. . . and it's not their genes either. – Dr. C

Goth Girl

Goth Girl is about a 14 year old who was lost, self-abusive, and hearing voices. Medical doctors were forcing her to take chemicals for her “psychosis.” Placed in a mental health facility for “crazy kids,”  Evie lost her feelings along the way.  You already may know, that can be a terrible feeling.

Goth Girl Pict

ORIGINALLY PUBLISHED @ BESTTHINKING.COM – JUNE 2013

Evoe

If we want a child to change his direction, we must understand what makes him move. Rudolf Dreikers, M.D.

Part I: Meet Evie
I’ll call her Evie. That’s not her real name, but her real name was just as pretty. It’s best to honor her privacy, as a professional and as a fellow human being. After all, this is her story, not mine.

Evie was 14 when I met her. Six months earlier, she was involuntarily placed in an emergency mental health hospital (called a “5150” in California) for her “psychosis.” She was given chemicals almost immediately and, after the legally required 72-hour hold, she was declared medically fit to go back home.

About two months later another “5150” occurred. This time, they gave her a new batch of chemicals (see Evie’s Chemical Cocktailabove) and upon release 72 hours later, she was placed, without her consent, in a residential mental health facility for teenagers. About four months later, I was brought in by the same agency as a consultant. I was there to train and supervise the therapeutic staff, and to train the child-care staff. For reasons you will see, I became Evie’s therapist. She was my only client.

Evie was “hearing voices,” according to the notes I read from her prior therapist. As I found out later, it was one voice. Evie had a friend who would talk to her once in awhile, especially when she was alone and when her emotions were in turmoil. I’ll call him Vlad. “Vlad is my friend, Dr. Cima,”she once told me. She wasn’t frightened. Vlad “spoke” to her at times, and she wrote to him.

Temperament: Sphere
For those trained in Keirseyan temperament theory, Evie is a Sphere – a young Idealist. That makes her rare (about one in twenty), and very hard to spot, especially in residential settings. Young spheres tend to blend in and take on the characteristics of Stars (young Artisans) or Squares (young Guardians), though, for reasons I’ll talk about later, they rarely, if ever, take on the characteristics of Cubes (young Rationals).

However, when Spheres are alone with someone they trust, their vivid metaphorical imagery quickly exposes their identity to an observant adult. We all use our imagination to some degree, now and again. However, Spheres stand alone in their ability to express their life experiences with metaphorical language. Little wonder why so many writers and poets are Spheres. (A few famous adult Sphere/Idealists: Emily Dickinson, Pearl Buck, Charles Dickens, James Joyce, Leo Tolstoy, Upton Sinclair, Oliver Stone, Paul Robeson, Joan Baez – and Plato. You can see more famous Spheres/Idealists here.)

Goth
Evie was “Goth.” Goth – from “gothic” – is one of those adolescent subcultures found in every generation. “Hippies,” “Hip-hops,” “Emos,” “Grunges” – and don’t forget the “beatniks” of the 1950’s” – are just a few adolescent subcultures. The more shocking and defiant the subculture, the more it brings out the worst in adults intent on “dealing with it.” Unwittingly, by “dealing with it” adults fortify one of the reasons kids join these subcultures – to gleefully irritate and annoy their supervisors. Another reason? Goth culture offers comforting refuge for some unhappy kids struggling to find their lost identity, especially true for Spheres.

Goth is often described as “somber, macabre, and glamorous.” You can throw in a touch of romance too. Black is the color of choice for the Goth crowd, and you could always find it in Evie’s lipstick, eye makeup, nail polish, and clothes – down to her black socks and black shoes. Evie always wore something in her dyed black hair too, usually flowers, often a black flower. Evie liked flowers.

She was introduced to Goth when she was twelve. She told me she fit in almost immediately. She started to read Gothic novels. A combination of horror and romance, famous Gothic literature includes novels like the Headless Horseman, The Legend of Sleepy Hollow, and The Adventures of Ichabod and Mr. Toad. Modern movie renditions include Edward Scissorhands, Beetlejuiceand Batman. (You can read more about the Goth subculture here.)

