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Part 1 – A Balancing Act
“The body of man has in itself blood, phlegm, yellow bile and black bile; these make up the nature of this body, and through these he feels pain or enjoys health. Now he enjoys the most perfect health when these elements are duly proportioned to one another in respect of compounding, power and bulk, and when they are perfectly mingled.” – Hippocrates, On the Nature of Man, circa 5th century BC
21st century schools of medicine teach their graduates human behavior – what you and I do in our own bodies in the next moment of our lives – is understood by microscopically studying invented and invisible anatomical brain centers, each center equipped with miraculous behavioral functions. Students of psychiatry are instructed undesirable behavior (psychiatry’s symptoms) is caused by a chemical imbalance effecting the brain centers. Treatment, then, is to prescribe laboratory chemicals to intermingle with natural body chemicals that are, somehow, out of balance. Worth noting, the Psychiatric Medical Model (PMM: pronounced “pim”) offers no definition, or explanation, of balance.
Practitioners of PMM believe you and I are victims of our excessive or insufficient chemicals – usually serotonin or dopamine – as well as our faulty “neuro-connectors” that negatively impact the brain centers where all behavior is neatly stored. In turn, psychiatric patients are taught by doctors that undesirable and life altering behaviors are caused by a disease, or disorder, or deficiency, or delay, or disability, or derangement, or disturbance, or a dysfunction (the 8 D’s of PMM). Patients inadvertently suffer the consequences of these brain flaws. “It’s not you,” the doctor confidently instructs the patient, “it’s your disorder that’s causing you to experience the undesirable behavior.” Hence the title: The Zombie Theory.
Humankind has witnessed miraculous progress in medical science during the past 100 years. Thanks to new discoveries, new medicines and new procedures, we have benefitted greatly when it comes to our physical well-being. Especially true in modern countries, we live longer, our quality of life is better, our physical maladies better treated. Our flesh, blood and bones have never been in better hands. However, when it comes to human conduct, medicine has failed miserably throughout human history, up to and including today, without exception.
Medicine as Art [i]
Twenty-five hundred years ago, the Hippocratic School of Medicine began to understand medicine as an art form, and healers as practicing artists. Disease was no longer divine wrath, nor healing a gift from God. Over time, heavenly punishments and gifts were replaced with the idea of cause and effect, providing the underpinnings for this burgeoning artform to become a rational science in the physical world. Along the way, medical ethics and standards of care were crafted, both keystones of the ancient Greeks that continue to guide modern day medicine. Most important, three primary conditions were identified and interconnected: the disease, the patient and the healer.
Healers were trained in the Seven Natural Factors in this holistic system of medicine: The Four Elements, The Four Humors, The Four Temperaments, The Four Faculties, The Vital Principles, The Organs and Parts and The Forces. The underlying theory was simple. When there is balance and harmony within the Seven Natural Factors, there is health. When they are not in balance, there is dysfunction and disease. When any one of the Seven Natural Factors ceases to function, there is death. Balance then, as it is now, was the pursuit.
For the first time detailed experiments were conceived and conducted, data was collected, results were assessed and treatments were formalized. Six healing pathways emerged, from mild to severely invasive. The first treatment of choice? Diet, considered the most gentle and safest path to restore balance. Second in this formal progression of treatment paths focused on altering the patient’s lifestyle and hygiene habits that were causing the imbalance of body humors (fluids). Only when the first two treatments were found to be ineffective did the healer select the third treatment path: medicine. Chemical concoctions with professed healing powers were dispensed in the form of supplements, potions, tonics and herbs. These first three paths were self-administered, under the guidance of a healer.
Paths four, five and six were administered by the healer. The first of these, physiotherapy, included heat treatments to induce sweating, massages with medicated oils, and a variety of muscle, bone and body manipulations designed to release trapped toxins. Physiotherapy was often a preparative stage for detoxification, the fifth path of treatment. Common purification methods included emetics (to induce vomiting), enemas, diuretics and, frequently, bloodletting. Only when the first five paths fail does the healer turn to surgery, the last treatment path. Surgery was seen as the most invasive and, except for immediate trauma and other emergencies, the last resort for the trained healer.
Also historic, diseases were systematically classified according to similarities and differences as the disciplines of etiology and pathology began to emerge. The goal was to ensure the healer’s diagnosis and choice of treatment was supported by fact-based information. As momentous, individualized treatment was a core value. “It’s more important,” professed Hippocrates in one of his famous aphorisms, “to know what kind of person has a disease than what kind of disease a person has.” Healers were trained to understand individual patients as living in a dynamic relationship with their environment. This new art form treated the patient, not just the disease.
What About Madness?
For epochs before this new medicine ancient civilizations viewed madness as punishment from an angry God for divine trespasses. The healers of 10,000 years ago treated their patients with music, prayer, charms, spells and other incantations. This new school of medicine declared madness to be the result of natural occurrences in the brain, centered around the four essential humors. To treat madness, patients would routinely be bled from the forehead, or from a large vein in the arm or leg or rectum to draw away corrupted fluids from the brain in order to bring the body back into balance.
Thus, Greek medicine began with two interrelated principles. The first is to provide the body its natural beneficial cravings: a wholesome diet, healthy habits, adequate exercise, and sufficient rest and sleep. The second is to cleanse the body of wastes and pathogenic matter inside and out, creating a healthy body balance. Though form and fashion may be different, modern medicine embraces these same basic principles. Unfortunately, as you will see, so does PMM.
Primum Non Nocere – “First, do no harm” [ii]
The Hippocratic Oath is the first expression of medical ethics in human history and it remains a rite of passage for medical graduates around the globe. This oath reminds the healer to be aware of the possible harm that can occur from any kind of intervention. “Practice two things in your dealings with disease,” reiterated Thomas Inman, a 19th century Liverpool surgeon, “either help or do not harm the patient.” Nonetheless, history has many examples of this oath being violated, and much harm done.
Here’s the longest lasting.
For more than two millennia the treatment of choice for healers around the world was bloodletting, mainly because of its versatility. In addition to madness, this medical technique was prescribed for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis – and a hundred more condetions, including heartbreak.
The Talmud was cited by healers to proclaim the most beneficial days and times of the month to use this procedure. Christian healers gave guidance to their followers by declaring the specific Saints’ Days favorable for this medical technique. Islamic healers too heralded bloodletting, particularly for fevers. During medieval times bleeding charts were common, designating specific bleeding sites on the body. The vein in the right hand, for example, was bled for liver problems, the vein in the left hand for spleen problems. “Do-it-yourself” instructions were created and distributed worldwide.
Bloodletting was in its heyday during the Middle Ages, prescribed by healers as both a curative and preventative medical intervention. The actual procedure was often done by a trained barber-surgeon, the red and white barber pole symbols of blood and bandages. There were a variety of techniques too. A phlebotomy occurred when blood was drawn from the larger external veins, an arteriotomy from arteries usually from the temple. Some healers used a scarificator, a specially crafted tool cast in a brass case that enclosed a spring-loaded mechanism with blades of steel. Leeches were commonly used too.
Bloodletting theory – the science of how it “works” – was based on two ideas; (1) blood did not circulate and would stagnate in the extremities; (2) removal was done to attain humoral balance to fight off illness and to restore health. The more severe the disease, the more blood that needed to be depleted, fevers requiring the largest amount of drainage. Importantly, six hundred years after this medical art form was born, Galen, a philosopher-physician from the Roman Empire, revitalized, reinvented and “rebooted” Hippocratic humoralism as a meticulously detailed, rational, technique-focused medical theory that retained its popularity in cultures around the world for another seventeen centuries.
The End of Bloodletting
The 19th century was revolutionary for medical science. During the first half a British chemist, Humphry Davy, discovered the anesthetic properties of nitrous oxide, a French doctor, Rene Laennec, invented the stethoscope, and James Blundell, a British obstetrician, performed the first successful blood transfusion. In the fourth decade Crawford Long, an American surgeon, used ether for the first time, and a Hungarian doctor, Ignaz Semmelweis, discovered that disinfecting the hands of medics, midwives and nurses drastically reduced the incidence of death from childbed fever that was killing nearly a third of infected mothers.
The second half of the century was equally impressive. Joseph Lister, a British surgeon, introduced phenol to clean wounds and to sterilize surgical instruments. Louis Pasteur published the Germ Theory of Disease in 1870 and within 12 years his labs produced vaccines for chicken cholera, anthrax and rabies. The first Nobel Prize in Medicine was awarded to German physiologist Emil von Behring for creating vaccines for diphtheria and tetanus. X-rays were discovered by German physicist Wilhelm Röntgen, earning him the Nobel Prize in Physics. Finally, in 1897, a German pharmaceutical company, Bayer AG, created a new wonder-drug: aspirin. Within two years aspirin was a global phenomenon.
The successes of this maturing art of medicine spelled the end to the ancient and barbarous practice of bloodletting. Centuries old theories and traditions as well as healer and patient testimonials could not stand up to the new and emerging regimen found in medical science. By the end of the 19th century bloodletting was nearly extinguished worldwide (though not completely![iii]).
In its place was a new awakening: modern medical science.
NEXT: Part 2: The Era of Medical “Experimentalism”
Life is short; and the art long. – Hippocrates
[i] History of Greek Medicine: http://www.greekmedicine.net/b_p/Standards_of_Health.html
[ii] The Hippocratic Oath does not include the words “First, do no harm.” The oath is nearly 400 words and certainly includes the sentiment. The actual quote is attributed to a Parisian pathologist and clinician Auguste François Chomel (1788–1858). Please see the entire oath here: https://en.wikipedia.org/wiki/Hippocratic_Oath
[iii] Bloodletting is still indicated for a few indications such as polycythemia, haemochromatosis, and porphyria cutanea tarda, while leeches are still used in plastic surgery, replantation and other reconstructive surgery, and very rarely for other specific indications.
Part 2: The Era of Medical Experimentalism
“The reproducibility of published experiments is the foundation of science. No reproducibility – no science.” – Moshe Pritsker, Ph.D., CEO of JoVE
By the turn of the 20th century medical science had fully embraced empiricism – the philosophy that knowledge is determined by rational experiments perceived by our senses. Proof rather than deduction or revelation was the new measuring stick. Experiments were designed, theories created, measurements taken, successes heralded, experimenters often rewarded with fame and fortune. As important, empiricism brought with it the process by which all modern science is evaluated: the scientific method. The formality and rigor of this process was transformational in science. It’s worth a quick review.
The Scientific Method
The 5-step scientific method is simple to describe, and difficult to implement – and that is the point of this exacting process. The technique is designed to create empirical evidence – sometimes referred to as sense experience – utilizing the tools of observation and experiment. Results must be measurable in the physical world. When done as designed, the method provides quantifiable observations to the scientist – the facts of an experiment. In turn, the scientist provides an explanation of the facts – the theory of an experiment.
Step 1 of the scientific method requires the scientist ask a question about nature, make detailed observations and gather information. In Step 2 the scientist forms a hypothesis (theory) about the observations and creates specific predictions. Next, in Step 3 the scientist tests the predictions with a detailed, observable, quantifiable experiment. Step 4 requires the scientist to analyze the data, to draw conclusions, and to accept, reject or modify the hypothesis. Finally, and most importantly, Step 5 compels the scientist to provide step-by-step directions to duplicate the experiment, and a new scientist must independently reproduce the experiment and find the same results before any knowledge can be proclaimed.
Turn-of-the-century medics must have been truly inspired. For the first time they could listen to – and see – telltale signs of health inside a living body. They could anesthetize their patients prior to surgery, and they used sterilized instruments in a disinfected operating room, blood transfusions available as needed. As important, given the overwhelming success of Pasteur’s germ theory, new hypotheses were being introduced at a fast pace, each theory looking for other likely germs that were the root cause of so much human suffering.
Thus, 20th century medical experimentalism launched with new tools, a new paradigm and a multitude of exciting projects. To kick off this new era, two medical devices were revamped during the last decade of the 19th century, setting the stage for the incredible 100 years to follow: the microscope and the culture dish.
Let There Be Light
August Köhler[i] was a student of zoology, botany, mineralogy, physics, and chemistry in late 19th century Germany. As a young, post-graduate staff member at Carl Zeiss AG (an optical systems manufacturer) he developed a new technique, dubbed Köhler Illumination. Kohler’s invention produced even lighting across the field of view and greatly enhanced the contrast of the light microscope. During the next 45 years Kohler contributed to numerous other innovations including fluorescence microscopy and grid illumination, a method used in the treatment of tumors.
Around the same time, Julius Richard Petri was working for the Imperial Health Office in Berlin. Lab scientists were uniformly frustrated. In order to observe cultures through a microscope the cover had to be removed, exposing the bacteria to contaminants like dust, hair, and human breath. Petri had the simple idea of placing a slightly larger clear glass dish upside down over the culture dish to protect it from the external environment and, according to one science writer, “changed medical history.”[ii] Petri moved on to work in a lab in Germany for the rest of his career where he published nearly 150 papers about the spread of diseases.
Another German, Paul Erlich[iii], coined the term “chemotherapy” in 1900. Erlich theorized toxic compounds could be created to selectively target a variety of disease-causing organisms. He predicted future chemists would produce substances to seek out these disease-causing agents, dubbing these new substances “magic bullets.” He was right. Magic bullets and other microscope observations began to materialize in science labs around the world. By 1901 blood types were discovered by Austrian Karl Landsteiner, in 1906 Frederick Hopkins discovered vitamins in England, and a Canadian, Sir Frederick Banting, discovered insulin in 1921.
It was a banner century for another magic bullet: the vaccine. The most celebrated was Jonas Salk’s polio vaccine. Once introduced in the United States (some may remember the March of Dimes immunization campaign in the early 1950’s) the annual number of polio cases fell from 35,000 in 1953 to 5,600 by 1957. By 1961 only 161 cases were recorded in the United States. Medical science also gave us vaccines for bacterial meningitis, chickenpox, haemophilus influenza, hepatitis A, hepatitis B, Japanese encephalitis, measles, mumps, papillomavirus, pneumococcus, rotavirus, rubella, tetanus, typhoid, tick encephalitis, whooping cough and yellow fever – saving and changing the lives of millions of people.
The Century’s Preeminent Magic Bullet – Penicillin
Before antibiotics (lit. against-life), 90% of children with bacterial meningitis died, strep throat was often fatal, and even minor infections would often lead to serious illness and death. Then in 1928, Sir Alexander Fleming[iv], a Scottish biologist and pharmacologist, made a fortuitous discovery from a discarded Petri dish. The mold that had contaminated an experiment turned out to contain a powerful antibiotic: penicillin. This one discovery, and the analogues to follow, has saved hundreds of millions of lives around the world. Fleming also predicted science would find many new “bacteria killers.” He was right too. Today there are thousands of antibiotics, more created every year.
