The Boy Who Was Raised as a Dog (22 page)

In fact, some theories of language development suggest that humans learned to dance and sing before we could talk, that music was actually the first human language. It's true that babies learn to understand the musical aspects of speech—the meanings of tones of voice, for example—long before they understand its content. People universally speak to babies—and interestingly, to pets—in a high pitch that emphasizes a nurturing, emotional, musical tone. In all cultures even mothers who cannot carry a tune sing to their babies, suggesting music and song play an important role in infant development.

Connor, however, had missed out on music and rhythm when he most needed it. When he cried during the day in his early infancy no one came to rock him and calm him and bring his stress response systems and hormones back down into the normal range. Though he did get normal care at night and on weekends during his first eighteen months, those lonely eight-hour stretches left a lasting mark.

In order to make up for what he'd lost, we decided to have Connor participate in a music and movement class that would help him consciously learn to keep a beat and, we hoped, help his brain get a more general sense of rhythm. The class itself was nothing unusual: it looked a lot like what you would see in any kindergarten or preschool music class, where children learn to rhythmically clap their hands, to sing together, to repeat sounds in patterns and tap out beats with objects like blocks or simple drums. Here, of course, the children were older; unfortunately, we had many other patients who had suffered early neglect with whom to study this approach.

At first Connor was remarkably arrhythmic: he couldn't keep time with the most basic beat. His unconscious rocking had rhythm, but he couldn't deliberately mark out a steady beat or imitate one. I believe this was caused the missing early sensory input to the brainstem, which created a weak connection between his higher and lower brain regions. We hoped that by improving his conscious control over rhythm we could improve these links.

Early on the class was frustrating for him, and Jane became discouraged. At this point we had been treating Connor for about nine months. The frequency of his outbursts had lessened, but one day he had a ferocious temper tantrum in school. School officials called Jane at work, demanding that she pick her son up immediately. I'd gotten used to regular, frantic calls from her several times a week, but this incident brought her despair to a new level. She thought that this meant Connor's treatment had failed, and I had to use all my persuasive powers to keep her committed to this admittedly unusual therapeutic approach. She had seen dozens of very good therapists, psychiatrists and psychologists and what we were doing didn't look remotely like any of these previous treatments. She, like so many parents of struggling children, just wanted us to find the “right” medications and teach Connor to “act” his age.

That weekend, when I saw her number come up on my pager again, I cringed. I didn't want to call her back and learn about yet another setback or have to talk her out of trying some counterproductive alternate treatment from some new “expert” someone had told her about. I forced myself to return the call, taking a deep breath to calm myself first. I thought my worst fears were confirmed when it was immediately clear from her tone of voice that she'd been weeping.

“What's wrong?” I asked quickly.

“Oh, Dr. Perry,” she said. She paused and seemed to have difficulty going on. My heart sank.

But then she continued, “I have to thank you. Today Connor came up to me, hugged me and said he loved me.” It was the first time he'd ever
done that spontaneously. Now Jane, rather than worrying about our approach, became one of our biggest fans.

 

AS CONNOR PROGRESSED in the music and movement class, we began to see other positive changes as well. For one, his gait became much more normal, even when he was nervous. Also, over time the rocking and humming gradually lessened. When we first got to know him these behaviors were almost constant if he wasn't engaged in a task like schoolwork or playing a game. But now he only reverted to them if something seriously frightened or upset him. I wish all of my patients were as easy to read! Because of this trait I was able to know instantly if we had gone too far with any challenge and pull back until he could comfortably face it. After he'd been in treatment for about a year, his parents and his teachers began to see the real Connor, not just his weird behavior.

After he'd learned to successfully sustain a rhythm, I began parallel play therapy with him. The music and movement class and massage therapy had already improved his behavior: so far, he had had no further tantrums after the incident that had almost prompted Jane to end his therapy with us. But he still lagged in social development, was still being bullied and still had no friends. A typical treatment for adolescents with such problems is a social skills group like the one Connor had been in when he first came to us. However, because of the developmental lag he'd experienced due to his early neglect, this was still too advanced for him.

The first human social interaction begins with normal parent/infant bonding. The child learns how to relate to others in a social situation in which the rules are predictable and easy to figure out. If a child doesn't understand what to do, the parent teaches him. If he persists in misunderstanding, the parent corrects him. Repeatedly. Mistakes are expected and rapidly and continually forgiven. The process requires enormous patience. As Mama P. reminded me, babies cry, they spit up, they “mess,” but you expect it and love them anyway.

In the next social arena the child must learn to master—the world of peers—violating social rules is far less tolerated. Here, rules are implicit and are picked up mostly by observation rather than direct instruction. Mistakes can result in long-term negative consequences as peers rapidly reject those who are “different,” those who don't understand how to connect and respond to others.

If someone hasn't developed the ability to understand the clearly defined rules of the parent/child relationship, trying to teach him peer relations is almost impossible. Just as higher motor functions, such as walking, rely upon rhythmic regulation from lower brain areas like the brainstem, more advanced social skills require mastery of elementary social lessons.

I had to approach Connor carefully because, at first, he was skeptical about me: talking to shrinks hadn't done him much good, and he found relating to others difficult in general. So I didn't attempt to engage him directly. I gave him control of our interaction; if he wanted to talk to me, I would talk to him, but if he didn't, I would let him be. He'd come in for therapy and would sit down in my office. I would continue to work at my desk. We simply spent time in the same space. I demanded nothing, he asked for nothing.

As he became more comfortable, he became more curious. He'd move a little bit closer to me, and then closer still, and pretty soon he'd come over and stand near me. Finally, after many weeks, he'd ask, “What are you doing?” And I'd say, “I'm working. What are you doing?”

