatred. Leon's story illustrates a much more dangerous—and fortunately, less common—potential outcome. Leon would teach me more about how much damage parental neglect—even unintentional neglect—can inflict, and how modern Western culture can erode the extended family networks that have traditionally protected many children from it.

Leon had been convicted of a capital offense and faced the death penalty. His defense had hired me to testify during the sentencing phase of his trial. This hearing determines whether there are “mitigating” factors, such as a history of mental health problems or abuse, that should be weighed when sentencing decisions are made. My testimony would help the court decide between life without parole and the ultimate punishment.

 

I VISITED THE PRISON on a perfect Spring day, the kind of clear day that makes most people happy to be alive. The cheery sound of chirping birds and the warmth of the sun seemed almost inappropriate as I stood in front of the massive gray building. It was five stories tall and made of cement block. It had too-few barred windows and a tiny green one-room guardhouse with a red door attached to one wall, which looked incongruously small compared to the imposing bulk of the prison. The grounds were surrounded by a twenty-foot wire fence with three coils of barbwire at the top. I was the only person outside. A few old cars were parked in the lot.

I approached the red door, my heart beating fast, my palms sweating. I had to tell myself to calm down. The whole place seemed fenced by tension. I walked in through a double door, passed through a metal detector, was summarily frisked and then taken into the compound by a guard who seemed as caged and resentful as a prisoner.

“You a psychologist?” she asked, looking me over disapprovingly.

“No. I'm a psychiatrist.”

“OK, whatever. You could spend a lifetime here.” She laughed disdainfully. I forced a smile. “Here's the rules. You must read this.” She handed
me a one-page document and continued, “No contraband. No weapons. You may not bring gifts or take anything out of the prison.” Her tone and attitude told me she had no use for me. Maybe she was angry that she had to spend this perfect day in prison. Maybe she was resentful because she thought that mental health professionals working with the justice system mainly help criminals escape responsibility for their actions.