The Boy Who Was Raised as a Dog (2 page)

Our work brings us into peoples' lives when they are most desperate, alone, sad, afraid and wounded, but for the most part the stories you'll read here are success stories—stories of hope, survival, triumph. Surprisingly, it is often when wandering through the emotional carnage left by the worst of humankind that we find the best of humanity as well.

Ultimately, what determines how children survive trauma, physically, emotionally, or psychologically, is whether the people around them—particularly the adults they should be able to trust and rely upon—stand by them with love, support and encouragement. Fire can warm or consume, water can quench or drown, wind can caress or cut. And so it is with human relationships: we can both create and destroy, nurture and terrorize, traumatize and heal each other.

In this book you will read about remarkable children whose stories can help us better understand the nature and power of human relationships. Although many of these boys and girls have had experiences far more extreme than most families will encounter (and thank goodness for that), their stories carry lessons for all parents that can help their children cope with the inevitable stresses and strains of life.

Working with traumatized and maltreated children has also made me think carefully about the nature of humankind and the difference between humankind and humanity. Not all humans are humane. A human being has to learn how to become humane. That process—and how it can sometimes go terribly wrong—is another aspect of what this book is about. The stories here explore the conditions necessary for the development of empathy—and those that are likely, instead, to produce cruelty and indifference. They reveal how children's brains grow and are molded by the people around them. They also expose how ignorance, poverty, violence, sexual abuse, chaos and neglect can wreak havoc upon growing brains and nascent personalities.

I have long been interested in understanding human development, and especially in trying to figure out why some people grow up to be
productive, responsible, and kind human beings, whereas others respond to abuse by inflicting more of it on others. My work has revealed to me a great deal about moral development, about the roots of evil and how genetic tendencies and environmental influences can shape critical decisions, which in turn affect later choices and, ultimately, who we turn out to be. I do not believe in “the abuse excuse” for violent or hurtful behavior, but I have found that there are complex interactions beginning in early childhood that affect our ability to envision choices and that may later limit our ability to make the best decisions.

My work has taken me to the intersection of mind and brain, to the place where we make choices and experience influences that determine whether or not we become humane and truly human.
The Boy Who Was Raised as a Dog
shares some of what I've learned there. Despite their pain and fear, the children in this book—and many others like them—have shown great courage and humanity, and they give me hope. From them I have learned much about loss, love and healing.

The core lessons these children have taught me are relevant for us all. Because in order to understand trauma we need to understand memory. In order to appreciate how children heal we need to understand how they learn to love, how they cope with challenge, how stress affects them. And by recognizing the destructive impact that violence and threat can have on the capacity to love and work, we can come to better understand ourselves and to nurture the people in our lives, especially the children.

chapter 1

Tina's World

TINA WAS MY FIRST child patient, just seven years old when I met her. She sat in the waiting room of the University of Chicago child psychiatry clinic: tiny and fragile, huddled with her mother and siblings, unsure what to expect from her new doctor. As I led her to my office and shut the door, it was hard to tell which one of us was more nervous: the three-foot-tall African-American girl with meticulously neat braids or the six-foot-two white guy with the long mane of unruly curls. Tina sat on my couch for a minute, checking me out, looking me up and down. Then, she walked across the room, crawled into my lap and snuggled in.

I was touched. Gosh, what a nice thing to do. What a sweet child. Stupid me. She shifted slightly and moved her hand to my crotch and tried to open my zipper. I was no longer anxious. Now, I was sad. I took her hand, moved it from my thighs, and carefully lifted her off my lap.

The morning before I first met with Tina I read through her “chart”—one small sheet of paper with minimal information taken during a phone interview with our intake worker. Tina lived with her mother, Sara, and two younger siblings. Sara had called the child psychiatry clinic because her daughter's school had insisted that she get her evaluated. Tina had been “aggressive and inappropriate” with her classmates. She'd exposed herself, attacked other children, used sexual language and tried to get them to engage in sex play. She didn't pay attention in class and often refused to follow directions.

The most relevant history the chart contained was that Tina had been abused for a two-year period that started when she was four and ended when she was six. The perpetrator was a sixteen-year-old boy, her babysitter's son. He had molested both Tina and her younger brother, Michael, while their mother was at work. Tina's mom was single. Poor, but no longer on public assistance, at the time Sara worked a minimum wage job at a convenience store to support her family. The only childcare she could afford was an informal arrangement with her next-door neighbor. That neighbor, unfortunately, often left the children with her son so she could run errands. And her son was sick. He tied the children up and raped them, sodomized them with foreign objects, and threatened to kill them if they told. Finally, his mother caught him and put a stop to the abuse.

Sara never let her neighbor care for her children again, but the damage had been done. (The boy was prosecuted; he went to therapy, not jail.) Here we were, one year later. The daughter had serious problems, the mother had no resources, and I didn't know squat about abused children.

“Here. Let's go color,” I said gently as I took her from my lap. She seemed upset. Had she displeased me? Would I get angry? She anxiously studied my face with her dark brown eyes, watching my movements, listening to my voice for some nonverbal cue to help her make sense of this interaction. My behavior didn't fit with her internal catalog of previous experiences with men. She had only known men as sexual predators: no loving father, no supportive grandfather, no kind uncle or protective older brother had touched her life. The only adult males she'd met were her mother's often inappropriate boyfriends and her own abuser. Experience had taught her that men wanted sex, either from her or her mother. So quite logically from her perspective, she assumed that's what I wanted as well.

What should I do? How do you change behaviors or beliefs, locked into place from years of experience, with one hour of therapy a week? None of my experience and training had prepared me for this little girl. I didn't understand her. Did she interact with everyone as though they wanted sex from her, even women and girls? Was this the only way she knew how to
make friends? Was her aggressive and impulsive behavior at school related to this? Did she think I was rejecting her—and how might that affect her?

