Twilight Children (25 page)

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.”

“That’s because they hate me,” she muttered.

“No, I think it’s because you’re breaking the rules.”

She hit her heel hard against the mat and didn’t answer.

“There are certain things the other staff and I can’t let you do,” I said. “We’re sorry you have to spend time in lockdown, but when you break the rules, that’s the consequence.”

“It’s not fair!”

“You think it’s not fair,” I said.

“
No
. Because I can’t help it,” she muttered.

“You don’t think you can help acting this way?”

“
No
. I wouldn’t be in here otherwise, would I? So don’t be stupid.” She kicked the mat again. “I might as well be dead.”

“You’re really feeling angry.”

“I hate you. You’re no good. You don’t help me any.”

“It would be easier to help you if you weren’t in lockdown, however. Wouldn’t it?”

“Dr. Brown used to help me. When I saw her, she didn’t make a bunch of rules like you do. She didn’t even have a seclusion room. I got
better
when I was with her.”

“You wish I were Dr. Brown. And you wish you could do things your way. But sadly, that can’t always happen because we can’t allow you to hurt yourself or to hurt other people.”

“Yeah, but you always want to do it
your
way.
Everything
has to be your way. And that’s not fair,” Cassandra said.

“I’m older and more experienced. I’ve been taught a lot of things to make me smart. So when I ask you to do things my way, it’s because I know these are ways to help kids get better,” I replied.

“Dr. Brown knew better stuff than you,” she said disparagingly.

“Cassandra, I know you liked Dr. Brown—”

“I
didn’t
like Dr. Brown. I
had
to go to her. But
she
knew what she was doing.”

“Okay. What I’m saying is, it’s not helpful to keep bringing Dr. Brown into the conversation. She isn’t here. So I’m going to stop talking about her. And when you discuss Dr. Brown from now on, I’m not going to participate.”

“I
wish
she was here.”

I stood up.

Cassandra swiveled her head and looked up at me.

“So I’m going to go now,” I said.

“Huh?”

I started for the door of the seclusion room.

Cassandra leaped to her feet. “Hey, wait. This is my time with you.”

“Yes, I know it is. But sadly, you’re in lockdown.”

“Yeah, but you’re supposed to work with me now. This is the time I always go with you,” Cassandra cried.

“Yes, I know. But you aren’t ready today.”

“I’m ready. I didn’t say I wasn’t ready, did I? Why are you always such a bitch?”

“You aren’t ready, because you’re in lockdown. And why are you in lockdown?”

Cassandra shrugged. “I don’t know.”

I looked pointedly at her.

“I don’t remember.”

“Okay, in that case, I’ll help you remember,” I said. “One reason is because you were in Selma’s bedroom again. A second reason is because you did not come out when a staff member asked you to, even though you know that is not a place you are allowed. A third reason is because you punched and fought with Larry when he tried to remove you. A fourth reason is because you were screaming about Larry touching you sexually when that wasn’t happening. Those are the reasons why you are here. Now, when people are put into the seclusion room, they are meant to stay in here until their time is up and they feel more in control of themselves.”

“I feel in control,” Cassandra said.

“Yes, you say that, but events show differently. Every day for the last four times, you’ve been in lockdown when it is time for your session with me. Each day I’ve let you come with me, but then the next morning you are back in lockdown again. That means the same things are happening over and over, instead of your getting more in control of them. When I see you doing the same thing over and over, I get concerned that I’m not helping you by taking you out of here to go for our sessions. So, from today, if you want to come to your sessions with me, you need to be on the ward, not in lockdown. If you’re in here, you will stay until it is time for you to come out; and if you miss our session, I will be sorry about that but that is just how it is.”

“No fair!” she cried, outraged. Indeed, her face went all red with the intensity of her feelings. “No
fair
! You’re just making up rules as you go along! Just to boss me!”

“I’m sorry you feel that way. But my job is to help you get better so that you can go home, and when I see I am doing something that doesn’t help, then I change it.”

“No
fair
! You hate me! You don’t want to help me! You don’t
want
me to get well!”

I went out and closed the door behind me.

Cassandra exploded inside the seclusion room. Shrieking, screaming, howling like an injured animal, she flung herself against the padded walls, against the padded door.

The hardest moment I had thus far had with her was then, when I walked away.

L
osing Drake continued to eat at me. As the hours passed and the next week started, I kept thinking about him, replaying in my mind our therapy sessions, trying to glean from my memory what I had not managed to see in real life.