More “Magic Bullets”
Here is a selection of other magic bullets discovered and invented during the 20th century (there are many others):
• Arsphenamine syphilis (1910) • Oral contraception –“the pill” (1960)
• Nitrogen mustard (1946) – 1st cancer drug • Propranolol – 1st beta blocker (1962)
• Acetaminophen (1948) • Cyclosporine – immunosuppressant (1970)
• Tetracycline (1955) • Lovastatin (Mevacor) – 1st statin (1987)
There were an amazing number of new medical procedures too that were created by modern medicine over these 100 years too. Here’s a list of some of the “firsts”:
• Electrocardiogram (1903) • Kidney transplant (1954) • MRI (1971)
• Stereotactic surgery (1908) • Pacemaker (1958) • CAT Scan, (1971)
• Laparoscopy (1910) • “Test Tube Baby” (1959) • Insulin pump (1972
• Electroencephalogram (1929) • Liver transplant (1963) • Laser eye surgery (1973)
• Dialysis machine (1943) • Lung transplant (1963) • Liposuction (1974)
• Heart-Lung Machine (1953 • Pancreas transplant (1966) •Heart-lung transplant (1981)
• Ultrasound (1953) • Heart transplant (1967) • Surgical Robot (1985)
Mankind has been the beneficiary of these creations and we gratefully acknowledge and salute medical science for their wondrous contributions, inclusive of all medical specialties – save one.
Again – What About Madness?
Medical scientists addressing madness contributed to this otherwise spectacular century with four magic bullets of their own during the first 50 years of the century, each an unmitigated disaster. The first three are collectively called Shock Therapies and include, Deep Sleep Therapy, Convulsive Therapy, and Insulin Shock Therapy. The fourth is Psychosurgery. Here’s a review.
Deep Sleep Therapy (DST)
Jakob Klaesi, a Swiss psychiatrist re-popularized DST in 1920 (after two failed attempts earlier in the century) using Sonmifen (a sedative) for his schizophrenia patients. For the next 20 years Klaesi and his colleagues dominated the mental health hospital circuit in Zurich using DST and found worldwide fame among colleagues, despite high mortality rates and never ending doubts about efficacy. Undeterred, DST was promoted by many eminent psychiatrists of the time, including William Sargant of Great Britain:
“All sorts of treatment can be given while the patient is kept sleeping, including a variety of drugs. . . the patient does not know how long he has been asleep, or what treatment, even including ECT, he has been given. . . a new exciting beginning in psychiatry and the possibility of a treatment era such as followed the introduction of anesthesia in surgery.”
The Australian Chelmsford scandal of 1983 finally put an end to this toxic procedure. Dr. Harry Bailey was in charge of Chelmsford Private Hospital in Australia and DST was the primary treatment for madness. Over sixteen years, 27 deaths were directly connected to DST with another 24 reports of suicide in the same year patients received treatment. Facing condemnation from families, the general public and the government, Bailey committed suicide in 1985.[i] The scandal brought about new stringent laws and regulations regarding psychiatric care in Australia.[ii]
Insulin Shock Therapy (or Insulin Coma Therapy)[iii]
Dr. Manfred Sakel was a young doctor in Vienna in 1928 when he was given the task to reduce the unpleasant withdrawal symptoms of opiates. Experimenting with a newly discovered pancreatic hormone – insulin – he unexpectedly found a large dose would cause his patients to go into a stupor. Once recovered, he noted, his patients were less argumentative, less hostile, and less aggressive. Thus, Insulin Shock Therapy (IST) was born. For the next 30 years IST was the go-to method for hundreds of thousands of mental health patients. IST doctors proudly proclaimed an “80 per cent cure rate for schizophrenia.” [iv]
The actual procedure was intense. Insulin injections were administered six days a week for two months or more as the daily dose was gradually increased until hour-long comas were produced. Seizures before or during the coma were common as were hypoglycemic aftershocks. Often patients were subjected to electric shock therapy while comatized. Given the profuse cases of brain damage – and an estimated mortality risk rate ranging from 1-5%[v] – IST fell out of use in the United States, and nearly everywhere else, by the 1970s.[vi]
Convulsive therapy took hold quickly. In 1934 Ladislas J. Meduna, a Hungarian neuropsychiatrist known as the “father of convulsive therapy,” used metrazol (a stimulant) to induce seizures in patients with schizophrenia and epilepsy. By 1937, the first international meeting on convulsive therapy was convened in Switzerland, and by 1940 metrazol-convulsive therapy was being used worldwide.
Around the same time Ugo Cerletti, an Italian neuropsychiatrist, was using electric shocks to produce seizures in his animal experiments. He noticed when pigs were given an electric shock before being butchered, they were in an “anesthetized state.” With his colleague Lucio Bini, they replaced metrazol and other chemicals used to create convulsions with electricity. As a bonus, they surmised, ECT brought about retrograde amnesia so patients had no ill feelings about a treatment they could not remember. Cheaper and more convenient, ECT replaced chemical-induced convulsive therapy and by 1940 was being used in England, Germany, Austria, and the United States. (NOTE: Cerletti and Bini were nominated, though not selected, for a Nobel Prize.)
There was a marked decline in the use of ECT from 1950s to the 1970s because the public perceived the procedure as dangerous, inhumane and overused.[vii] However, because ECT was convenient and cost-effective, mental health providers balked. By 1985, the National Institute of Mental Health (NIMH) and the National Institutes of Health (NIH) convened a conference on ECT and concluded, though controversial, ECT was effective for a narrow range of psychiatric disorders. In 2001 the American Psychiatric Association expanded the role of ECT and, by 2017, ECT was covered by most insurance companies. This incredibly cruel and torturous “treatment procedure” has gained popularity – again.[viii]
In 1930 Antonio Egas Moniz, a Portuguese neurologist, used the term “leucotomy” (lobotomy) for the first time to describe a surgical operation that destroys brain tissue by extraction, burning, freezing, electrical current or radiation. The objective is to sever the connections between the frontal lobes and deeper structures in the brain. Approximately 40,000 lobotomies were performed in the United States alone from 1930 to 1970. By the way, the majority (nearly two thirds) were performed on women.[ix]
Use declined rapidly due to increased concern about deaths and brain damage caused by the operation, and by the introduction of neuroleptic (lit. nerve-seizing) drugs. By the mid-1970s the use of psychosurgery had declined to about 100–150 operations a year and disappeared completely by the 1980’s. Remarkably, Moniz (and Walter Rudolf Hess) shared the Nobel Prize in 1949 for this discovery, though not without controversy that still exists in the scientific community today.[x]
What A Century
For medical scientists focused on physical human ailments, it was a stupendous century. Life expectancy is approaching 80 years in the United States, up from 50 years at the beginning of the 20th century. We are routinely treated with medicines and procedures for debilitating diseases that diminished, disfigured and killed our ancestors not that long ago. As important, the consistency and precision provided by empiricism and the scientific method paid off for all medical specialties during those amazing 100 years – save one.
For medical scientists focused on madness it’s been one grotesque failure after another. These scientists put us to sleep for weeks at a time, induced comas for months at a time, used chemicals and electricity to convulse us, and surgically destroyed our brain tissue, all in an effort to fix our brain diseases. Along the way all of them ballyhooed their successes, using their special brand of science and patient testimonials to convince us of the medical necessity and efficacy of their magic bullets.
Then in 1950, as if a reprieve for past travesties, a fifth magic bullet appeared: psychiatric drugs. This new state-of-the-art medicine was primed to replace the first four fiascos. Given the track record of PMM, it’s a wonder anyone took them serious.
Unfortunately, nearly everyone did.
“Medicine men devised all manners of disabling methods—for three centuries—finally discovering drugs as an easy and efficient means of achieving disability.
– David West Keirsey, Disable Madmen[i]
NEXT: Part 3: Thorazine to the Rescue
[i] You can read more about this @ https://chelmsfordblog.wordpress.com/aftermath-of-the-scandal/
[ii] In her book First Half, Toni Lamond described her experience at Chelmsford: I was given a semi-private room. On the way to it I saw several beds along the corridors with sleeping patients. The patient in the other bed in my room was also asleep. I thought nothing of it at the time. Although it was mid-morning, the stillness was eerie for a hospital that looked to be full to overflowing. I was given a handful of pills to take and the next thing I remember was Dr Bailey standing by the bed asking how I felt. I told him I’d had a good night’s sleep. He laughed and informed me it was ten days later and, what’s more, he had taken some weight off me. I was checked out of the hospital and this time noticed the other patients were still asleep or being taken to the bathroom while out on their feet. https://en.wikipedia.org/wiki/Deep_sleep_therapy
[v] Ebaugh, FG (1943). “A review of the drastic shock therapies in the treatment of the psychoses”. Annals of Internal Medicine. 18 (3): 279–296. doi:10.7326/0003-4819-18-3-279.
[vi] In 1953, British psychiatrist Harold Bourne published “The Insulin Myth,” arguing there was no sound basis for believing that insulin counteracted the schizophrenic process. He said treatment “worked” because patients were chosen for their good prognosis and were given special treatment. Bourne submitted the article to the Journal of Mental Science. After a 12-month delay, Bourne received a rejection, telling him to “get more experience.” https://ipfs.io/ipfs/QmXoypizjW3WknFiJnKLwHCnL72vedxjQkDDP1mXWo6uco/wiki/Insulin_shock_therapy.html
[vii] Later on, the public’s negative perception of ECT was further tarnished by the movie One Flew Over the Cuckoo’s Nest.
[x] There have been calls in the early 21st century for the Nobel Foundation to rescind the prize it awarded to Moniz, characterizing the decision at the time as an astounding error in judgment. To date, the foundation has declined to take action and has continued to defend the results of the procedure.
[ii] How Julius Richard Petri’s Dishes Changed Medical History
[iii] Erlich shared the 1908 Nobel Prize in Physiology or Medicine with Élie Metchnikoff for their contributions to the field of immunology.
[iv] Fleming, Howard Florey and Ernst Boris Chain jointly shared the Nobel Prize in Medicine in 1945.
Within the last 70 years, with the assistance of a trillion dollar worldwide pharmaceutical business and their partners in academia – and a willing populace – human beings are being drugged into“balance” to treat fictitious brain diseases in astronomical numbers. In 2018, the World Health Organization (WHO) estimates 300 million people around the world have depression disorder, 60 million have bi-polar disorder, and another 23 million have schizophrenia disorder and other psychoses[i] – all of them in need of psychiatric medication. According to WHO, it’s likely these numbers are significantly higher as poorer countries have no way to record mental illness. Leading the way – the United States.
The Journal of the American Medical Association (JAMA) reported in 2017 more than 40 million adults were prescribed one or more psychiatric prescriptions in America.[ii] Race, you should know, is a factor. One in five white adults, one in ten black adults, one in twelve Hispanic adults, and one in 20 Asian adults are prescribed psychiatric medications. By gender, the difference is as significant. Nearly twice as many women (20.8%) are taking psychotropics than men (11.9%). Age matters too. About one in ten 18-39 year-olds are psychiatric patients, nearly one in five 40-59 year-olds, and, out in front by a wide margin, a solid one fourth of adults between the ages of 60-85 are prescribed psychiatric medications. By the way, why is “mental illness” dependent on race, gender and age? How does the (PMM) scientist explain this? They can’t, so they don’t.
There are about 74 million children in the United States in 2021[iii]. Nearly 17 million are diagnosed with a brain disease. The Center for Disease Control (CDC) reports 6.1 million children have been diagnosed with ADHD disorder, 4.5 million with a behavior disorder, another 4.4 million with anxiety disorder, and 1.9 million with depression disorder[iv]. And why are nearly one in five children being drugged? The American Academy of Child & Adolescent Psychiatry (AACAP) declares there are eleven psychiatric symptoms and disorders for which psychiatric medication may be prescribed for children. The list includes bedwetting, anxiety, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, depression disorder, eating disorder, bi-polar disorder, psychosis,
autism spectrum disorders, severe aggression and sleep problems[v].
Toddler & Infants Too
From the New York Times, May 2014:
“About 15,000 American toddlers 2 or 3 years old, many on Medicaid, are being medicated for attention deficit hyperactivity disorder, according to data presented Friday by an official at the federal Centers for Disease Control and Prevention[vi].”
From Medical Daily, December 2015:
“The report shows that psychotropic drug prescriptions among babies nearly doubled in one year, from 13,000 prescriptions in 2013 to 20,000 in 2014, despite the lack of evidence that shows they are effective and safe for young children . . . psychiatrists often prescribe these drugs . . . for behavioral issues like unusual aggression, temper tantrums, or lethargy[vii].”
What Are We Taking – and Why Are We Taking Them?
From PsychCentral, here of the top 25 psychiatric drugs that were sold in America – and the reasons we take them – in 2016[viii]:
Knot in the Mood
More than 338 million prescriptions were written just for anti-depressant medications in 2016, by far the winning diagnosis. And depression isn’t as simple as you may think. There are all kinds of depression including atypical depression, bipolar disorder I, bi-polar disorder II, catatonic depression, cyclothymia, depressive personality disorder, double depression disorder, dysthymia, melancholic depression, minor depressive disorder, postpartum depression, premenstrual dysphoric disorder, psychotic major depression, recurrent brief depression, and last, but not least, seasonal affective disorder, affectionately known as SAD.
Is there a common denominator for all of these chemicals? Of course, and it’s easy to see. All 25 chemicals address the same innate, unavoidable, uncomfortable, ever-changing, seemingly whimsical and sometimes-hard-to-shake-life-altering-human-experience: mood. And yes, that includes ADHD, including the effect ADHD has on the mood of others. Ok, you may notice, schizophrenia is about consciousness, not mood.
Nonetheless, the PMM provides treatment for schizophrenia and other aspects of consciousness with the same mood medications: tranquilizers. Anything else these chemicals have in common? Yes, of course, and it’s easy to see too. Twenty-two of them are central nervous system depressants (CNSD), and three of them are central nervous system stimulants (CNSS). What’s that about and why is it important?
Lost In the Shuffle
Rhône-Poulenc, a French pharmaceutical company, was developing antihistamines for nausea and allergies in the late 1940’s. Scientists noticed some chemical compounds exhibited unusual calming effects. Dr. Henri Laborit, a French surgeon, called this effect artificial hibernation, and described it as “sedation without narcosis (unconsciousness).” By 1951 Laborit was conducting clinical trials of the newest compound – chlorpromazine (CPZ) – for use as an anesthetic booster for surgery patients. He proclaimed CPZ the “best drug to date” in calming and reducing shock during surgery. Known as Laborit’s drug among colleagues[i], by 1953 CPZ was released for use in the operating room.
Laborit was also a persistent advocate for clinical trials for psychiatric patients using this new wonder chemical. His persistence paid off. On January 19, 1952, for the first time, CPZ was administered to a manic patient named Jacque. Jacque’s improvement was reported to be “dramatic.” After three weeks – and 855 mg of CPZ – Jacque was released from the hospital. Word spread quickly about the “breakthrough.”
Dr. Pierre Deniker[ii], another French surgeon, ordered CPZ for a clinical trial at the Sainte-Anne Hospital Center in Paris. His findings were even more dramatic. Often doubling Laborit’s doses, Deniker found CPZ had much more than calming effects. His patients showed “remarkable improvement in thinking and emotional behavior.” By the end of 1952, Deniker abandoned old, ineffective, and harmful shock methods and began to treat mental illness with CPZ.