It was 1987. I was a fellow in Child and Adolescent Psychiatry at the University of Chicago, just starting the final two years of some of the best medical training in the country. I'd had almost a dozen years of postgraduate training. I was an MD, a PhD and had finished three years as a medical and general psychiatry resident. I ran a basic neuroscience research laboratory that studied the stress-response systems in the brain. I had learned all about brain cells and brain systems and their complex networks and chemistry. I had spent years trying to understand the human mind. And after all that time all I could think to do was this: I sat down with Tina at a small table set up in my office and handed her a set of crayons and a coloring book. She opened it up and paged through.

“Can I color in this?” she asked softly, clearly unsure what to do in this strange situation. “Sure,” I told her.

“Should I make her dress blue or red?” I asked Tina.

“Red.”

“OK.” She held up her colored page for my approval, “Very nice.” I said. She smiled. For the next forty minutes we sat on the floor, side by side, coloring quietly, reaching over to borrow crayons, showing our progress to each other and trying to get used to being in the same space with a stranger.

When the session was over, I walked Tina back to the clinic waiting area. Her mother was holding a young infant and talking to her four-year-old son. Sara thanked me and we set up another appointment for next week. As they left I knew I needed to talk to a supervisor with more experience who could help me figure out how to help this little girl.

Supervision in mental health training is a misleading term. When I was a medical intern learning to put in a central line, or run a code or draw blood, there were older, more experienced physicians present to instruct, scold, assist and teach me. I often received immediate—usually negative—feedback. And while it was true that we followed the model “watch one, do one, teach one,” a more senior, experienced clinician was always close by to help during any interactions with patients.

Not so for psychiatry. As a trainee, when I was with a patient, or a patient and her family, I was almost always working alone. After meeting with the patient—sometimes multiple times—I discussed the case with my supervisor. During training a child psychiatry fellow will typically have several supervisors for clinical work. Often I would present the same child or issue to multiple supervisors to gather their different impressions and gain from their multiple, hopefully complementary, insights. It is an interesting process that has some remarkable strengths but also has some clear deficiencies, which I was about to discover.

I presented Tina's case to my first supervisor, Dr. Robert Stine
¹
. He was young, serious, intellectual and in training to become a psychoanalyst. He maintained a full beard and wore what seemed like the exact same outfit every day: a black suit, a black tie, and a white shirt. He seemed a lot smarter than me. He used psychiatric jargon with ease: “the maternal introject,” “object relations,” “counter-transference,” “oral fixation.” And whenever he did, I'd look him in the eyes and try to look appropriately serious and thoughtful, nodding as if what he was saying was clearing things up for me: “Ah, yes. OK. Well, I'll keep that in mind.” But really I was thinking, “What the hell is he talking about?”

I gave a short but formal presentation, describing Tina's symptoms, history, family and the complaints from her school, as well as detailing the key elements of my first visit with her. Dr. Stine took notes. When I finished he said, “Well, what do you think she has?”

I had no clue. “I'm not sure,” I stalled. Medical training teaches a young physician to act much less ignorant than he or she really is. And I was ignorant. Dr. Stine sensed this and suggested we use the diagnostic guide for psychiatric disorders, the Diagnostic and Statistical Manual (DSM).

At that point, it was the DSM III. Every ten years or so it is revised to include updates in research and new ideas about disorders. This process is guided by objective principles but is very susceptible to sociopolitical and other nonscientific processes. For example, homosexuality was once
considered a “disorder” in the DSM and now it is not. But the main problem with the DSM—to this day—is that it is a catalog of disorders based on lists of symptoms. It is kind of like a computer manual written by a committee with no knowledge of the machine's actual hardware or software, a manual that attempts to determine the cause of and cure for the computer's problems by asking you to consider the sounds it makes. As I knew from my own research and training, the systems in that “machine”—in this case, the human brain—are very complex. As a result it seemed to me that the same “output” might be caused by any number of different problems within it. But the DSM doesn't account for this.

“So she is inattentive, a discipline problem, impulsive, noncompliant, defiant, oppositional and has problems with her peers. She meets diagnostic criteria for Attention Deficit Disorder and oppositional defiant disorder,” Dr. Stine prompted.

“Yeah, I guess so.” I said. But it didn't feel right to me. Tina was experiencing something more or something different than what was described by those diagnostic labels. I knew from my research on the brain that the systems involved in controlling and focusing our attention were especially complex. I also knew that there were many environmental and genetic factors that could influence them. Wasn't labeling Tina “defiant” misleading, given that her “noncompliance” was likely a result of her victimization? What about the confusion that made her think that sexual behavior with adults and peers in public is normal? What about her speech and language delays? And if she did have Attention Deficit Disorder (ADD), might the sexual abuse be important in understanding how to treat someone like her?

I didn't raise these questions, though. I just looked at Dr. Stine and nodded as if I was absorbing what he was teaching me.

“Go read up on psychopharmacology for ADD. We can talk more about this next week,” he advised.

I left Dr. Stine feeling confused and disappointed. Is this what being a child psychiatrist was like? I had been trained as a general (adult) psychiatrist and was familiar with the limitations of supervision, and with the
limitations of our diagnostic approach, but I was not at all familiar with the pervasive problems of the children I was seeing. They were socially marginalized, developmentally delayed, profoundly damaged and sent to our clinic so we could “fix” things that to me didn't seem fixable with the tools we had at our disposal. How could a few hours a month and a prescription change Tina's outlook and behavior? Did Dr. Stine really believe that Ritalin or some other ADD drug would solve this girl's problems?