I could only envision three possible scenarios to explain his mutism. In the first, Drake was as he had appeared to me in observation: an elective mute, who just happened also to be outgoing and otherwise well adjusted. If this was the case, I wasn’t too worried about his long-term prognosis. My sense was that he was adaptable and mentally stable. Thus, the mutism would most likely resolve itself as part of the maturational process, whether we burned the house down to roast the pig or not.

In the second scenario, Drake was not speaking because, in fact, he couldn’t speak. There was a physical reason for his silence. The audiotape and the Mayo report made it unlikely this was the case, but if so, leaving the problem untreated was going to do nothing but create greater problems in the long term. We were wasting valuable time chasing imaginary problems and not dealing with the real one.

In the third scenario, Drake was a child in real danger. Such severe mutism at such a young age red-flagged a seriously troubled environment. While it was puzzling that he had not given signs of distress in other areas, I had to admit how deft he was at using charm to deflect attention from things he didn’t want to deal with. Perhaps he was using the same remarkable control he showed in not speaking to wall off his traumatized feelings. If this was so, then we had really failed him.

Over and over I thought about these different interpretations. All of them were fatally flawed. If he were really all right and this was just a quirky kid thing, why had it not responded to intervention? If it were a physical disability, how could he talk on the tape? Why had nothing shown up in the Mayo exam? If it were the result of trauma, why were there not additional indicators? Why had we not seen his guard slip even the littlest bit during treatment?

The one wild card was Drake’s family. Respectable and industrious citizens of Quentin they may have been, but it was not hard to discern dysfunction below the surface. The worst among them, of course, was Mason Sloane. Along with his imperious attitude and his explosive temper, he was a perfectionistic control freak. None of us had had a single chance to speak face-to-face to Drake’s parents without his grandfather being present, other than that brief exchange with Lucia I’d had out in Quentin after Sloane had stormed out. Otherwise, Mason Sloane controlled everything.

I wondered more and more about Lucia’s role in all this. Sloane always garnered the attention with his outrageous behavior, but Lucia, in fact, was in a much more influential position with Drake. I had not interacted with her often enough to understand whether marrying into such a difficult family was the source of her problems or whether she was a troubled individual in her own right; however, Lucia oozed anxiety and unhappiness the way an overfull septic tank seeps into the surrounding ground.

And Drake’s father? We kept being told Drake had one, that he did, in fact, really exist. None of us, however, had concrete evidence of this. Even the day Drake was brought to the unit, it was by Mason Sloane and Lucia. Even on that occasion, Walter was “working.”

Given this group of adults, dysfunction was a rational assumption, but was it enough to conclude serious child abuse? Moreover, assumptions, however logical, are not the same as evidence. This is a very important—and necessary—distinction. It is evidence, not creative deduction, which counts, and this is how it should be. And the flat truth was, we had absolutely no concrete evidence of abuse in Drake’s case. Nonetheless, this interpretation of his mutism weighed heavily on my mind, making me so regret losing Drake at this point.

In the end, I couldn’t rest comfortably on the case, so I decided to call the Sloanes. This was well within acceptable procedure for the unit. Because we were, in part, a diagnostic unit, this meant long-term care was almost always in the community. Consequently, there was normally extensive follow-up in the period immediately after a child was released in order to continue programs started on the unit. With Drake, this wouldn’t be the case, of course, given the manner in which he had been removed from the unit; however, a follow-up call was still within reasonable protocol.

Along with finding out how Drake was doing, I also hoped it would give me a chance to catch Lucia on her own. I timed the call for early afternoon, thinking that not only would Drake probably be taking a nap but most likely so would the old man, wherever he might be.

Lucia answered. She sounded startled when I said who I was. I said how sorry I was that things had ended as they had, and I said I was still concerned about Drake. I explained we usually followed up our work on the unit, so I was phoning to see how he was.

“He’s fine,” she said and her voice was curiously flat. “He went back to his preschool on Monday. Everyone was so happy to see him. He was glad to be back.”

“That’s good. And what do you think is going to happen now regarding his mutism?” I asked.

I heard an intake of breath, the sort before one starts to speak, but nothing followed.

“Have you got plans to get further help?”

“Father says there is a program in California,” she replied in a mousy little voice.

“By ‘Father,’ you mean the elder Mr. Sloane?”

There were little noises on the other end of the phone. I could imagine her nodding but she didn’t speak.

“So, what program is this? Something especially for treating elective mutism?” The only programs I could think of in California that had gained nationwide attention were for autistic children, so I was dismayed to hear this. I had horrible visions of Mason Sloane, full of unrealistic expectations, trailing Drake around the country from specialist to specialist.