Something Else You Should Know
Evie was a “cutter.” Cutting is a form of self-mutilation. It occurs when a child takes sharp objects like razors, knives, or even pieces of glass and cut themselves, usually in secret. It’s usually done on the underside of the forearm, on the tops of thighs, but anywhere on the body is possible. When it occurs in residential settings, it can be “contagious.” Children vying for the attention of adults notice that “cutters” get a lot of attention. Like no other child at this 40-bed facility, Evie had the attention of everyone, and everyone was worried. She was an “active cutter.” (Nearly all long term “cutters,” in my experience, are Spheres.)

Also, as if there wasn’t enough turmoil in her life, for reasons unrelated to this story, her assigned therapist abruptly left the organization the Friday before I started, without a goodbye. Evie lost her only confidant, and she was devastated. When I arrived the following Monday morning, a number of staff members let me know Evie had an emotional, “cutting” weekend. I decided to be her therapist.

Summing up
Evie was emotionally turbulent. Her family had deteriorated, and so had Evie. She drifted into the Goth subculture a few years earlier. She was talking to a voice in her head, and she was cutting on herself almost daily. Four months earlier, she was removed from home and placed in a facility that was, as she would say over and over – “a place for crazy kids”– and she just lost her therapist, the one person she could trust.

The worst of this? The medical profession declared Evie “mentally ill” and gave her chemicals because she was “psychotic” and she was depressed. Good thing I’ve seen this hundreds of times in my career or I would have been depressed too – and maybe a little “psychotic.”

Part II: The Story
Unlike most therapists in society who meet with their clients once a week in an office, in residential settings, the kids live and the staff work at a self-contained campus. Bedrooms, classrooms, and therapist rooms are usually within short walking distance of each other.

That means, if you’re a therapist, it’s not unusual to have lunch with one of the teenagers, or to meet with her teacher, or to take a walk and have a private conversation – in addition to a more formal one-hour session in the office. In fact, it was my job to make sure therapists didn’t linger in their offices too much. “If you want to know how your kids are doing,”I would tell them, “go see them where they live.” So, I spent some time where she lived.

I began to see Evie, formally, once a week. Our first meeting was cordial. My job was to develop a trusting relationship, and Evie was rightfully cautious. As I had lectured my staff ad nauseamover the years, the adult is responsible to earn the child’s trust, not the reverse. I talked to her about things she liked. She said she liked to write. I asked what she wrote about, and if she would share them with me. “Oh no Dr. Cima,” she said,“I’d be way too embarrassed!”I told her I understood and maybe she would share with me some day. We talked about her life a little bit. She told me she loved her mother very much, though she had many “acting out” episodes when she lived with her mom, especially in the last year or two.

I also learned Evie had sporadic, unpredictable contact with her stepfather. He married Evie’s mother when she was three, and he was the only father she ever knew. Her parents divorced a year earlier and were more or less estranged for at least two years before the divorce was final. Evie’s stepfather had a girlfriend, and her mother was not dating.

Meet Pamela and Tom
I contacted Evie’s mother after my first talk with her. I’ll call her Pamela. Pamela lived by herself in her home about an hour from the facility. She worked long hours in a responsible position. I asked her if she was able to meet with me, she said of course, and we met the following Monday.

Over the next several months, I routinely met with Pamela at the facility. The two of us would have a conversation, and then we would bring in Evie. Pamela needed her own private time too. A good mother, she was confidently independent. She had a good enough paying job that she could afford to pay her bills and take care of her daughter even if her ex-husband didn’t contribute, which was often. (For the temperament trained reader, Pamela is a Protector Guardian.)

Sometimes, though, she was overwhelmed with self-recrimination about how all this happened, about what happens next, how the ex-husband’s girlfriend “didn’t help,”that she had no interest in dating, how she is responsible for all of Evie’s troubles, how her ex-husband is responsible for all of Evie’s troubles, and everything else that occurs when couples, with children, divorce. It’s important to keep in mind divorce is a process, not a date on the calendar, and it inevitably involves unavoidable upset for everyone involved. Evie was Pamela’s only child, and they were always very close.

Evie’s stepfather – let’s call him Tom – was a blue-collar worker (from Pamela’s portrayal, probably a Promoter Artisan). I never met him, though we did have one conversation over the phone. From what Pamela told me, over the past three years, Tom has been less and less involved in Evie’s life, missing gifts for birthdays and Christmas, and often not showing up for scheduled visits. Still, Evie wanted to see her dad.