Soon after, Kline & French Pharmaceuticals (today’s GlaxoSmithKline) purchased the rights to CPZ from Rhône-Poulenc. By 1954, Smith-Kline & French received FDA approval to market CPZ as Thorazine to treat schizophrenia. The world’s first psychiatric medication was created – and marketed. Advertisements and professionals soon were boasting how “Thorazine helps to keep more patients out of mental hospitals.” Please remember, hospital beds were required because psychiatric patients needed time to recover from electrocution, the surgeon’s knife, or chemically induced, months-long comas. While a chorus of public outcries about the inhumane treatment of psychiatric patients had already begun to empty the beds of these torture asylums, psychiatric scientists and drug company marketers at the time attributed this exodus to the “dramatic success of Thorazine.”
Then, in October 1955, Deniker’s Saint-Anne Hospital Center convened the first international Thorazine (CPZ) conference. Attendees included scientists from Austria, Belgium, Brazil, Canada, Cuba, France, Germany, Great Britain, Holland, Luxembourg, Peru, Portugal, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States and Venezuela. Soon to follow were thousands of papers from scientists around the world publicizing their own “dramatic successes” with Thorazine for an ever-widening variety of brain disorders, affecting millions of patients. By 1957, Laborit, Deniker (and Heinz Lehmann) were awarded the prestigious Albert Lasker Award for their contributions to the clinical development and use of Thorazine – dubbed “the world’s first anti-psychotic medication[iii].”
During the 1950’s and 1960’s, the pharmaceutical ads for Thorazine were ubiquitous.
Thorazine was prescribed for bursitis pain, cancer pain, emotional stress, anxiety, nausea and vomiting, “management of menopausal patients,” child behavior disorders, acute alcoholism, severe asthma, depression, hiccups, catatonic schizophrenia, schizoaffective conditions, epileptic clouded states, agitation in lobotomized patients, confusional states, senile psychoses, gastrointestinal disorders, psoriasis, and more[iv]. By 1964, fifty million people around the world had used Thorazine[v]. All this, from one calming tranquilizer.
In his book The Creation of Psychopharmacology (2002)[vi], David Healy, the renowned British psychiatrist, professor, scientist, author – and current director of an ECT clinic in Wales – proclaims the discovery of Thorazine as significant to medicine as the discovery of penicillin. As important, he asserts, Thorazine was also the first profitable psychiatric medication for pharmaceutical companies. He marks the convergence of these two events – a wonder treatment and profitability – as the genesis of what he terms “biological psychiatry,” and the 1980 publication of DSM-III as bonding psychiatry to the biological
cause of mental illness, forever. Healy also details the prodigious growth of pharmaceutical companies and their promotional strategies, including coordination with academia to find new mental illnesses, and to manufacture the medications to treat them.
There were huge profits in the making for this burgeoning “take-a-pill-for-it” market, and Big Pharma began to flourish. By the end of the 1960’s pharmaceutical companies had created dozens of “new and improved” medications for a growing number of new mental illnesses. By then, Thorazine was regarded as just another, less effective medication, now criticized by its competitors for its notorious side effects. And what were these “new and improved” medications created by Big Pharma? More tranquilizers.
Was the discovery of Thorazine really as significant as penicillin? Yes, it was – if you are a proponent of the PMM. Dr. Healy is, and he has company. So is 94%[vii] of the general public and, presumably, 99+% of professionals. However, if you are a PMM antagonist, then Thorazine was – nothing more and nothing less – the world’s first chemical tranquilizer, and a precursor to the hundreds of tranquilizers to follow.
A Lost Cause
Take a look at this chart of the top ten diagnosed brain disorders, and their causes:
There are a total of 713 medications manufactured by drug companies for the top ten brain disorders, for which there are no known causes. How is that possible? By the way, these are just the top ten diagnoses. You can see the entire list of Medications for Psychiatric Disorders at drugs.com[i]. Please be warned. If you are looking for a cause for any of the brain disorders of PMM, you will be disappointed. There are none.
So, do you wonder too? What the hell are they treating?
Jacque to the Future
When Jacque took that first dose of CPZ in 1952, everything changed in psychology and psychiatry. In just a few decades, psychological diagnoses became medical diagnoses, needing medical oversight, medical solutions, and medical doctors to do so. Now, a psychiatric medical patient sees a medical doctor for psychiatric medication to address a brain disorder. Behaviors once considered understandable responses to the challenges of life by psychology became symptoms to the doctors of the PMM, and the symptoms became evidence of the underlying disease, or disorder, or deficiency, or delay, or disability, or derangement, or disturbance, or dysfunction, or – and may these children forgive us some day – a handicap.
We are approaching 50 million men, women, children, toddlers and infants in the United States who are taking pills for brain disorders. And business is booming. Psychiatric medications – the majority tranquilizers, a handful of stimulants, and an occasional analgesic – now number in the thousands, more created every year. Not a single cure, and not a single cause for any of the ever-growing brain disorders of the PMM.
Did I mention business is booming?
Welcome to Zombieland
Psychiatry entered the last half of the 20th Century on an upnote, despite a horrendous track record for the first 50 years. The PMM scientists created a new, simple, humane, and easily administered treatment solution for mental illness, and by the 1960’s big pharma was making money hand over fist. Only one thing was missing to unify this marriage. Healy’s “biological psychiatry” needed a coherent, science-based, peer-reviewed theory to explain how all these miracle drugs worked.
Well, they found one. It’s about bad brain parts. And a Zombie comes with it.
NEXT: Part 4: The Dope About Dopamine – and Other Ridiculous Notions
“When the doors to that dorm opened up a strange group of men would exit. They would seem to be in a hurry,
but unable to coordinate their movements. Their heads would hang down and half expressions would ripple across
their faces. They would run their hands over their heads over and over, and open and close their mouths while sticking
their thick tongues out. Their gait was particularly peculiar, with stiff legs dragging their feet along, all the while
seeming about to topple. We called this the ‘thorazine shuffle.’”
– John Lash – Behind the Thorazine Shuffle, the Criminalization of Mental Illness (2012)
[i] Some of his colleagues referrered to the effect as “non-permanent, pharmacological lobotomy.” https://en.wikipedia.org/wiki/Antipsychotic#History
[ii] Pierre Deniker Foundation – for research and prevention of mental illness
[iv] For a thorough review of thorazine advertisements see: http://www.bonkersinstitute.org/medshow/thorazine.html
[vi] See a review of The Creation of Psychopharmacology @https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279263/
[iii] ChildStats.gov: https://www.childstats.gov/AMERICASCHILDREN/tables/pop1.asp
[v] American Academy of Child & Adolescent Psychiatry (AACAP) https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Psychiatric-Medication-For-Children-And-Adolescents-Part-I-How-Medications-Are-Used-021.aspx
AUTISM AND SELF-DEFILING PHENOMENA
by R. L. Cima
Cal State Fullerton – Counseling 536 – Department: Counseling/Psychology.
Submitted: December 1982
The term autism comes from the Greek autos, meaning oneself, and ismos, meaning characteristic of. It has been translated as morbid concentration. A Swiss psychiatrist, Paul Eugen Bleuler, was the first to use the word autistic as an adjective to describe his patients’ “psychotic image of their being.” (Ritvo, 1976, pg. 8). At the time this phenomenon was called Childhood Schizophrenia, Symbiotic Psychosis, and Atypical Ego Development.
The algolagnic (hurt luster) presents a rather unique set of symptoms and is perhaps why Keirsey refers to the ISFP as “the most misunderstood of all types.” In no other set of symptoms are the subjective interpretations of others so critical to determine pathology. The idea of someone doing something harmful to their own well-being assumes the observer knows and understands what the well-being is for the person observed.
Reviewing the investigated literature, the over-riding concern is to understand symptomology using the various familiar models and theories. The attempt here is to report phenomenological behavior and to search for the commonality of behaviors in autism, vagrancy, fetishism and masochism. As the literature was somewhat sketchy as to etiology, except for autism, it will become obvious this writer’s ideas have filled in the gaps. These ideas will be noted.
In Dr. Leo Kanner’s book, Autistic Disturbances of Affective Contact (1943), he first used the word as a noun, referring to this phenomenon as Early Infantile Autism. From that beginning, when autism was first described as a medical disturbance, all literature has taken its lead. Based on eleven observed cases he summarized: “The outstanding pathognomonic, fundamental disorder is the children’s inability to relate themselves in the ordinary way to people and situations from the beginning of life” (Kanner, 1943, pg. 5). There is, he would note, from the beginning, an extreme autistic aloneness.
To begin to describe the symptoms of autism, it was noticed in virtually every publication investigated these symptoms were termed “bizarre.” Doubleday Dictionary (l975) defines bizarre as “exceedingly odd,” with synonyms that include “fantastic,” “outlandish,” “grotesque,” and “freakish.” Indeed, as seen by an objective observer, these overt behaviors, or lack of proper overt behaviors, could be viewed as strange and alien. Moreover, from this writer‘s analysis, there are certain symptoms that can easily be construed as talent rather than symptoms, and these views will be given.
The parents of autistic children commonly summarize their concerns by noting their children are “self-sufficient,” “like in a shell,” “happiest when left alone,” “acting as if people weren’t there,” “perfectly oblivious to everything about them,” “giving the impression of silent wisdom,” (Kanner, l943, pg. 18). Additionally, they note the apparent non-affection of their child, and more precisely, the aversive reaction these children seemingly have to being picked up or cuddled.
In The Autistic Child (1977) by Ivar Lovaas, he reports about a particular autistic child: “His parents became aware that he was different at 3 months, when he seemed to avoid social interaction or contact with adults or other children and was content to remain alone for long periods of time. He would respond to others by screaming and crying. He seemed insensitive to pain. . .” The summary of symptoms follows:
1. Extreme Autistic Aloneness. Without exception, all cases reported these children’s predilection for privacy. Any disturbance could be met with resistance and/or screaming and crying, and in some cases, tantrums. Quite often, when alone, these children will engage in head-banging and other self-destructive behavior that, when mediated, meets with the same resistance.
2. Insistence on the Preservation of Sameness. This symptom had vague explanations and descriptions, but it appears any environmental change of routine can be very upsetting to these children. In one case in Your Child is Asleep (1969), the author reports when confronted with the living room where a single small table had been removed, a child maintained a severe tantrum until the table was replaced. A drive to the doctor’s office must occur along the same route; a new visitor to the household will be met with fear and apprehension above predicted norms.
3. Child Appears Unoriented (not disoriented). These children appear detached and disinterested in events about them and may occupy themselves for hours with repetitious activities involving the manipulation of an object or part of his own body (Des Laurers & Carlson, 1969, pgs. 25-27). They may engage in wall scratching, twirling an object, and ritualistic bizarre hand movements. While doing so they were described by several authors as independent, self-sufficient and self-absorbed.
The particular behaviors of twirling and rocking appears consistently throughout the literature. Spinning in place, walking in a circle, and twirling a toy is very common for autistic children:
“She rocked from foot to foot in her crib so incessantly she wore out several mattresses. She also spun bar stools and toy wheels, twirled her hair and the strings of her blanket, closely examined minute pieces of lint and dirt, giggled, laughed, and clapped her hands inappropriately and rubbed her own skin, ground her teeth, and looked out of the sides of her eyes” (Lovaas, l977, pg. 80).
Additionally, there seems to be a high degree of fascination with mechanical devices (vacuums, stoves, light switches, faucets), particularly the sounds they emanate as witnessed by an autistic boy of 8 who had a pre-occupation with washing machines. It seems, upon close observation, he would mimic the sounds of the washing machine, imitating each cycle, taking approximately the proper time for each cycle to finish. (Coffey & Wiener 1967, pg. 20)
As an opinion, what is called “unoriented” by authors may be quite oriented to these children. A fascination with all their senses, as well be shown, is a common trait.
4. Eating Difficulties and Peculiar Eating Habits. While autistic children are described as generally healthy, and particularly beautiful (Des Laurels & Carlson, l969, pg. 30), ingestion is a problem. It is often reported eating skills develop late and there are often no signs of hunger. Also, autistic children sometimes refuse to chew and are insistent on certain meals. One girl reportedly refused to ingest anything but milk for the first 6 years of life (Rimland, 1962, pg. 8). Another case spoke of the insistence of one 4-year-old boy to only eat squares of chocolates, and not round pieces (Rimland, l962, pg. 10). Also, Lovaas (1977) reports a 2-year-old boy who refused to eat objects of certain colors; he would not put anything red in his mouth. Smelling and licking of objects and people is common.
5. Physical Ability
Autistic children, when picked up as infants can become either stiff and unpleasant, or lump and listless. Gross motor skills are not good, and these children may appear clumsy in gait. However, very often they exhibit a high degree of fine muscle coordination and are quite adept at twirling, spinning, and picking up small objects (DeLaursers & Carlson, l969, pg. 26). In fact, manual dexterity is said to be extremely well developed by some authors. Ritvo (l976) reports of a 17-month-old boy who could quite easily catch and throw a ball with either hand. Tinbergen & Tinbergen (1972) state that autistics have a distortion of motility that can include hyperkinesis, catatonia, and bizarre postures (pg. 8). Regarding this symptom, there seems to be little follow-up or investigation as to its utility in treatment, with tracking over time non-existent.
Of all the behaviors of autistics, how they communicate, or don’t communicate, is perhaps the most intriguing, and the most confusing and unusual. It is reported by several authors speech is non-existent in about 50% of reported cases, with communication taking place by pointing or grunting, or by moving the observer’s hand or body to the desired object. Indeed, many autistic children are first diagnosed as deaf or dumb or even blind:
“Linda was first suspected to be deaf and blind. She showed no startle response to a loud clap behind her yet would react to the sound of the opening of a gum wrapper. She would stare at the light on the ceiling or at a point on the wall, and not look at people who approached her, but would look right through them, even when they attempted to distract her” (Lovaas, 1977, pg. 50).
In the cases where speech does occur, it is said to be quite peculiar, and has four distinct characteristics: a) affirmation by repetition of questions (absence of yes), b) pronominal reversal (absence of I), c) delayed Echolalia, d) Irrelevant and Metaphorical use of language.
a) Affirmation by Repetition of Question (absence of “yes”). If asked the question do you want a drink, an autistic child may respond in the affirmative by stating “do you want a drink.” Several authors make a distinction between this and echolalia, deducing this response as a “yes” to a question rather than simply an echo.
b) Pronominal Reversal (absence of “I”). When asking for something, or referring to himself, the autistic child is quite likely to use second or third personal pronouns, most often singular, i.e., “you want a piece of candy,” instead of “I want a piece of candy.” It should also be noted it is very common for speech to be in a monotone, high pitched voice, without use of pronouns, modifying words, or articles. (Coffey & Huber, 1967, pg. 20.)
c) Delayed Echolalia. As illustrated by the boy who could quite easily mimic the sounds of the cycles of a washing machine, these children possess an ability to remember phrases of speech or sounds, long after they first heard them. In Psychological Experiments with Acute Children by B. Hermelin and N. 0’Connor (l970), there is much evidence autistics have excellent rote memories. It was found in their experiments comparing autistic, mongoloid, and normal children, autistics did as well as normal children and did better at rote memory exercises with a list of nonsense words (pg. 18).
d) Irrelevant and Metaphorical Use of Language. A stimulating, if not poetic, example that caught this writer’s attention that sums up this symptom (or ability!) is seen by a 6-year-old girl who said, “Real is real, touch the ground or wall…dreaming is when you sleep — and imagination is when you are awake” (Coffey & Weiner, 1967, pg. 35). These children may know “brush and comb,” “shoes and socks,” or “mommy and daddy,” but may have difficulty in labeling the single object, and may interchange the nouns, or more likely use them both when referring to one. “Bumped the head” was used by one boy when he sought comfort for any type of injury (Rimland, 1963, pg. 48). One mother reports she once intervened with her 3-year-old son when he was about to do something inappropriate and told him “Don’t throw the (stuffed toy) dog off the balcony.” For months he would repeat the phrase “don’t throw the dog off the balcony” verbatim whenever he meant “no” (Rim1and, 1962, pg. 50).