“Uh, I'm in therapy?” he'd say questioningly.

“Well, what's therapy to you?”

“We sit and talk?”

“OK,” I'd say, “What do you want to talk about?”

“Nothing,” he'd reply at first. I'd tell him that was fine, I was busy, he should do his homework and I'd do my work.

After a few more weeks, however, he said he did want to talk. We sat face to face and he asked, “Why are we doing this?” This had not been at all like the therapy he was familiar with. So I began to teach him about
the brain and brain development. I told him what I thought happened to him when he was an infant. The science made sense to him, and he immediately wanted to know, “What's the next step? What do we do next?” That's when I talked about forming relationships with other people, saying that he didn't seem very good at it.

He said emphatically, but with a smile, “I know, I suck!” Only then did I start to do explicit social coaching, which he was instantly eager to start.

It was harder than I'd thought it would be. Body language and social cues were unintelligible to Connor: they simply didn't register. Working with Connor, it hit me over and over again how sophisticated and subtle much of human communication is. I told him, for example, that people find eye contact engaging during a social interaction, so it is important to look at people while you listen to them and when you talk to them. He agreed to try it, but this resulted in him staring fixedly at me, just as he'd formerly fixed his gaze on the floor.

I said, “Well, you don't want to look at people all the time.”

“Well, when do I look at them?”

I tried to explain that he should look for a little while, and then look away, because lasting eye contact is actually a human signal of either aggression or romantic interest, depending on the situation. He wanted to know exactly how long to look, but of course, I couldn't tell him because of how dependent such things are on nonverbal cues and context. I tried telling him to wait three seconds, but this resulted in him counting out loud and made matters worse. As we practiced I rapidly discovered that we use more social cues than I had ever realized, and I had no idea how to teach them.

For example, when Connor looked away after initiating eye contact, he would turn his whole face, rather than simply moving his eyes. Or, he'd look up afterwards, his eye rolling unintentionally signaling boredom or sarcasm. It was like trying to teach someone from outer space to make human conversation. Eventually, however, he got to the point where he could socially engage, even though he still often seemed a bit robotic.

Each step was complicated. Trying to teach him to shake hands properly, for example, resulted in alternately limp fish approaches and too-firm grips. Because he didn't read other people's cues very well, he often wasn't aware that he'd said something that hurt someone's feelings, or perplexed them, or seemed frighteningly odd. He was a nice young man: when he came in, he would always say hi to the secretaries and attempt to engage them in conversation. But something about the interaction would be off, often his wording and tone of voice would be odd and he wouldn't notice the awkward silences. Once someone asked him where he lived, and he responded, “I just moved,” and left it at that. From his tone and short reply the other person figured that he didn't want to talk. He would seem brusque or weird; Connor didn't understand that he needed to put the person at ease by providing more information. Conversations have a rhythm to them, but Connor didn't yet know how to play along.

At one point, too, I tried to address his fashion sense, which was another source of trouble with his peers. Style is partly a reflection of social skills; to be fashionable you have to observe others and read cues about “what's in” and “what's out,” and then discover how to copy them in a way that suits you. The signals are subtle and a person's choices, in order to be successful, must reflect both individuality and appropriate conformity. Among adolescents, ignoring these signals can be socially disastrous—and Connor was clueless.

He'd wear his shirt buttoned all the way up to the neck, for example. One day, I suggested not buttoning the top button. He looked at me like I was crazy and asked, “What do you mean?” I responded, “Well, you don't always have to button it.”

“But there's a button there,” he said, uncomprehending.

So I took a pair of scissors and cut it off. Jane was not pleased, calling me up to say, “Since when are scissors part of a normal therapeutic intervention?” But as he continued to improve, Jane calmed back down. Connor even made friends with another boy in our treatment program, a teenager who had also suffered neglect and who was at a similar level of emotional development. They'd been in the music and movement
class together. When the other boy was frustrated about not being able to keep time, Connor had told him that he'd been just as bad at first, and then urged him to stick with it. They bonded even further over, of all things, Pokémon cards. At the time they were popular with elementary school-age children, but this was the emotional level of these boys' development, even though they were high school sophomores. They tried to share their obsession with their peers, but the other teens, of course, made fun of them.

Connor had one final out-of-control incident, incidentally, which was a result of the Pokémon obsession. He was defending his friend from some other adolescents who were teasing him about the cards, trying to tear them up. Jane, of course, panicked when she heard about it. She'd thought I shouldn't encourage the boys in their Pokémon games, fearing just such an incident. I did speak with both of them about when and where to flash their Pokémon cards, but I thought it was better to allow the connection between these two to flourish since it was giving both boys an opportunity to practice their social skills. I didn't think they'd be able to go from preschool to high-school socialization without elementary-school-like experiences (such as Pokémon) as intermediate steps, as awkward as I knew they'd be. We explained the situation to the school and Connor and his friend continued to enjoy Pokémon, but with a bit more discretion.

Connor went on to graduate high school and college without further outbursts. He continued his “sequential” development with just a bit of help from our clinical team; we saw him on breaks from school. He continued to socially mature. I knew the treatment had been a success when Connor—now a computer programmer—sent me an email with the header: “Next lesson: Girls!”

 

CONNOR IS STILL SOCIALLY awkward and may always be “geeky.” However, even though he suffered almost exactly the same kind of neglect during a similar developmental period as Leon did, he never showed anything like the other teen's malicious, sociopathic behavior. He became a victim of bullies, not a bully himself; while he was an outsider,
he was not someone filled with hate. His behavior was bizarre and his tantrums appeared threatening, but he didn't attack other children or steal from them or enjoy hurting people. His rages were prompted by his own frustration and anxiety, not by a desire for vengeance or a sadistic wish to make others feel as bad as he did.