In my one conversation with Tom, I told him he would have to make appointments to see Evie with me, and that I wouldn’t tell Evie about this until he showed up. In the next six months, Tom called my office on two different occasions to arrange a visit with Evie. He didn’t show up either time. I emailed him a few times and I left a few voice messages. I offered to go to his house to meet with him. He never responded. It was a choice he made. This also meant Evie didn’t hear from him during this time either. Evie let me know her feelings about this through her ongoing conversation with Vlad.

Making Progress
By the third or fourth time I met with Evie alone I asked again to read some of her stories. I could tell she was glad that I remembered to ask a second time. This time she said “okay,”with an apprehensive smile. She gave me her well-worn spiral binder and she asked me if I could read it right away. I told her I would.

I’ve read many stories and many poems from children in foster care over the years. Anger is a common theme, as is fear, and so is freedom. Despair is almost always part of them. For many kids in foster care, futures can be dim. Evie’s was different. It really wasn’t a story.

When I first began to read her words, I couldn’t make heads or tails of what she was saying. Her spelling was okay and her grammar was about the same. She capitalized the first letter of every sentence, every sentence ended in a period, and each sentence made sense. There were no questions marks, no exclamation marks, no quotation marks – just periods. After a while, when I read the sentence Where are you going Vlad, I finally “got it.”

Imagine reading a novel, and the person who wrote it deleted everything in the novel except the dialogue. There was no introduction, no building of the scene, no sense of when or where this was talking place, or even who was talking. Instead, the first sentence of the story started in the middle of a conversation between two people, neither of them identified, one sentence after another. I finally realized Evie wasn’t writing a story for someone to read. She was writing down the conversation she was having with Vlad, like dictation.

What was the conversation about? Well, for lack of a better description, it was about a “fair maiden in distress,” who was receiving advice by a loving friend named Vlad. Vlad was heroic, sometimes dark (he spoke of werewolves and may have been one himself according to Evie). Vlad loved the maiden in the conversation, Evie once told me, “just as a friend, Dr. Cima.” Nothing sexual about this relationship, at least in her written and spoken words, and Evie wanted me to know that.

Part III: An act of chivalry
When the three of us were in session – Evie, her mom, and me – I would read aloud the most recent additions to her conversation. By now, she always wanted to hear what I had to say, and that was good. She spoke of her many troubles, and Vlad comforted her with sound advice and concern.

I should tell you I already had a few private conversations with Evie’s mom about this. Pamela told me Evie always had a vivid imagination. She had “friends” she would talk to when she was a toddler, as many kids do. Like most kids, she grew out of it by the time she started school. Pamela never thought it was a problem. She thought it was normal for some kids. It is, of course, for all kids, with spheres by far the most adept at using their imaginings to tell stories about their life experiences.

Vlad “arrived” right around the time their marriage was “falling apart,”Pamela told me. As she entered her teens, Evie was becoming increasingly alone, questioning everything her mother did or should have done. She was becoming desperate as her father receded from her world. She was angry, hurt, and isolated.

Once, while I read her story for the three of us, the fair maiden (the girl in the story didn’t have a name other than “maiden”) said to Vlad, “Thank you for your chivalry my friend.”I smiled. What could this sad and frightened little 14-year-old Goth girl from Southern California know about chivalry, I said to myself. So, I asked her. Before she could answer, Pamela interrupted, beaming, and proudly said, “She knows what it means too!”

“Really?”I said. “What does chivalry mean, Evie?”

“Dr. Cima!”She was a little angry. “I know what chivalry means! It means that when a fair maiden is about to step into a puddle of water, the gentleman is supposed to take off his coat and lay it on the ground so she won’t get her feet wet,”she said grinning, with as much pride as her mother. It was a good moment for all three of us. From that time forward, we changed her story of desperation into her search for inspiration.

About That Voice-In-Her-Head
One day, sometime in the second month or so that I knew her, Evie asked me, causally, “Dr. Cima, do you think I’m crazy?”It was, I think, a question to test my answer more than anything else. She had her fill of answers by then.