Speech, to summarize, may begin early or late, or not at all. Quite often, as evidenced in A Child Called Noah (Josh Greenfie1d, 1972), a book in diary form by the father of an autistic child, speech may begin, and then, by the age of 3 or 4, disappear. Speech is said to be of the “peculiar non-communicative kind” (Rimland, 1962, pg. 15), a rather peculiar statement.
To digress, rather than symptomatic, many behaviors expressed can be seen as abilities or talents. Bizarre to be sure in many cases, nonetheless when described as what they do, as opposed to what they don’t do, or do “bizarrely,” treatment possibilities seem to exist. This will be explored later.
Much of the literature is contradictory. In Hermelin and O’Connor’s work (1970) which compared autistic, mongoloid, and normal children, their results were:
1) Autism is not a marked distinct aloofness from other people. Autistics respond less frequently and for a shorter period to a whole range of stimuli;
2) Relatively fast adaptation to Iight at the cortical level;
3) Unresponsive to verbal and non-verbal auditory stimuli;
4) Autistics show more activity which is non-stimulus directed and are less able to use visual information in perceptual motor tasks (pg. 350).
Finally, while not described as a symptom, there is a rather remarkable behavior most autistic children seem to possess – marked musical ability. One of Kanner’s (1943) original cases did in fact become a composer. In Parents and Children in Autism (Marian K. DeMayer, 1979) it is noted, “observations have been made that autistic children may have some normal or supernormal music abilities” (pg. 141). Rimland (1964) has also stated special musical abilities are “nearly universal” in autistic children with 15% carrying tunes unusually well, and 15% having unusually well-developed rhythm (pg. 75). Ritvo (1976) concurred, noting their “excellent memories and music abilities” (pg. 44).
Indeed, Ritvo describes a boy of 17 months who spontaneously repeated in full an aria from Don Giovanni. Between 18-36 months he sang “a remarkable repertoire of music, consisting of symphonies by Mozart and Haydn, songs by Schubert and Brahms, selections from Carmen, a Tchaikovsky Piano Concerto, and diversified well known songs” (pg. 80). Ritvo also described an autistic child who would reorganize a set of blocks with pictures and numbers in precisely the same disorganized pattern days apart, with careful attention to where each block was to be placed, its angle, and where each number and picture belonged. There are many instances of children completing jigsaw puzzles as readily as when the picture is face down, as face up.
ADDITIONAL CASE STUDIES
Reeve – 2 years 3 months
Normal pregnancy, C-section. He has frequent ear and respiratory problems, colic, and allergies. No evidence of neurological disease and no indication of brain damage. No family history of psychological disorders. Developmental milestones within normal limits. His parents became aware he was different at 3 months. He avoided social interaction with adults and children, remaining alone for hours on end. He seemed insensitive to pain. His mother reports he sat up on the operating table during hernia surgery (26 months) and only a few days after the operation attempted to walk up the stairs of his home. He engaged extensively in self-stimulating activities such as gazing at his hands, at lights, or off into space. He chanted continuously, ran in small circles, rocked frequently in his crib, on the floor, and particularly next to a vacuum cleaner. He compulsively lined up papers and toys in particular patterns. He showed some destructive behavior consisting of head banging concentrated on sharp corners of furniture (Lovaas, 1977, pg. 66).
Timmy – 8 years old
“When disturbed he was an extreme head-banger.” His pediatrician once reported when he went to his home to treat the boy for an earache, Timmy’s terror of the pain caused him to ram his head into a wall. Though he seemed to show no pain reaction, if accidently hurt even slightly in some other area of his body, “Timmy would fall quite apart and act as though he was mortally wounded” (Coffey & Weiner, l967, pg. 33).
Bobby – (as an adult in an institution)
Born in l940 to a professionally trained father and a mother who later completed a teacher‘s education, Bobby has been mute since birth. He is insensitive to pain and has not cried since infancy. He developed no conversational speech but acquired a reading ability of 2000 words, mostly nouns referring to specific objects. To express his needs, he grunts and points. He has made no significant progress in any direction since his teens. Bobby’s sex drive is low, and he does not distinguish between men and women. He understands the watch and calendar, but money means nothing to him. He writes words to show their patterns and similarities but not to convey meaning, though he can fill in a single missing word in a sentence (DeMayer, l977, pg. 111).
Mr. A – (Recovered or cured autistic adult)
Now in his fourth decade of life, Mr. A illustrates how poor emotional control and inability to read the nuances of social situations override the influence of superior intelligence. He has difficulty holding a job, and has a continuing problem starting and maintaining friendships. In describing his social problems Mr. A states, “I lack intuitive capacity. . . which makes it difficult to perceive the subtleties that other people find easy. . . I tried to learn what different kinds of situations called for.” Mr. A went on to complain the adult autistic who is recovered receives help from no one, and complained autistic healers are biased towards those who are institutionalized. Demeter, 1979, pg. 150)
1. Age – Most authors describe autism as beginning at birth (Kanner, 1943) (Churchill, Alpein, DeMayer, 1971) (Lovaas, 1977). Hermelin & 0’Connor state the onset occurs before two. They diagnose these symptoms occurring in 8-year-olds and older as childhood schizophrenia. Those within the 3-5 range are difficult to diagnose, but symptoms are probably a result of a brain disease (1970).
2. Sex – More prevalent among boys. Estimates range from 2.5 to 4.3 to l ratio of boys to girls
3. Incidence – Autism is estimated to occur in ranges of 4.1 per l0,000, 4 per 9000, and 4.3 per 10,000. There is also a greater incidence among first borns (Hermelin & 0’Connor, 1970).
4. IQ – There is some disagreement here, but only in reference to “spikes.” It is accepted most autistic children are of subnormal intelligence (Kanner, 1943). I.Q. can occur at all levels, though bias is towards the lower levels (60 or less) with 70% being below 55 (Hermelin & 0’Connor, 1970, pg. 4). The spikes referred to account for some normal and exceptional abilities most autistic children possess such as fine motor skills, rote memory, pattern arrangement, and musical ability.
5. Family & Socio-economic Background – Kanner (1943) first noted autistic children came from families of middle or upper socio-economic status, and the parents were of above average intelligence, noting this phenomenon differs from all other known psychiatric disorders in childhood. He also describes parents as obsessive, intellectual, and cold (pg. 51). Further, the parents were often described as humorless, detached, and highly or excessively rational and objective. “Most of the parents declare outright that they are not comfortable in the presence of people; they prefer reading, writing, painting, music, or thinking. They are, overall, polite and dignified people who are impressed by seriousness and disdainful of anything that smocks of frivolity” (Churchill, Alpine, DeMayer, 1971, pg. 75). “Parents have a single-minded dedication to purpose and are prone to conscientiousness” (Kanner, 1949, Pg. 421).
Des Laursers and Carlson (1959) provided their explanation for the occurrence of the high-intellectual and educational background of the parents of autistic children, suggesting, “There may be a spurious correlation due to the frequency that autistic children are frequently misdiagnosed the first time as mentally defective, brain-damaged, deaf-mute, or childhood schizophrenics. It is reasonable to assume only those with financial means could afford the costs involved for second and third procedures. Occurrence may be high in the Jewish community because of their well-known psychological sophistication and facilities.” It is noted these reports, for the most part, were intuitive summations on the part of the authors. No testing or studies to support these conclusions were found.
6. EEG – Abnormal EEG‘s occurs in 50% of tested cases. However, abnormalities are not associated with seizures or detectable neurological deficits (DesLaursers & Car1son, 1959).
7. Response to Treatment – Treatment effects of psychoanalysis are said to range from poor (Kanner, 1943) to non-existent (Churchill, Alpein, DeMayer, 1971). It is also agreed by all drugs have shown very poor results. There is also no indication whether autistic children do better or worse than children with other disorders using operant conditioning. There are some indications educational techniques may work (Churchill, Alpein, DeMayer, 1971). In the book, Autism-New Directions in Research and Education (Webster, Konstantareas, Oxman, Mack, 1980) there is further evidence educational techniques are effective. There has been good success using sign language, albeit particularly designed for the autistic child.
Perhaps the most promising and successful treatment intervention can be found in Barbara Knickerbocker’s book A Holistic Approach to the Treatment of Learning Disorders (1980). For example, regarding head-banging, she states: “Efforts to provide him with more suitable means to provide this kind of stimulation to the point of being satiated would be one method used in the holistic approach.” (pg. 59)
Further, as can be seen, her methods are prescriptive in nature and she speaks of letting the “child be your guide,” and to “feed the need”; that is, allow him to do as he does, under direction, (although she calls this technique “non-directive”). She believes in “more structure, less instruction” and her rationalization is as follows: “Behavior such as this (twirling themselves and objects) is representative of an excessive need for stimulation of the vestibular system and a means of facilitating sensory integration. When this need is satisfied the tendency to twirl himself and objects will be greatly diminished or may cease altogether.” (pg. 80)
8. Long Term – A small minority recover by adolescence. Of the adult population, 50% are in institutions, approximately 30-40% remain cared for at home, and some 10-15% are considered recovered.
Etiologies are varied, and best summed up Hermelin & 0‘Connor’s book (1976):
(1) Bett1eheim (1967) views autism as emotional malfunction between mother and child.
(2) Knight (1963) Beres (1955) Mahler, et al (1959), suggest an impediment of the ego structure. Rimland (1964) and Wing (1966) argue against this view on 3 points: a) few orphanage children develop autism, b) no adequate demonstration of coldness or rejection of mother made available, c) mothers of autistic children have normal children.
(3) Bender (1961, 1963) and Chapman (1957) support a genetic view; however, no chromosomal studies support hypothesis.
(4) Kanner (1954) suggests condition is congenital.
(5) Rimland (1964) and Hutt (1964, 1965) have developed a physiological hypothesis.
6) Feister & DeMayer (1961, 1962) take an environmental point of view.
(7) Anthony (1963), using Piaget‘s stages in child development, has 3 theoretical explanations: a) Derangement of sensory input; b) interference with central coordinating and integrating mechanisms; c) disorder of output.
At this point, rather than offering this writer’s ideas, a digression is necessary. Up to now, this paper has dealt exclusively with autism. Originally intended to find some common ground between autism, fetishes, self-mutilation, masochism, vagrancy, and passive sodomy, this endeavor, following the criteria of the ISFP, was frustrating, and for the most part, fruitless.
What were looked for in the literature in each category were common personality traits. These were glaringly missing, as descriptions centered about the deviant behavior, with virtually no demographics given; or at least none, other than statistical, which would give clues to temperament. There is very little information on fetishes other than historical tribal rites and old Freudian viewpoints, which described the malady and not the people. Such was the same with the other behaviors of the ISFP.
Perhaps the one exception is the information given on the vagrant. At least it was the most romantic, and while perhaps not descriptive of the ISFP, it certainly describes rather well the SP in general. In You Owe Yourself a Drunk; An Ethnography of Urban Nomads by James P. Spradley (1970) he states, “The tramp is on a perpetual journey and the trip is more important than the destination . . . The wandering may have boundaries – for some it is the world; others the nation; others the city” (pg. 252). And “the highly sophisticated organization of behavior . . . is not that of a burned-out schizophrenic. It is that of men adapting to a society whose structure and institutions hold no place for them” (pg. 258). He speaks of a world of strangers who are friends.
From The Hobo – The Sociology of the Homeless Man (Nels Anderson, 1923) it is reported Alfred Adler tested 100 hoboes and found that 43% had paranoid personalities, 35% had inadequate personalities, and 22% had emotionally unstable personalities (pg. 73). (Note: Not a healthy one in the bunch!). From Old Men Drunk and Sober (Bahr & Cap1ow, 1973) it is noted only 20% of those living in the Bowery had no institutional experience, 47% were middle born, and 50% never married.
Wanderlust is a general theme of the Hobo. Anderson (1923) prints a Tong poem written by a tramp unnamed, of which the first stanza is given:
Nothing To Do But Go
I’m the wandering son with nervous feet,
That were never meant for a steady beat,
I’ve had many a job for a little while,
I’ve been on the bum and I’ve lived in style,
And there was the road stretchin’ mile after mile,
And nothing to do but go. (pg. 198)
Wanderlust is the yearning to see new places, to feel the thrill of new sensations, to encounter new situations, and to know the freedom and the exhilaration of being a stranger (pg. 82).
In the cases read, while sketchy at best, most men reported a failure in academia, or boredom, and had a marked ability with mechanical devices and tools, as seen in the case of W.E.: “a job on the railroad…job in the extra-gang… to a farm where he tired of ‘eating at the same table’ everyday…to a box factory in Kansas City where he became an expert at working with tools… was maintenance of way of tools on Railroad…got a job timbering…tried millwright work…went to a bridge gang. Each month he may come to town, spend his money, and each time he goes out to some different job” (Anderson, l923, pg. 74).
Unfortunately, there was again little information given on family background, or childhood, or additional personality traits.
Masochism, defined as submitting to physical or mental cruelty, was derived as a symptom from the writing of the Austrian, Leopold Von Sacher-Masoch. Virtually all of the cases given were of a sexual content, including passive sodomy, and again were viewed in Freudian terminology – that is, explanations of deviancy were given with very little descriptive notes, and no personality clues given.
In the following section, whatever correlation is made to the seemingly diversified symptoms of autism, vagrancy, et al, will be done for the most part, regrettably, by intuition and inference.
To give supporting evidence to this writer’s perspective, it is first necessary to review some of Keirsey’s remarks regarding the ISFP temperament. Keirsey speaks of “the tendency of ISFPs not to express themselves directly, but through action,” they are “more inclined to the fine arts”; “they experience intensely, now”; and “the act is the ISFPs master.” Further, he notes about the ISFP temperament:
“They are usually quite oblivious to these accompaniments (fatigue, pain, or danger)… as they are wholly engaged by an action…the ISFP is attuned to color, line, texture, shading– touch, motion, seeing, and hearing in harmony . . .”kindness is unconditional . . . sympathy carried to its most extreme form . . . not interested in developing facility in speaking . . . speech, after all, is abstract, not concrete . . . this reluctant speech is not so much a lack of ability as it is disinterest . . . the number of great artisans . . . who have been ISFPs is truly awesome. (Keirsey & Bates, pg. 204-266).
The infant ISFP, as will be suggested, steps into a world of prejudice.
ISFP children evolve through action, love the senses of being, are enthralled by doing. Unfortunately, what they do, innately, from the womb, they are asked not to do. Perhaps as in no other type does this social stigma begin because of natural action as with the ISFP and is perhaps what Keirsey meant when he said they were the most misunderstand of all types.
If sensing and the senses are the life source of the autistic child, imagine what it may be like to hear for the first time, to see, to touch, to taste, to smell. Colors, forms, patterns abound in the new world, and would be a source of constant fascination, and a never-ending source of doing. What many authors called “an extreme autistic aloneness” can be seen as a fascination in what they are doing; a child described as “appearing unoriented in events about him and may occupy himself for hours with repetitious activities” can be quite oriented and interested – in his own pursuits.
Pronominal reversal and delayed echolalia, as these symptoms are described in the literature, may simply be a fascination for sound, with the content met with disinterest. It can even be speculated a typical autistic phrase such as “don’t throw the dog off the balcony” when he means “no,” is a single, harmonious sound that quite readily serves its function to the toddling ISFP.
The whole idea of non-communication is rather a ridiculous notion. Clearly, these children communicate, naturally, although in their own manner. They are adept at getting picked up or put down, asking for toys, getting fed what they want to eat, and so on. Messages are sent and received. What is termed bizarre so often can be explained as misunderstood or not understood messages. Interestingly enough, and to the credit of the autistic child, with time and persistence, he teaches his significant others his language. It is not a coincidence sign language has been found to be particularly useful, action, senses, movement.
One author characterizes the bias we all, to some extent, possess when we try to describe symptomatic behavior of the autistic child (in reference to play activity), “. . . seen as profoundly disturbed play pattern, since it was perseverative and did not lead into any other interest,” as though perseverance and no other interest were symptoms of illness. The psychological world is intent on describing and rectifying what people don’t do rather than observing what people do. It would seem in the case of the ISFP child, this bias is pre-eminent. In effect, we ask a sparrow not to behave as a sparrow.
Social acceptance and the ability to “make it” is almost solely dependent on the interpretations of others, and that includes the very real prejudices, values, and judgments we all possess. A lingering question remains: At what point does this behavior become pathological? That is, when do significant others decide the expressed doings of this child is no longer acceptable?
Imagine, again, the emergence of the ISFP to his environment with which he artfully plays. If his parents were the seemingly cold, logical types, his actions could be seen as undirected and purposeless and an area of concern; he could be seen as lacking in “intellectual abilities.” To the emotive, empathetic types, his aloofness to others and his “absence of warmth” would be an area of alarm; he could be said to be suffering from some emotional disorder. Were he born to the socially conservative, salt-of- the earth types, his patterns of communication would be indeed worried over; he may be said to have brain damage or a low I.Q. Combinations of types would only add to complexities. It is also worth mentioning, professionals and adult concerns about these symptomatic behaviors are one-sided. Until they are notified by the adults in their lives, these children are perfectly happy to pursue what comes natural to them.
Self-mutilation, sodomy, masochism, head banging, and other destructive behaviors tend to have an obvious connection – pain. Keirsey states the ISFP “simply doesn’t notice” pain. Perhaps it is as stated in Pain & Emotion by Roger Grigg (l970); “There is therefore some plausibility in holding that those who are apparently insensitive to pain are merely indifferent to it” ‘ (pg. 165). To put self-inflicted or other inflicted pain in perspective, it may be necessary to re-define its content. If pain were seen as an activity, a doing of something, as simply a sense to explore, play with, and manipulate, perhaps it would be easier to explain such strange behavior. Indeed, many people report pain as a sensation, and not as uncomfortable nor even as something to avoid. As it is so reprehensible to most others, it is hardly understood as possible, let alone something one would actively pursue . Whether an indifference or a lack of feeling, banging your head, or chewing on your lip, is something to do. If, as Keirsey says, and action is their master, then surely pain would not be a deterrent.
How then, does one intervene? Whether it’s “feed the need” or prescription of behavior, clearly the evidence indicates what works is to allow the ISFP to do what he does; to be what he is. To the head-hanger, supply him a drum. For the child who twirls get him a top or show him dance. To those who are mute, get him a horn or show him how to hum. To those who echo, teach them to sing. What cannot go unnoticed is that classical and modern psychological techniques have universally failed. Those techniques that have worked have been educational. Perhaps psychological methods haven’t worked because this is not a psychological problem. The problem is misunderstood communication. The responsibility lies with the adult in this reciprocal relationship; before you can teach someone else a new language, you first must understand their language.
The perspective here, to summarize, is simply stated. With just the slightest manipulation, done carefully, the phrases and words Keirsey uses to describe the ISFP temperament can be seen as the very symptoms to describe the pathological autistic child. Perhaps this malady is as Kanner put it – congenital. But rather than something to change, rather than congenital, were we to change our understanding and call it innate, then perhaps this little sparrow could flourish and become the artisan we will, in later years, enjoy and admire.
- Knickerbocker, Barbara; A Holistic Approach to the Treatment of Learning Disorders Charles B. Slack, Inc.,
- Reik, Theodore; Masochism in Modern Man; Farrar & Rinehart, 1941.
- Spradley, James; You Owe Yourself A Drunk; 197O.
- Anderson, Neis; The Hobo – The Sociology of the Homeless Man; The University of Chicago Press, 1923.
- Eister, Robert; Man Into Wolf; London, Spring Books.
- Bahr, Howard & Caplow, Theodore; Old Men Drunk & Sober; New York University Press, 19?3.
- Hermelin, B. & 0’Connor, N.; Psychological Experiments with Autistic Children; Pergamon Press, 1970.
- Kanner, Leo; Autistic Disturbances of Affective Contact; 1943.
- Des Laursers, Austin, M., Carlson, Carole F.; Your Child is Asleep; Dorsey Press, 1969.
- Lovaas, Ivar; The Autistic Child; 1977
- Tinbergen, E.A. & Tinbergen, N.; Early Childhood Autism; Paul Parey Publisher,1972
- Axlene, Virginia; “Dibs“- In Search of Self; Pelican Book, 1971.
- Greenfield, Josh; A Child Called Noah; Holt, Rinehart and Winston, 1972.
- Hassibi, Maken & Brewer, Harvy Jr.; Disordered Thinking and Communication in Children; Plenum Press, 1980
- DeMayer, Marian D.; Parents and Children in Autism; Halstead Press, 19?9.
- Coffey, Huber S. & Wiener, Louise; Group Treatment of Autistic Children; Prentice Hall, 1967.
- Churchill, Don; Alpern, Gerald; DeMayer, Marian; Infantile Autism; Charles C. Thomas, 1971.
- Webster, Konstantareas, Oxman, Mack; Autism-New Directions in Research & Education; Permazon Press, 19?0.
- Ritvo, Edward; Readings In Autism, Special Learning Corp., 1978; Article: “Autism-From Adjective to Noun”, Spectrum Pub1ishing, 19?6.
- Rimland, Bernard; Infantile Autism; Appleton-Century-Crofts, 1962.
[ORIGINALLY PUBLISHED @ BESTTHINKING.COM – MAY 2017]
Julia is the newest muppet on Sesame Street. Julia has autism. The show will educate the public about this brain disorder. Everyone is happy because we will see how autistic children need our understanding and patience. On second thought, I should have said ALMOST everyone is happy.
On an April Sunday night this year, Lesley Stahl, my favorite 60 Minutes reporter, introduced America to Julia, the newest character on Sesame Street. Julia, we were informed, has autism.
Ms. Stahl interviewed a number of producers and cast members from Sesame Street. She also spoke to parents with autistic children, and others who love them too. It was an emotional segment, in a good way. Sesame Street intends to de-stigmatize children with autism, and 60 Minutes was there to document this historic step. Everyone was proud. As a side note, I started watching 60 minutes and Sesame Street in the 1960’s. Like most Americans, I learned to love, and trust, both shows.
Coincidentally, during the same decade, I first became interested in autism. Lloyd Nolan, a character actor from the 40’s, 50’s, and 60’s, was a guest one night on the Johnny Carson show. He spoke of his “strange” 4 year-old son who had something called autism. I was captivated as he described in some detail the very odd behaviors of his son, Jay. I’ve been captivated ever since.
Fifty years later, autism, Sesame Street, and 60 minutes converged in 2017, with one reviewer of the show saying: “Sesame Street’s new Muppet Julia brought 60 Minutes viewers to tears.”
Brought me to tears too. For different reasons.
It’s Not So Easy Being Mean
Dear parents and other caretakers who love and protect and cherish these very unique children, I love them too.
For me, it’s a matter of temperament. There is no flawed biology to this, or genetics. These kids aren’t defective or damaged. They aren’t disabled or disturbed or diseased either. That means they don’t they don’t need doctors, or their medicine. They do need our protection, because they are unique, and because they are so terribly misunderstood, and because someone is always trying to fix them.
From a temperament point of view, these children are born with unique talents. Some of their famous counterparts include Mozart, Steven Spielberg, Cher, Mel Brooks, Neil Simon, Michael Jackson, Bob Dylan, Jackie Onassis, and Harpo Marx. There is much more about this, for a different time. (See Blossoming Composers in Endnotes 1)
For now, parents, caretakers, teachers and others who love these children as I do, please consider the following:
In 1982, the autism rate was 4.3 in 10,000.
I know this is accurate. I was 37, in the profession for nearly 10 years, and I was in the final year of my Master’s program (I received my Ph.D. about 4 years later). As my field assignment, I selected an internship at one of California’s Regional Centers. For the next year, I was the family therapist for 6 families, each with an autistic son. (See Girls & Boys in Endnotes 2)
I researched everything known at the time about autism, beginning with Leo Kanner and Hans Asperger. I read everything they wrote, and everything written about what they wrote, and that included the entire library booklist available in 1983 about autism. My Master’s thesis was titled: Autism and Other Self Defiling Phenomena. I still have it. I was as informed about this very small population as anyone was at the time. (See Partial Bibliography in Endnotes 3)
To remind you, in 1983 the incident rate was 4.3 in 10,000. Keeping it simple, this means if there were 10,000 children randomly gathered in a large auditorium, we could expect to find 4 or 5 children who fit the description of autism at the time.
In 2017, the autism rate is 1 in 68
Doing the math, this means the same auditorium with 10,000 randomly gathered children would now have about 150 children who fit the evolving, all inclusive description of autism. That’s an increase of 3500% – in 34 years.
How did that happen?
Is autism contagious? If so, how so? If not, how does it “spread?” Is there a virus or bacterium on the loose? Did something drastic happen to our water system in the last 4 decades? In the last 34 years, did the mercury just suddenly appear in the fish these children or their parents ate, that wasn’t there before? Did someone change the formulae for vaccines? Was there some other environmental catastrophe that triggered this incredible spike in the number of diseased children in that auditorium? By the way, these are some – not all – of the speculated causes of autism. (See List of Causes/Correlations/”links”/”evidence of”/”associations”/etc. of Autism in Endnotes 4)
I’ve asked medical professionals who should know how this epidemic occurred, many, many, many times. They usually duck the question, or provide some form of psycho-babble. I’m skilled at recognizing, and confronting, psycho-babble.
So, can anyone from medicine explain this epidemic, please? Short answer? No. No one can. Long answer? No. No one can.
So what really happened?
I’ve been awestruck, and demoralized, as the rate of autism skyrocketed in the last 40 years. It’s been dramatic. Take a look:
Why the epidemic? Because there has been an epidemic of diagnosers, all of them armed with an ever-widening, all-inclusive diagnosis – nothing else.
The Psychiatric Process: Change the Definition
In 1980, autism was added to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), psychiatry’s book of disorders-diseases-disturbances-deficiencies-disabilities. This made it official. Autism was under the purview of psychiatry. It was called infantile autism disorder back then. There were six characteristics listed. Each of the six (100%) had to be present to be diagnosed. At the time, doctors mostly ignored what was then a very, very rare phenomenon. (See what Leo Kanner said about the rarity of autism in Endnotes 5)
By 1985, the rate was 1 in 2500.
In 1988, and again in 1994, the definition of autism changed significantly. This is when I first became concerned. I knew what was coming. After a forty year career – the last 25 as director of several mental health facilities for children – I’ve seen psychiatry do this as a matter of course.
The 1988 DSM III-R declared there were now 16 characteristics of autism. Only 8 (50%) were necessary for a diagnosis. By 1994, in DSM IV, only 6 of the revised 16 characteristics (38%) were required. As a result, in just a decade, the universe of diagnosable children grew 500%. The game was officially rigged.
The autism “epidemic” began.
By 1995, the rate was 1 in 500.
Enter Autism Spectrum Disorder (ASD): The Final Solution
In 2013, DSM 5 was released. The diagnostic criteria for the newest expanded definition included these instructions to all professionals: “Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder (PDD) should be given the diagnosis of autism spectrum disorder.”
There you have it. Psychiatry “lumped” together all the symptoms of Asperger’s and PDD with autism, and the population’s diagnostic horizon widened – again. Now, any child who is a little too quiet, a little too distracted, a little too defiant, a little too introverted, a little too independent, a little too self-absorbed, can be on the “spectrum.”
By 2016, the rate is 1 in 68.
The Rest Is Easy for Psychiatry
Psychiatric scientists will continue to argue for years, in the right journals, with academic vigor, about scientific studies that expose the real cause of autism. Is it genetic? There’s some “convincing evidence.” Is it the vaccine? Studies show a “link.” What about a “chemical imbalance” in the brain? “There’s a correlation” says the psychiatric scientist.
By the way, psychiatry will neither offer, nor promise a cure. There is a good reason for this. Psychiatry has a perfect record in this regard. Zero cures. (See what Hans Asperger had to say about the cure for autism in Endnotes 6)
Will psychiatry ever find a cause? No, they won’t, for two reasons: (1) they never have, for any of the more than 400 “disorders” in DSM V and, (2) autism, like all the others, isn’t a disease, so a medical cause will never be found.
In the meantime, psychiatry eagerly “treats the symptoms” with a variety of chemicals. Here’s what they’ve tried so far with these children, with miserable results:
And, as always, psychiatry will caution us routinely, in eye-popping, fear invoking headlines that the epidemic is worsening, again. This is what psychiatry has to offer humanity, and it’s 2017.
One More Thing to Consider
In 1957, Hollywood released The Three Faces of Eve. Based on a true story, the movie is about a young woman with three personalities. Joanne Woodward won an Academy Award for her portrayal of Eve. For a few years afterwards, there was a short-lived “outbreak” of what was then called Multiple Personality Disorder (MPD) as reported by psychiatrists in America. A small industry was born. As the movie faded from memory, so did the “outbreak.” With it, the industry.
If this movie was made in 2017 instead of 1957, we would all know about MPD. There would be MPD websites, MPD theories, MPD medications, and a slew of MPD books. MPD professional and lay experts would abound, and they would all be sharing their experiences, some of the more eminent appearing on Dr. Phil, Dr. Oz and, likely, 60 Minutes. Sanjay Gupta would be educating us about this plague, including the latest science from the NIH and CDC. MPD would be on Facebook, a part of our social network, and we would be educating each other.
Professionals from psychology, psychiatry, education, social work, and many, many others would be required to attend CEU workshops where they would receive news about the latest “science” and “state-of-the-art” treatment approaches. Most importantly, they would hone their ability to make an accurate diagnosis – and they would do so in “epidemic” numbers.