Her doctor told her, and her mother, she had “schizoaffective disorder” and something called “major depressive disorder,” and that she needed a chemical to make her better. Her therapist told her she was “substituting Vlad for her father,” though she had a “psychiatric disease” too. Her social worker told her she sent her to this facility for her “mental illness.” A few counselors, frustrated because she wasn’t improving, told her she was “psychotic.” The other kids at the facility? They told her she was a “wing-nut,” and other similar terms, as you can imagine. All of this convinced Evie this really was a place “for crazy kids.”I answered her question.

“No Evie,”I said, “I don’t think you’re crazy.”

“Ok, Dr. Cima,”she replied, almost as a challenge, “then where does Vlad come from?”

I shrugged and said “I think it’s just you talking to you. What do you think Evie?”

“Yeah,”she said with a sly grin, “it’s just me talking to me.”

That seemed to help. After all, that’s what it is. We should remember, parents and professionals alike, there really isn’t another person talking, and the voice isn’t coming from the clouds. It’s her own imagination at work, nothing more. She’s having a discussion with herself, it seems spontaneous, it seems to be real and, for the most part, she’s was okay with it. We decided she was having “a wide-awake dream, that’s all.” That seemed to make sense to her. We never talked about “why” she was having her wide-awake-dreams, so it made it easier for her to talk to me about them.

After awhile our conversations were about the words she wrote, and the metaphorical meanings they had in her life. It was a great way for her to explain her inner turmoil, and a great way to encourage her candor. She was, in the next few months, increasingly candid.

About That Cutting
About one month into our relationship, at a particularly vulnerable and honest moment, I asked Evie if I could see her scars. She was very ashamed of her scars, in front of me, and she always wore long sleeve shirts to hide them. Evie took off her jacket and extended her arms. There were several dozen criss-crossed scratches from her wrist to three fourths of the way up both of her arms, most of them permanent scars. When I gently held her arm to look, she started to cry.

I’m sorry, Dr. Cima,” she said, her eyes fixed on the floor.

“Sorry,” I replied,“why are you sorry Evie?

“Because it’s a stupid thing to do!” she said, with a bit of anger in her voice.

She said, at different times, she did it because she couldn’t stop herself, and because Vlad said it was a sacrifice she had to make, and because she felt so empty inside, and because her dad wasn’t around, and because it brought her a lot of attention and, sometimes, because she was bored. Mostly, she said, “I do it when I don’t feel anything.”

Not a small item for Spheres, the loss of feelings. Feelings provide Spheres their life energy. Spheres without feelings are like Cubes without a puzzle to solve, or Squares without a job to do, or Stars without a game to play. In desperate times, in a strange place for “crazy kids,” feeling something is better than feeling nothing. We talked about her feeling nothing, and decided that feeling nothing was a feeling too. Even if it felt terrible and empty, it was a feeling. At least, we decided, she was feeling something. Evie slowed and then stopped cutting herself six weeks after we met.

About That Chemical Cocktail
I convinced Pamela her daughter didn’t have a “disorder” or a “disease.” Frankly, and not surprising to me, it didn’t take that much to convince her. She never saw any improvement in her daughter’s behavior, despite the number of “cocktails” they tried. She consented because a doctor said her daughter needed “medicine.”

This is a common experience for the many hundreds of parents I’ve worked with in my career. Parents will say they saw improvement in the first few weeks, then things began to get back to where they were. Chemicals were increased, or decreased, or changed, or added – it didn’t matter much. Over time, nothing changed, often their child was worse, and now their child was living in“a place for crazy kids.”

Pamela expressed her right as a parent and asked that her daughter be taken off her “medication.” The doctor cautioned her against doing so, however, Pamela insisted. With my support, we began a “titration schedule,” and simply reduced and eliminated both her chemicals in a matter of a few weeks. Good riddance, and a huge boost to the self-confidence of Evie – and her mom.

How Did it End?
Evie went home to her mother about six months after I arrived. She had stopped “cutting” for more than four months, she was still writing in what we were calling her “journal” by then, and most important to me, she was chemical free. Evie called me two times in the first month just to say hello and to say that she was doing okay. She was in school, and she was glad to be home. She thanked me a few times, and I thanked her for trusting me. We never spoke again.

About four months later, Pamela called. She wanted to let me know that Evie was still in school, doing okay. She said Evie seldom wrote anything in her journal anymore. She also said she thought Evie may have a boyfriend. Nothing had changed with the relationship with her step-father, although Evie, according to Pamela, was much more steady with this unsteady, one-sided, relationship. Finally, Pamela told me she was dating. She met a man at work, they had lunch, and they had dinner. A third date was planned. She sounded happy. I think that’s why she really called, but that’s just me.

This is how it usually ends in my business. It’s rare to have much contact with children and their families once they leave these kinds of facilities, as it should be. After all, we are there to help them during an extended life crisis, not to ensure everyone lives a good life. Our job is to provide them with our security, our trust, our guidance, and to discover and encourage their strengths, as children and families work to move forward in their lives.

Epilogue
I started writing “Goth Girl” two weeks before I found a video about another girl. Her name is Emily Longden. She was hearing voices too. I wrote a blog about her at “Your Kid’s Aren’t Sick.” You can learn about the Hearing Voices Network, and you can meet – and see – this brave young woman here.

~~~~~~~~~~~~~~~~~

READER COMMENT

Eitan Schwarz, MD FAACAP DLFPA
June 11, 2013 at 12:55 am

You have described Evie beautifully. In this age of increased emphasis of the mind as a function of the brain, you remind us of the need for balance. As a child and adolescent specialist for 40 yrs, I have met and sought to understand several Evies. They can be very different from each other. They have in common a blend of fierceness and delicacy, lace and leather. They are worthy conversationalists and usually quite expert in something interesting. Some try their own chemicals. Many have had decent therapists who helped them accept their medication and became happier Goths for longer.

I also know of how varied kids are and frightened parents are. I know that there are some doctors and “therapists” out there unworthy of trust because they don’t talk with people and don’t think carefully about the symptoms or diagnosis, like the type and function of “auditory hallucinations” and then misdiagnose and mistreat, often overmedicating with the same drugs. I am always glad to see folks alert to that.

Yet I wonder to myself what is really new about your approach — it is pretty standard for the rest of us who work with kids and like to see their lives improve, except we don’t jump into a therapy relationship in quite the way you describe your involvement too often.

Your POV is not unusual either. But would you consider that the medical chemicals made it possible for Evie to connect with you initially?

 

MY REPLY:

Thank you for you comments Dr. Schwarz.

The short answer to your question, politely, is absolutely not – the “medical chemicals” had nothing to do with connecting with Evie.  Please.  They were on obstacle to overcome – for her, her mother, and me.  The long answer is a little more telling.

Evie – and her mother – had to be convinced she wasn’t “crazy,” when the “evidence” (5150, removal from home, the “psychosis,” the “depression,” etc.) was just the opposite – topped off by those chemicals to fix her “diseases.”

Having done this many hundreds of times, I know parents are very reluctant to take their children off “medication” for their “diseases.”  So, no thanks, it has never been an asset while developing a relationship with a child.  Evie didn’t trust me because she was taking a pill.  I earned her trust.

Sounds like we both have been doing this work since the 70’s.  We both know these “medications” were being used for kids on an experimental basis in those days. I know from first hand observation, the experiment failed – and most professionals deny it.  You should know that too.  Unequivocally, from watching thousands of children, I’ve never seen these chemicals do any of them any good, and always did harm.  I know of no exceptions.  If you like you can read more about my reasoning on my blog “Your Kids Aren’t Sick”@ https://doctorcima.wordpress.com.

Nonetheless, I don’t deny that you have a knack for what we do.  You must.  You’re instincts about Evie were so accurate.  I can tell you’ve had Evie – and kids just like her – in front of you many times.  Lucky for them.  I suggest you had those instincts with you as you entered grad school and medicine.  That “knack” can’t be taught, and it has nothing to do with medicine.

A psychiatrist friend told me a long time ago “I try to make sure my training doesn’t get in the way of my effectiveness.”  I suspect you do the same.  I applaud your effectiveness.  You, in particular, didn’t need to prescribe any chemicals to anyone.  You are the vessel of efficacy, not a chemical.  Respectfully, prescribing chemicals not only masks “symptoms,” they often mask the impotence of the prescriber.  Medicine is needed for broken bones, not broken hearts, broken families, or broken spirits.

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