There would be endless studies among medical professionals searching for the cause of MPD. They would be looking at genes, brain imbalances, environmental stressors – maybe even vaccines. There would be millions of sufferers – that might even include you – or your neighbor. To the rescue, psychiatry would be there to lead the way, ready to create and supply the chemicals to “treat the symptoms,” while their scientists frustratingly continue for years and years and years – and years – to pursue the ongoing, ever-elusive, not-quite-yet discovery of the cause of MPD.
This is, as far as I’m concerned, the genesis of modern day psychiatric “epidemics.”
Like I Said – It’s not so easy being mean
The people at 60 minutes, and the actors and crew at Sesame Street, and the parents and professionals who know these children have unquestioned love and honest and pure intentions. They are assertively protective of these children, and they make sure they are informed.
From my perspective, it has been a gut wrenching experience watching this tragedy unfold. I’ve known for forty years – as do many, many others, including many parents – these children need good teachers, not doctors. There isn’t a medical defect or – forgive us all – a “handicap” to fix.
I’ll Be Watching Too
How will they portray Julia on Sesame Street?
Will she be unresponsive? Will she avoid eye contact? Will she be off to herself, isolated? Will she be portrayed as socially inept? Will she be fixated on an unusual object? Will she engage in various rituals? Will she become expressionless? Will she use peculiar phrases? Will she lack an interest in making friends? These are just some of the “symptoms” of children on the “spectrum.”
Will adults – professionals and advocates – be defending her behavior by explaining to everyone, in as much medical detail as necessary, that Julia has a brain disorder and that she needs our understanding about her “medical limitations?” Not without hearing from me, for what it’s worth.
To Ms. Stahl, to Oscar, to Big Bird, and all the others at Sesame Street, and to the parents and caretakers of these very special kids – we are on the same side. I love these kids too. I want to protect them too.
Lastly, dear Julia, we all care about you, and that’s a good thing. I can already tell you’re gonna be great! A few of words of encouragement.
Have some fun – and just be yourself!
1 Blossoming Composers: “Autism” – from a temperament point of view:
“Composers are in tune with their senses, and so have a sure grasp of what belongs, and what doesn’t belong, in all kinds of works of art.”
“Composers have an exceptional ability – seemingly inborn – to work with subtle differences in color, tone, texture, aroma, and flavor”
. . . on their social side they show a kindness unmatched by all the other types. Composers are especially sensitive to the pain and suffering of others, and they sympathize freely with the sufferer.”
“Some have a remarkable way with young children, almost as if there were a natural bond of sympathy and trust between them. A similar bond may be seen between some Composers and animals, even wild animals. Many Composers have an instinctive longing for the wilds, and nature seems to welcome them.”
“Composers are just as plentiful as the other Artisans, say nine or ten per cent of the population, but in general they are very difficult to observe and thus greatly misunderstood. Very likely the difficulty comes from their tendency not to express themselves verbally, but through their works of art. Composers are usually not interested in developing ability in public speaking, or even in the art of conversation; they prefer to feel the pulse of life by touch, in the muscles, in the eyes, in the ears, on the tongue. Make no mistake, Composers are just as interested as other types in sharing their view of the world, and if they find a medium of non-verbal communication – some art form – then they will express their character quite eloquently. If not, they simply remain unknown, their quietness leaving their character all but invisible.”
D. Keirsey – (excerpts from Please Understand Me II)
2 Girls & Boys: In 1983, the demographics indicated autism was more prevalent among males, and that made me curious. Estimates at the time ranged from 2.5 – 4.3 to 1 ratio of boys to girls. Remarkably, and still a curiosity to me, the CDC currently reports that autism is 4.5 times more common among boys (1 in 42) than among girls (1 in 189). https://www.cdc.gov/ncbddd/autism/data.html
3 Partial Bibliography – In addition to Kanner and Asperger, some of the more influential writings at the time included:
• Your Child is Asleep – Des Laursers/Carlson • The Autistic Child – Lovaas
• Early Childhood Autism – Tinbergen/Tinbergen • “Dibs“- In Search of Self – Axlene
• A Child Called Noah – Greenfield • Infantile Autism – Churchill/Alpern/DeMayer
• Parents and Children in Autism – DeMayer • Readings In Autism – Ritvo
4 List of causes/correlations/”links”/”evidence of”/”associations”/etc. of Autism (Source: https://en.wikipedia.org/wiki/Causes_of_autism)
• Genetics/Epigenetics: heritability
• Prenatal environment: advanced age in either parent – diabetes – bleeding – use of psychiatric drugs in mother during pregnancy
• Infectious processes: cytomegalovirus – congenital rubella syndrome
• Environmental agents – teratogens – valproic acid – paracetamol – thalidomide – misoprostol – ethanol
• Other maternal conditions: thyroxine deficiency in the mother – iodine in the diet – flavonoids in food – tobacco smoke – herbicides – diabetes in the mother – maternal obesity
• Other in utero: folic acid – prenatal stress – higher levels of testosterone in the amniotic fluid of mothers – high levels of fetal testosterone – diagnostic ultrasounds administered during pregnancy – SSRI’s during pregnancy
• Amygdala neurons: “cortical areas that mediate social perception in the visual domain”
• Autoimmune disease: autoantibodies – viral infection
• Endogenous opiate precursor: digestive disorders develops opioid peptides
• Gastrointestinal connection
• Lack of vitamin D
• Oxidative stress
• Locus coeruleus–noradrenergic system impairment
• Mercury: mercury poisoning – Thiomersal
• Refrigerator mother
• Vaccines: “vaccine overload” – MMR vaccine
• Viral infection: borna disease virus – herpes virus family – multiple sclerosis
• Perinatal environment: low birth weight and gestation duration – hypoxia during childbirth – perinatal exposure to air pollution
• Postnatal environment: gastrointestinal or immune system abnormalities – allergies – exposure of children to drugs, vaccines, •, certain foods, or heavy metals.
• Social construct: boundary between normal and abnormal is subjective and arbitrary – no objective entity – social factors determine what it means to be autistic
Other “scientific” speculations include:
• Wireless radiation • Acetaminophen exposure after birth • GMO’s • Telephone wires
• Jet chemtrails • Circumcision
There’s more to come, as the list continues to grow. Results so far? Other than “promising,” and “in need of further study” – nothing.
5 Leo Kanner believed, and argued over his lifetime, that autism was rare. He too must have noticed an initial “outbreak” among his colleagues. The John Hopkins psychiatrist “undiagnosed” – and sent home – 9 out of 10 children sent to his practice by other doctors.
6 Hans Asperger believed the cure for the most disabling aspects of autism is to be found in “understanding teachers, accommodating employers, supportive communities, and parents who have faith in their children’s potential.” (See more here.)
FINAL NOTE: Many people have read or are familiar with Kanner’s first 11 cases of autism. Less well known is the 30 year follow up for those cases. Note the outcomes for the children left in hospitals. You can read it here.
[ORIGINALLY PUBLISHED @ BESTTHINKING. COM – FEBRUARY 2014]
This is a story about a nine-year-old boy on the verge of being removed from his home. He was a “terror” in school, and his family was held hostage. The school was asking for him to be medicated for his psychiatric “disorder.” See what happens to this horrible kid, and what it means for other horrible kids.
CHAPTER I: How “horrible” can a kid be?
In 1999, a well established mental health agency in California opened one of the first private, non-profit “wraparound” programs in the State. I was selected as the Executive Director.
Wraparound programs were established to provide services to families struggling with troubled or troublesome children while the child was still living in the home. Without these services, children were in jeopardy of being removed from their families and placed in a foster home, a group home, or a larger mental health facility. Families are referred to these programs by the county Department of Social Services, the Mental Health Department, and, though rare, a school district. As a bonus, these types of wraparound programs were touted to be much more cost effective than out-of-home placement – at least they began that way. (More about wraparound here.)
After 12 months of operation, we had a number of successes with the families we were entrusted to help. Our team was routinely out in the community and in the homes of our families doing “whatever it takes” – the battle cry of all wraparound programs at the time – to keep the family intact. We had exceptional people working in the program filling the roles of counselor, Mental Health Resource Specialist (MHRS)[i] and a therapist. Though we were still learning, we were dedicated, and we were confident we had the skills to help our families.
One day I got a call from a county social worker. We were providing services for two of her families already, and she was pleased with our work. She wanted to refer a nine-year-old boy she had on her caseload for three months. Let’s call him Jerry. Without our help, she feared, Jerry was headed for out-of-home placement. “If I have to remove Jerry from his home,” she said with some caution, “I’m not so sure I’ll be able to find a foster parent willing to put up with this horrible kid!”
She gave me details, and I accepted the referral. I contacted Jerry’s school and spoke with his school counselor. I asked how Jerry was doing. She told me he was enrolled three months earlier, and he was in special classes for the “learning disabled.” She let me know Jerry was performing below grade level. When asked, she also said he didn’t have any friends, adding “he’s just horrible in the classroom!”
The school did some testing. Schools love to “test” kids, especially kids they have don’t know how to manage. The school counselor told me their psychologist determined Jerry “likely has ADHD.” She was frustrated with Jerry’s mother because, “I told her we wanted to refer Jerry to a child psychiatrist because of the benefits medication can have, and she refused. Perhaps,” she implored me, “you can help her accept the idea that Jerry has a real disability.”
Since there is no such thing as “disability,” I knew we were going to have to consider the school’s perspective as we developed our plan to help.
“Horrible . . . just horrible.”
That’s what Jerry’s mother said when I asked, for the first time, how Jerry was doing. We were in her home, her eyes a little misty; she was dejected, not mad. Her name, for this tale, is Gloria. Gloria had more or less surrendered herself to the idea Jerry was always going to be her responsibility regardless of the never-ending burden, and that he would never really improve. She had been told as much by a number of professionals by then. “The school is right,” she told me, “Jerry is unmanageable.”
Maybe you know kids like this. Tell him to go left, he goes right – often because you told him to go left. “Sit down and be quiet!” only seemed to provoke more animated refusals. “Time-outs” were, well, a waste of time, because he simply wouldn’t comply. Punishment – the most overused and least effective of all techniques – got nowhere.
Rewards? Desperation, and continued failure, placed the professionals in his life in the unenviable position of rewarding Jerry for not doing something. This is common in schools and treatment facilities. Rewarding a child for not having a tantrum is counter to behavioral techniques and, mostly, another waste of time. Rewards are provided to start behaviors you want to encourage, not to stop behaviors you want to discourage. Thus, this approach was also ineffective, leading to an inevitable, irresponsible, and much too common assertion from nearly everyone: “we’ve tried everything, and nothing works!”
Getting him to school was hit and miss. Gloria did her best in the morning corralling him into the school van that showed up, often with the help of the van driver. Too often, both would yield to the tantrums. Consequently, Jerry missed a lot of school. Once he got there, it was no cakewalk. Jerry was famous. Everyone in the small school, including office staff, nurse, maintenance, all the teachers and teacher’s aides, and every administrator in the building knew Jerry.
If sufficiently provoked, it was not uncommon for Jerry to throw objects, tip over chairs and anything else in his way, curse at the top of his lungs, and in other ways defy any and all directives from the adults in his life, sometimes to the point of physical restraint. He often did so with a sense of glee – and a grin on his face – that only served to irritate the adults in charge even more. He had the attention of everyone. They all greeted him the same way on those days when he did arrive at school. “Lets have good day today, Jerry . . .” adding, with an apprehensive smile, “. . . okay?”
The Path to Horrible
Jerry never knew his father. Gloria married when she was 28 years old, and she was pregnant a year later. Her husband left one day when Jerry was nearly two and never returned. Gloria and her young son were abandoned with no means, so she moved in with her mother. I’ll call her Eleanor. At the time, Eleanor lived in a nice home in Orange County, California. Gloria was Eleanor’s second child. She had an older daughter in Florida. Jerry was her only grandson. Eleanor was widowed a year before Jerry was born.
When she first moved into her mother’s home, everything was “okay,” so said Gloria. Jerry was mostly happy, and always active. He was alone most of the time, and seemed to enjoy himself. There were no other family members in California. Gloria was a full time bookkeeper for a department store, working 40 hours a week to support the family. Because her mother was home while Gloria worked, and because of financial considerations, Jerry never attended pre-school. He hadn’t had much interaction with other children his age until he started Kindergarten.
Real trouble didn’t start until Jerry entered school. By the time he was in the first grade, “he just refused to pay attention to his teacher,” said his mother. “He hated sitting still in the classroom,” adding, “I was constantly getting phone calls from school that he was becoming harder and harder to manage, and that he was falling behind his classmates.”
By mid-semester, the school suggested a special class for Jerry. Gloria dutifully agreed. After the required school meeting that included his mother and the relevant professionals in his life, Jerry was officially declared, “learning disabled.” Now six years old, his school career was getting off to a very rocky start. Over the next year, behaviors worsened.
Jerry was becoming harder to manage at home as well. By the time he was seven, he was a “terror” at home, according his mom. Both mother and grandmother were frightened by his outbursts and did what they could to appease him. By then, raising Jerry had become a full time job for Gloria and her mother. Speaking of jobs, Gloria told me she began to miss more and more work due to a series of crises involving Jerry and his school. As if not enough stress already for this family, Jerry was known in the neighborhood as the “wild child.” Neighbors kept their children away from him.
There were dozens of meetings, new plans were developed, and a string of professionals had come and gone, with no results. At some point, social services became involved. With encouragement from many, Gloria and Eleanor decided to move. Maybe, everyone reasoned, a fresh start in a different setting was in order. Eleanor found a tenant for her house in Orange County, and the family moved to an isolated home, in a small desert city, on the outskirts of Southern California. Social services transferred the case to the new county. By the middle of Jerry’s first semester in his new school, we received a referral to help this family remain together.
CHAPTER II: Time for Change
The family moved at the end of the school year. Gloria (Guardian/Inspector for the temperament trained) knew she had marketable skills. Having hired a number of bookkeepers in my career, I know how valuable they can be to an organization. Gloria found a job before she moved. She was frugal, God-fearing, simply dressed and, in a word, dutiful.
They moved to one of a dozen or so small, isolated towns that make up the “upper” and “lower” deserts in Southern California. I asked Gloria why she picked this particular location. “I asked a friend at work,” she said. “I told her I wanted to stay close enough so I could visit Orange County, but far enough away so there aren’t many people – or neighbors. She told me about this place.”
She found a home the first weekend she and her mother, Eleanor, went looking. Eleanor (Guardian/Provider), a retired schoolteacher, was devoted to her daughter and her only grandson. In her mid-sixties, she had some health problems. She was ambulatory, though she was using her walker more and more. Eleanor would help as much as she could around the house, but the bulk of the home chores were done by Gloria.
Houses are spread out in this small desert town. Gloria’s nearest neighbor was several hundred yards away. The county-maintained dirt and gravel roads were lined with Yucca and other cacti. Most people kept to themselves. Gloria and her family lived about a ten-minute drive to the middle of town where there were a few traffic light intersections, a two block square of small businesses, and City Hall.
In Jerry’s old neighborhood, there were kids around. Though he was shunned by his peers, during the day there were the sounds of children on bicycles, on skateboards, and playing catch on his block in Orange County. Not here. They were isolated. Their first summer before school started didn’t go well. They were hoping they would find relief, and support, once school started. They didn’t.
As director, it was my practice to meet new families that became part of our wraparound program. I called Gloria on the Friday we got the referral, and we set up a meeting the following Monday, one of her days off. I told her I’d like to meet with her alone first, so I scheduled a visit about 90 minutes before the school van dropped Jerry off at home. She said that would be a good idea, and added, “. . . though I can’t promise you he won’t be here anyway, if I can’t get him to go to school in the morning.”
In the middle of the one acre parcel sat an older, well-maintained house. There was a chain link fence around the property. There were some large cacti on the perimeter, blocking the view. The rest of the property was natural desert land, except for a small garden area for Eleanor to grow some flowers and vegetables. In front of the garden, there was an open dirt area where Jerry sometimes played, alone, on his bicycle – and not much else. As I entered the home for the first time, I began to understand how desperate this family had become.
Directly in front of me, as I walked in the door, was the living room. There was a tattered loveseat on the opposite wall. That’s where Gloria went to sit down. To her right, with a small table and lamp in between, was a cushioned rocker where Eleanor was sitting and, next to her, a walker. There was a coffee table in front of them both. There was another small chair to the left of the love seat. That’s where I sat. It was Jerry’s chair. All the chairs faced the front door wall.
At the entryway, looking to my right, I saw a small television and TV stand, and three folded TV trays. On the adjacent wall there was a padlocked bedroom door (used for storage I found out later), and next to that an old desk with a computer. Directly to the left of the desk, and on the same wall as the loveseat, was the door to the kitchen.
To the left of the Eleanor’s walker was an open entryway to a step down, large dining room. In it was a beautiful, formal, dark mahogany, dining room set that included a long table, eight chairs, and two china cabinets. Everything was covered in heavy plastic. There were stacks of boxes on the furniture, and along the wall of the room. There was dust everywhere, as though no one ever went in there. No one did.
Still standing in the entryway, to my left and down a very short hallway was the door to Jerry’s room. His room had a single bed. The room was small, though adequate and clean, and minimally decorated. The window in his room was nailed shut. A little further down the hallway on the right was the door to the master bedroom. Mother and daughter shared the master bedroom with two single beds. At the end of the hallway was the bathroom that Jerry used.
They managed to get Jerry to school the day I arrived. I introduced myself, and we began to talk. Within a few minutes, Eleanor started to cry. Here’s why.
Gloria made it nearly impossible for Jerry to go anywhere in the house without her or his grandmother knowing. There was a latch on the kitchen door, out of Jerry’s reach, that would be locked when he was home. They kept snacks like cookies and potato chips and fruit in the living room. There was a lock on the master bedroom door as well, except at night. There were boxes filling up the entryway to the dining room, making it very difficult to enter without raising the attention of mother and grandmother.
So, Jerry had access to the living room, his bedroom, his bathroom – and that’s it. At night, the front door had a deadbolt to keep everyone out and, added as soon as they moved in, a second deadbolt, at the top of the door, to keep Jerry in. He had snuck out in the middle the night many times over the years.
Mother and grandmother kept the door to their bedroom open and unlocked at night so they could hear. Still, they put two chairs in front of the door to act as a barrier, “. . . in case Jerry got up in the middle of the night,” said Gloria, “demanding something.” The door to his bathroom was unlocked and accessible. There were no items or decorations on the floor, on the walls, or on the counter, except for a toothbrush and toothpaste.
In the next 90 minutes, they told me much more about their plight over the past several years. Jerry would become belligerent and “explosive,” according to both of them. He would throw items in the home, sometimes at his mother and grandmother. Appeasement and capitulation were their remaining child management “tools.” They would do nearly anything to avoid an outburst. All of them – Jerry, mother, grandmother – were captives in their own home.
Gloria loved her son, and Eleanor loved her only grandson, dearly. Yet, reluctantly, they both acknowledged that maybe Jerry would be better off somewhere else “where they can take better care of him.”
“Can you help us?,” Eleanor asked, nearly without hope.
“Yes,” I answered, “we can.”
Just about then, we heard the van driving up the gravel road to drop Jerry off at home. Mother and grandmother began to apologize for Jerry’s behavior, before he entered the house.
Good, I thought to myself, time to meet this “horrible kid.”
CHAPTER III: Heeeere’s Jerry!!
Gloria got up, went to the door, and walked out to the van. “I’m praying he’ll be good, Dr. Cima,” she grimaced, “but I can’t guarantee it.” Gramma Eleanor began to cry, again.
Before Jerry arrived, Gloria said they never knew what to expect when Jerry came home. Sometimes he’d have a smile on his face, other times his face would be beet red from anger. He might ask for an apple, or toss his backpack at his mother. It was common for Jerry to be the only child in the school van, “for safety reasons.” Good days or bad, whether alone or with other kids, there was an extra staff member assigned to sit next to him, to and from school.
We decided it would be a good idea for me to meet with Jerry alone so, as planned, I followed Gloria outside. I met the teacher’s aide, and “escort,” John. He told Gloria that Jerry had a “mixed” day. John said Jerry was “good in the morning, but he became very agitated in the afternoon, so we had him in a ‘time out.’”
“Time out” meant he was taken from the classroom, and a staff member was assigned to supervise him in a separate and isolated room. No teaching occurred. It was supervision only, so Jerry wouldn’t disrupt the classroom. John was twenty-something, liked his job, very nice, and very poorly trained in child management methods.
Jerry was a normal sized 9-year-old, maybe a bit smaller than most, but not by much. He was slender and he looked in good health. He had light brown hair, he was fair skinned, and he was dressed nicely by his mother. However, on this day, his clothes were disheveled, as though he had been wrestling. I learned later, while being escorted out of the classroom to his time out, Jerry had to be restrained by John and another aide at school. I remember thinking, when I first saw him, he looked like an angry Dennis the Menace.
In her most cautious voice, as though she was trying to avoid an outburst, mother started to introduce me to Jerry. I interrupted, just a little, as I smiled at Jerry. I learned during my conversation with Gloria and her mother that he liked baseball.
“Hi Jerry,” I said, “I’m Dr. Cima. Wanna play catch?”
“Yeah!,” he answered.
He dropped his backpack, ran to his room, got a ball, and came back outside – with a good looking grin on his face. For the next 15 minutes or so, we played catch, and we were having some fun. He wasn’t very good at playing catch, as though he hadn’t had much practice. He was going to get some, we both found out. For the next six months, whenever I came to his house, he wouldn’t talk with me until we played catch, for about 15 minutes or so. It was our routine, and a small price to pay, having some fun with this fun-loving Star. That, and not coincidentally, he got better and better at catching and throwing a ball, and I was able let him know it. He was proud of his improvement.
By the way, when you can, it’s a good idea to meet a child for the first time when he’s at his best, not his worst. How does he behave when he’s happy? What does she like to do? What energizes him? What entices her interest? Besides, I knew all about Jerry at his worst, as attested to by his mother, grandmother, teacher, and social worker.
We had a short conversation, mostly about things he liked to do, nothing about things he didn’t like to do. He was wary. I was just another adult in his life, probably there to “boss me around, like everyone else.” It’s worth pointing out, Jerry was bright. That is, he could read adults very well. He knew how to provoke, or charm, as needed.
He told me he liked to play, that was clear, and he told me he liked to draw. I learned from mother he did a lot of drawing in his room using pencils from a set she bought him. I saw a few of his drawings. They were very colorful, some were well done, for a promising artist. If there was a theme to his drawings, I didn’t see one. There were pictures of animals, cactus, and unnamed people. No particular emotion jumped out at me either. These were mostly drawings of his surroundings. He didn’t keep many, and not many people had seen them.
About 45 minutes or so passed and I declared, to myself, that Jerry perfectly normal. He was, of course. At his best, he was cute, he was happy, and he was fun. To be sure, he was driving adults crazy, and they were ready to restrict his movements at a moment’s notice. Still others were clamoring to give him some sort of medicine, also intended to restrict his movements, and to get him to finally “pay attention!!”
If you were expecting this to be about how we changed or fixed Jerry, well, you may be surprised, though I hope not. If you didn’t know, I write a blog called “Your Kids Aren’t Sick,” here. That includes Jerry. He didn’t need changing or fixing and, from a temperament perspective, that’s not even possible. Instead, as you will see, we helped adults change their behavior, and Jerry’s followed. This is always true, and usually denied, by adults, especially professional adults.
I was confident we could help mother and grandmother. They had lost control of their child some years before, for reasons that really don’t matter. I knew mother and grandmother felt defeated. However, I also knew they wanted Jerry to remain at home, despite their doubts. Please remember, as a wraparound program, our mission was to keep the family whole. With a few child management techniques, and some modeling by our team, mother and grandmother would be back in control in a relatively short period.
My major concern was school. I had a scheduled meeting the next day with Jerry’s teacher, and others. I was sure with time, persistence, and some good work by our team, we could get Jerry to school in the morning, every day, with a smile on his face. I wasn’t sure, however, without interactive changes by the school, how long the smile would last once we did. Most important, unless the adults change in both locations, in the long run, not much will improve.
I brought my wraparound counselor, Angela, with me. The two of us met, after school hours, with Jerry’s teacher, two teacher’s aides from his classroom, the school psychologist, and the Principal. Wraparound was a new California statewide service in 1999, it was court ordered, and most professionals were supportive. When I asked for a general meeting with everyone, they readily agreed. They needed, and wanted, help too, so I knew we would have willing participants, at least in the beginning. The trick is to encourage the participants to become our partners in this endeavor.
For the temperament-tuned, Angela was a Champion Idealist, and her enthusiasm alone was enough to give everyone a much needed positive “boost.” She was smart, she was an experienced trainer in child management, kids liked her, and so did everyone else. Her relationship with school personnel was going to be key to creating the changes that needed to occur.
The school reported, as determined in Jerry’s Individual Education Plan (IEP), that Jerry needed an abundance of one-on-one time. They assigned staff members to bring him to school and to take him home. Others were there “to be with him” at breaks, recess, and lunch. He was rarely “in the right mood” to interact with the other children. His demeanor went, seemingly, from flat to fiery in a matter of moments. They used a token economy in the classroom to provide motivation and behavioral guidance. They also relied on Zero Tolerance as their discipline program. None of this seemed to help. Without hesitation, the Principal, teacher, and aides all agreed Jerry was their most difficult challenge of all their students.
The psychologist also reminded Angela and me of his professional assessment. He stated Jerry is “obviously ADHD.” He said he would like to refer Jerry to a psychiatrist and that “mother is not cooperating.” In private, those words rankle me to my core. Parents are routinely chastised, increasingly often, for not giving permission to a doctor to give their child an amphetamine, for a disease that doesn’t exist. Nevertheless, in this meeting, I listened. I wasn’t there to debate the school psychologist.
Instead, we told everyone we’d be developing a plan, and that we would like to collaborate with the teacher and aides. I said we were confident that, together, we could all help Jerry’s mother reach her goals. We also decided, at this first team meeting, that we were going to delay other recommendations, including psychiatric. It’s important to get everyone on board. They were skeptical, perhaps cynical, and they were expecting us to change Jerry. Nevertheless, we had their commitment, and that’s all we wanted to accomplish at our initial meeting.
Now, it was our turn. Angela and I needed to gather our team at the office. We needed to put together the plan.
CHAPTER IV: The Plan
Angela and I began to talk about a plan on the way back to the office. Two things were evident.
There was an ongoing crisis at home. Gloria changed jobs, moved her family from their long time home in Orange County, leaving security and friendships behind. Gloria and her mother Eleanor were hopeful and optimistic that a new start, in a new school, in a new neighborhood, would reap new behaviors. Instead, now isolated and desperate, the family was disintegrating. Unless we intervened, quickly, in a beneficial way, the county social worker was leaning towards removing Jerry from his home and placing him in foster care “to make sure he received treatment.” That would, I knew, inevitably lead to Jerry being medicated with one or more of those toxic chemicals, for his “disease.” And that, in my view, was intolerable.
Also evident, the school was out of ideas. The school psychologist told me “Jerry has not improved over the last three months despite our concentrated efforts.” He followed with, “and his behavior just seems to be getting worse and worse.” This type of logic makes me wince. Schools, treatment facilities, and other places where children gather to learn, to be trained, or to be helped are quick to take credit for a child’s success by touting the elements of their “evidence based” program. When no learning or training or help occurs, they are just as quick to place blame on the child for her own “failure to improve,” due to a “learning disability” or “psychiatric disorder,” or some other “deficiency.”
There was going to be two parts to the plan. Part I: Get Jerry to school. Part II: Make school a good experience so he wants to be there. I was confident about Part I. After all, he was nine years old. To be sure, mother and grandmother were engaging in some very common mistakes when managing Jerry. With coaching and some very intense initial support by our team, I knew it wouldn’t take long for mother to be back in control of her son.
I was less confident about Part II. The school, the principal proudly told me, was a “Zero Tolerance” campus. This is when a school decides they will model intolerance to their students and their families, and claim this as a virtue. This failed model of “control first” is designed to fortify adults, at the expense of the children they supervise. Principals, some with a dab of zealotry, can become very hard to manage when armed with Zero Tolerance.
As a reminder, we received this referral on a Friday morning. I visited the family the following Monday. Angela and I met with the school on Tuesday. The next day was our regularly scheduled Wednesday staff meeting.
Our team included a therapist, Jordan, a Mental Health Resource Specialist (MHRS)[i], Vincent, Angela, and me. We formally had three services we could provide: therapy, social work, and counseling. Less formally, as a wraparound program, I knew we could do anything we needed to do to help this family, and that gave us great latitude. Here’s what we decided that Wednesday morning.
1. Starting that day, enroll mother and grandmother in our Family Night every Wednesday.
We started Family Night six months earlier. We had about four or five families that showed up every Wednesday at 5:00 PM. We provided transportation as needed. Once there, we had coffee and edibles for the adults, and we talked about the past week. We interacted for about 90 minutes, 30 of those minutes used for training in child management techniques. As important, the parents got to know each other and, as they shared many common stories, they comforted one another. Jordan and I provided guidance for this part the support group. We encouraged the parents to bring their kids.
Angela and Vincent took care of the kids once they arrived. Sometimes they would take them out for pizza. Other times, they had arts and crafts projects they were working on at the office, and they’d bring in food. At the time there were two young teenage girls, a 12 year old boy, an 8 year old girl (who eventually befriended Jerry), and a 6 year old boy that often stayed with her mother and the rest of us adults. (A year later we had nearly two dozen families involved, and about 40 children – we had to add an extra night!)
So, right after our morning staff meeting, I called Gloria to invite her to Family Night. It was short notice, however, I was sure that if we made it easy, she would jump at the chance. She did. I told her Angela would pick up the three of them by 4:00 PM, and we would have them back home no later that 7:00 PM. This was also going to be a great chance for Angela to meet Jerry. The two of them were going to end up spending a lot of time together. As important, it was a priority to get everyone out of that house for a little while, every week. They had been trapped for many months. Over the next six months, they never missed our Wednesday Family Night.
2. Beginning on Monday, one of us on the team would arrive at Gloria’s home by 6:30 AM to help get Jerry out of bed, dressed, fed, out the door, into the van, and off to school.
We committed to do this every day until it was no longer necessary for one of us to be there. This was key. Everyone’s day in the household began with turmoil. Every night each of them went to bed, unhappy, dreading the inevitable morning encounter. That had to stop. So, our plan was to take turns, each of us doing a week at a time. We had other cases we were working so our schedules had to adjust. Since we were going to have Angela spend a lot of time at school, Vincent took the first week, Jordan the second week, and I had week three. We intended to do this between the three of us for as long as it took to get Jerry into school everyday, without incident.
Who was “Out of Control?”
Parents and professionals make similar mistakes when trying to get back in control of recalcitrant children. The most common mistake? Arguments. Once you acquiesce and engage in a “yes you will – no I won’t!” conversation, whether with a 3 year old or 17 year old – while in the middle of giving a directive – the ending is nearly always unpleasant. Most unpleasant, these kinds of confrontations don’t really end at all. If you’re in an argument, it means there’s a negotiation taking place, something you did not intend. By the way, children love to negotiate, for as long as you are willing and then some, especially when it comes to school, chores, and other unpleasant endeavors they want to avoid.
However, when arguing occurs daily for even the most minor directives, over time everyone’s emotions are unsettled, and everyone’s moods can, and do, adjust from moment to moment as “negotiations” continue. Arguments often deteriorate and may include a variety of invectives, and other hurtful words. For parents – especially conscientious parents – frustration mounts.
On the other hand, for children, especially bright children, an argument can be ignited – and fueled – simply by ignoring you, imploring you, delaying you, faulting you, or in other ways letting you know they will prevail in an argument you never intended to have in the first place. Inevitably, these types of two-way conversations lead to the second most common mistake that well-informed, loving parents and professionals unwittingly engage in: threats.
Threats sound like this: “If you don’t get your butt off the chair right now and into your room and take out the trash then . . . ,” followed by something you’re going to take way from him, whether a privilege, a possession, a level of freedom, or some other form of punishment. Giving “If . . . then!” directives unwittingly gives control of the outcome of the argument to the child, perhaps the most unintended of all consequences. [ii]
So, after first hand experience in her home, we knew we had to help Gloria avoid arguments and threats, however subtle or habitual they were. Much more important, we gave her new tools to handle those escalating conversations. Over the next few weeks, we were there every morning to model these techniques. [iii]
Beginning on Monday, Angela would be at school every day to assist Jerry in the classroom.
I called the principal that Wednesday afternoon and met with her the next day. While the classroom teacher may appreciate the help, school districts have rules to follow, with formal protocols for nearly everything. Adding a new person to the classroom would take some doing. Fortunately, I had a good relationship with Jerry’s school principal, and she was an advocate of our new wraparound program. It took an extra week before we could go into the classroom, but it was worth the wait. Now we had the support of the court, the principal, as well as the classroom teacher and her aides. Our full team was in place.
Angela showed up at school every morning at 10 AM. The classroom teacher was relieved. She knew she had extra help every day, just for Jerry, so Jerry became less of a management concern. She had Jerry’s schoolwork for that day prepared ahead of time. The other two classroom aides, who usually spent a good portion for their day grudgingly arguing, threatening, cajoling and in other ways, managing Jerry, had other children to attend to, and looked forward to handing Jerry over to Angela at 10 AM every day. Jerry, as much as anyone, looked forward to his time with Angela too.
Angela stayed until 1 PM every day. We thought it was a good idea to be there through lunch. Jerry was eating lunch with one of the aides who was assigned to him, in a separate room, because he was so disruptive. That changed immediately. Angela and Jerry sat together in the cafeteria with the other kids and adults for lunch. Within a few days, she organized some games during lunch for a few of the kids, Jerry joining in.
There’s often a honeymoon period when new elements are brought into relationships. Jerry had less apprehension about school, and so did the school staff. We altered the obvious yet unaware patterns of behavior of the adults in Jerry’s life that were exacerbating the otherwise normal behaviors of this 9-year-old Star. We also knew we had to take advantage of the honeymoon period. They usually don’t last too long without fundamental changes taking place.
One more thing, before I tell you about our results. When Family Night was over that evening, I told Jerry I would come by on Friday so we could play catch. He grinned. When I got there on Friday, I told him, as I was leaving, that I would see him again on Monday after school. He grinned again. For the first week, I showed up every day after school at 3 PM – except Wednesdays when the entire family came to the office. I usually stayed for about an hour. We played catch, we talked about the day, I checked in with mother and grandmother, and I left. The second week I showed up on Monday and Friday and, by the third week, I showed up Friday only – and every Friday after that, for the next 3 months.
Results at Home
I mentioned earlier that I had the third week to get Jerry out of bed and off to school. By then our team had met many times. Both Jordan and Vincent, though different in their approaches and temperaments, were successful. By the second or third day of their week, each of them was tested. Jerry didn’t want to go to school on those days, and he made sure he let everyone know, in his own inimitable way. So, with Jordan and Vincent equipped with patience, technique, and an undying persistence, Jerry got to school anyway. Both Jordan and Vincent had one day, and two days, respectively, when they had to drive Jerry to school because he didn’t get in the van on time. Nonetheless, he arrived at school. Persistence, training, and a conviction to avoid arguments and threats, paid off.
Now it was my turn. Keep in mind, I had spent a lot of time with Jerry. He liked me, and he trusted me, little by little. The first day, Monday, was a good day. I got there at 6:30 AM. He knew I was coming. He was up already, and he was cooperative, though a few times I had to give some reminders. Still, I got him off to school. (I forgot to mention that our team took over in the morning. We gave the directives to Jerry, and we were responsible to get him off to school. There were no confrontations between Jerry and his mother while we were there, and that was a good thing.)
By the second day, not nearly so easy. Jerry woke up in what his mother always called “a foul mood,” and he didn’t want to go to school that day. So, like Jordan and Vincent, I stuck with our techniques, and I was persistent. On my third day, Jerry declined to get up, period. He was in full-blown refusal mode. Still, he got into the van on time. Please remember, he also knew by then that Angela would be at school by 10 AM. That made a difference.
By the way, what do you think we did? You’d be right to think we chased after him, sometimes, around his room. On his worst days, we would corral him, verbally, and, avoiding arguments and threats, continue – like a broken record – to insist he get out of bed, in his clothes, fed, and off to school, even if that meant we would drive him there.
I mentioned earlier that Gloria had Mondays off. On a hunch, I checked with the school. Jerry never missed school on a Monday. Other days were hit and miss, Friday the most common missed day, but not Monday. Not even once. She could get him there on Monday, but not without a lot of turmoil. Still, she got him there.
If you play a slot machine and it pays off every once in a while, you keep playing. If your slot machine never paid off, you’d stop playing. Jerry figured out that some days his antics “paid off,” so he kept playing. It’s worth repeating: whatever those antics were – and they were energetic – they didn’t work on Mondays.
On my fourth day, I arrived on time as usual. By then, Jerry had more or less succumbed to the idea that he was going to school. He didn’t make it easy. He was also persistent in his techniques” to avoid school. However, there was an inevitability that seemed to finally win the day – as it always eventually does. After a few contentious moments in the next 90 minutes, Jerry got in the van and left for school. That’s when Gloria asked to talk to me.
“Dr. Cima,” she said, “you don’t have to come tomorrow. And you don’t have to send anyone else next week either. I can handle this myself,” she said, a little sheepishly, I noticed.
We honored her request, though we suggested one of us come by at 8 AM starting the following week, just to see how she was doing. She thought that was a good idea, so we did. The next week we showed up as promised, this time at 8 AM. The week was not without incident. Mother had one or two hard days. However, we never had to intervene, nor did we have to transport Jerry to school. He got in the van every day. It was getting easier for everyone. So was school.
Results at school
Angela was doing what I anticipated. She provided enthusiasm and fresh energy in a negative environment. Jerry was no longer a target. He couldn’t be. Once he got to school, he only had to make it to 10 AM, and he knew Angela would show up. Once she showed up, he got her complete attention. That eased the pressure on the entire classroom, kids and adults. Within a few weeks, Jerry improved dramatically. Who’s surprised?
In addition to his lessons, Angela had him drawing every day. He got better and better at something he was already doing. More important, he received acknowledgement from his teacher, aides, and classmates. The teacher, with Angela’s urging, announced she was going to have an art contest. Jerry won. Whether he deserved to win or not, he won. There was much less to frown about at school – for everyone.
He was befriended by two boys in class who started to eat with him at lunch. This took some time to develop. Jerry hadn’t had any real friends, well, ever. He was the problem child in school and his neighborhood nearly from the beginning of his school life. Other kids shied away, Jerry’s behavior so unpredictable, and adult responses so intense. Angela spent a lot of time helping him nurture his new found friendships. He also had a friend – a girl – he met from Family Night. She was also a Star. She also needed a friend.
By week five, Angela showed up 3 days a week. The following week, twice. By the beginning of the third month, she met with Jerry, and his teacher, once a week until the end of the school year. By then, it was a lunch date, as Angela arrived in time to have lunch with the two of them in the cafeteria. Was he still, at times, hard to manage? Of course. He was nine. However, by then, he was no worse or better than anyone else in class.
We had regularly scheduled weekly meetings with the team at school, and that included Gloria. Once a month the county social worker joined us. Progress was undeniable. Crisis avoided.
What about “Therapy?”
There was no time for therapy when we started. More important, therapy has nothing to do with child management. Unless they receive training, therapists haven’t a clue how to manage children, nor should they. Child management is not taught in graduate school. Level systems or point systems or other forms of behavior modification can be useful to start new behaviors, when used and designed for an individual child, and not a group of children. To the degree “b-mod” is used to stop unwanted behaviors or as a discipline tool, they continually fail.
Nonetheless, we had a gifted therapist. She made it a point to spend private times with all our parents on Family Night. She had a good relationship with Gloria. After the crisis was averted, she began to spend more private time with Gloria because, as Jordan told me, “now she can talk about other things in her life besides Jerry.” As you may guess, Gloria had a lot to talk about with our therapist. Jordan began to meet with Gloria every other week for an hour or so, just to talk. By then, Gloria started to get a grin too.
Vincent, our Mental Health Resource Specialist, was very resourceful. By the second month, he began to search for a Big Brother and, after interviewing a few candidates, he selected Domenic, a 25-year-old graduate school student, majoring in economics, with a minor in physical education. Domenic was single, stable, lived close, liked kids, and he was a great model for this long time fatherless – and friendless – child. Domenic was the perfect “medicine.”
Looking back, I think this may have been the most important addition to this family. Our wraparound team was gradually withdrawing our involvement, as we inevitably needed to do. Domenic took to Jerry immediately, and vice versa. He saw Jerry at least twice a week, and usually for a half day every weekend. They went places and they did things. That’s all that was needed.
A Few Final Thoughts
Yes, dear reader, it took this much initial effort to avoid a catastrophe that had been brewing for several years. By the time we were involved, everyone was overwhelmed. The school knew all about Jerry long before he arrived. The prior school sent all of Jerry’s incident reports along with his academic shortcomings to the new school. The psychologist told me that they knew they were getting “a firecracker!” Reputations matter. It was as if he had a giant X on his back from the first day. (I’ll be writing about “The Baldy Maneuver,” a reputation-changing technique that we used with much success during our meetings with school personnel and the county social worker.)
By the way, do you remember John, one of the teacher’s aides in Jerry’s class who was also the transport driver in the van? I told you he was likable, and very poorly trained. Well, since he was there every morning with us, everyone on our staff got to know him too. Six months later, he applied for a job in our expanding program, and I hired him. Also, the teacher became good friends with Angela and, with her urging, convinced the principal to have us come in and do some child management training for the school. We did, once a month, for the next six months.
About a year after I first got the referral, I was offered and accepted a position as Executive Director for a residential facility that housed teenage boys. I managed to leave the wraparound program in good hands. At that time, Domenic was still involved with Jerry. About three months later, I had lunch with my replacement. I learned that Gloria took her family back to Orange County. The program lost touch with her. I don’t know if Domenic was still involved, but I like to think he was.
What happened, exactly? The adults in his life changed their behaviors, and Jerry inevitably followed. Maybe, I speculate, if he had a different Kindergarten teacher, trained in different methods that encouraged his innate ways, none of this would have occurred. He certainly didn’t have a disability or disorder. That was clear, despite the insistence of doctors and educators. If so, where did this disability go?
No. This wasn’t a “learning disability,” or “ADHD,” or a “disorder” that needed “medical treatment” or some other flaw in Jerry. Instead, this common school experience points to a “teaching disability,” the most prevalent problem in modern day public and private education.
So, dear reader, maybe you know a child like Jerry. Maybe you’re raising one. Or, maybe, you were Jerry a long time ago, and school is a bad memory. It‘s a bad memory for way too many Jerrys – and Jills. I hope, and trust, by reading this much too common tale, at the least, you’re convinced, way back then, you weren’t sick. Most important, You’re Kids Aren’t Sick either.
[i] In the Mental Health System in California, an MHRS is the equivalent of a Social Worker.
[ii] Here’s a another example. After 10 minutes of arguing, a mother tells her 16 year old daughter, in no uncertain terms: “If you don’t get your room clean, I’ll take your cell phone!!” Her daughter quickly replies, with a sense of confidence mother doesn’t appreciate: “I don’t give a crap about my cell phone!,” and throws it at her mother as she does. Mom has been trumped. Now she’s stuck with her meaningless threat, a still unclean bedroom, and a phone she didn’t really want. Worse, there’s nothing she can do about it because, inadvertently, she gave her daughter a choice. Either clean your room or lose her phone. She made her choice, something else mother didn’t intend. She can expect more of the same tomorrow. Why? This kind of exchange “works” for her daughter.
Threats, in the middle of an argument, can become an exciting challenge for some kids, young and old. They either call your bluff, or they let you know they are willing to experience whatever punishment you can dish up, rather than clean that room. Children are famous for biting off their own nose. Some seem to cherish it. They think as long as you lose, they win. That’s why we call them children. And that’s why we should never argue or threaten, when giving directives to children. Ever.
[iii] The techniques we trained on are taken from Active Response Training (ART), my own creation. This was mandatory training for all professionals who worked at my facilities. Incorporated into ART are a dozen effective proactive and reactive strategies found and developed by Dr. David Keirsey. I will be following this story with a series of blogs about these techniques and how they are used for each temperament.)
[iv] Rule # 7: If it’s a question of whether to do what’s fun or what is supposed to be good for you, and nobody is hurt whichever you do, always do what’s fun.
See all of Harpo’s family rules here: http://harposplace.com/Family/FamilyStory.php
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.
ORIGINALLY PUBLISHED @ BESTTHINKING.COM – JUNE 2013
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 Cocktail above) 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 a while, 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.
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.)
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, Beetlejuice and 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 mostly 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.
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 Evie 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 nauseam over 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.
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 taking 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 a while 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 crisscrossed 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 chemical 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 more stable with this unstable, 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.
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 @ https://www.youtube.com/watch?v=AgZHOSxN5cE&feature=youtu.be.
Eitan Schwarz, MD FAACAP DLFAPA
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?
Dr. Schwarz: Thank you for your comment, and sorry for this very late response. My wife and I were on a long overdue, extended vacation.
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.
She – and her mother – had to be convinced she wasn’t “crazy,” when the “evidence” (5150, removal from home, the “psychosis” &“depression dx,” 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 to 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’re 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.