The Boy Who Was Raised as a Dog (28 page)

I asked her when she did think about it.

“Sometimes when I'm going to sleep,” she said, “But then I just go away.”

“Go away?”

I knew she was talking about dissociation but I wanted her to describe what happened. There was a change in her posture: she cocked her head and stared into space, her eyes fixed down and to the left. I knew she was running some painful images through her mind.

“When it first started to happen I was so scared,” she said in a quiet, almost child-like voice. “And it hurt. Sometimes I couldn't breathe. I felt so helpless and so small and so weak. I didn't want to tell my mom. I was so embarrassed and confused. So when it would happen, I would close my eyes and try to think about other things. Pretty soon, I was able to go to a safe place in my head.”

As she described it, she seemed to change. “Little by little, I made that place my special retreat. Whenever I thought about going there and being there, I felt safe. Nobody knew where it was. Nobody could come in there with me. Nobody could hurt me there.” She paused. She was now speaking in a low tone of voice, in a monotone, almost robotically. She was staring off into space as she spoke. She hardly blinked. We sat in silence for a moment and then she continued.

“I felt like I could fly when I was in that place. And I began to imagine that I was a bird, a raven. I tried being a beautiful bird, a bluebird or a robin but I couldn't be beautiful there. I tried being a majestic bird, like an eagle or a hawk, but that didn't work either. My mind kept making me something dark. Like a raven. But I was powerful. I could control other animals. I was wise and I was kind, but I was absolutely ruthless in hunting down and using my power to kill evil. To those creatures, the bad ones, I was the Black Death.”

She paused again. This time, she looked at me. Her words had been moving. I knew she'd never shared this with anyone and that she felt that some of the power of her fantasy to comfort her lay in its secret nature. It is critical to protect someone when they are vulnerable in moments like this.

“Are you still the Black Death?” I asked. She looked away for a moment and then back at me and started to cry. That was the real start of our work.

 

AS THE WEEKS went by I learned more and more about her. Amber's story would ultimately teach me a great deal about the dissociative response to trauma and how to help those who suffer from it.

The sexual abuse that Amber had experienced was violent and terrifying, beginning when she was about seven years old. Her parents had split when she was two, and her mother found a new partner several years later and relied upon him to support the family. Duane would only molest her when he'd been drinking, which was about once every ten days or so. Then, for days afterwards, he would seem remorseful, showering her with gifts and praise, trying to make up for what he'd done. Since his drinking was unpredictable, Amber lived in a constant state of fear, always worrying about when it would happen next and about the pain and terror of the event itself. Her grades began to decline and she went from being a happy, outgoing child to being a withdrawn and anxious little girl.

She was too frightened to tell her mother what Duane was doing; he threatened her with even worse if she told. Feeling that the situation was inescapable, Amber did what she could to get control over it. She began to serve Duane drinks and behave provocatively, with the aim of getting the abuse over with. Knowing when it would happen allowed her to study and sleep through the night rather than worrying about when he'd come into her bedroom. In essence, she could schedule and isolate her terror so that it didn't interfere with the rest of her life. Her grades improved again and, to those around her, she seemed to be back to herself. Although her behavior probably doubled the frequency of the molestation, the control she gained over the situation allowed her to manage her anxiety such that it minimized the effects that the abuse had on her daily life. Unfortunately, of course, this would later produce a whole new set of problems related to her guilt over her feelings of complicity in his actions but, at the time, it helped her cope with the trauma.

When she was actually being raped or sodomized, Amber dissociated, withdrawing into her Black Death/Raven fantasy world. She would be chased by evil creatures and demons, but she would always triumph over them, as in a role-playing video game. The fantasy was elaborate and detailed. In fact, it was so encompassing that she literally no longer felt what was actually happening to her body. She encapsulated the trauma in a way that allowed her to function and cope, although, of course, she still suffered its effects when she was exposed to cues that reminded her of what had gone on, such as Duane's scent or the smell of certain drinks that he favored. Such cues would prompt a dissociative response that she could not control, in which she retreated to her “safe” world and did not respond to outside stimuli. The most extreme reaction was the one that had put her in the hospital the day after he called.

The abuse had continued for several years. Then, when Amber was around nine, her mother caught Duane in bed with the little girl, and immediately kicked him out. She didn't blame Amber, as many mothers unfortunately do in such situations, but, other than calling the police, she didn't seek help for her, either. Sadly, the district attorney didn't pursue the case after the perpetrator moved out of state. And Jill had problems of her own to deal with: as a single mother with few skills, she now had to struggle to support herself and her daughter. She and Amber made many moves from state to state, seeking better employment opportunities. Jill eventually managed to go back to school and get a higher paying job, but the instability and the abuse had done its damage to Amber.

Amber continued to cope on her own, getting decent, but not spectacular, grades. Intelligent as she was, she almost certainly could have done better but, probably at least in part because of what had happened to her, she stayed a B-student and an underachiever. Though she was not the most popular girl in her class, she was not the least popular either. She hung out with a group of teens in the middle of the social spectrum who were “Goths,” dressed in black but were not especially extreme in their behavior. They didn't drink or take drugs, for example, but their interest in mysticism and alternative culture made them tolerant of those
who did. A recent study of Goth youth culture, in fact, found that it tends to attract adolescents like Amber who have histories of self-harm. Interestingly, becoming a Goth didn't increase self-harm: before these teens found a community that accepted their “dark” interests, in fact, they were more prone to cut or otherwise harm themselves.

In school, Amber discovered that pinching or deeply scratching her arms relieved some of her anxiety. And later, in private, she found that cutting her skin could produce a dissociative state, allowing her to escape what she experienced as an intolerable build-up of stress. “It's like I have magical skin,” she told me, describing how cutting into it with a knife or razor prompted an incredible sense of relief and access to her “safe” place. Many teens, of course, find similar escape with drugs.

Though teen drug use is often seen as simple hedonism or rebellion, in fact, the teenagers who are most at risk for lasting drug problems are those like Amber, whose stress response systems have suffered an early and lasting blow. Research on addicts and alcoholics finds dramatically increased numbers of early traumatic events, as compared to those who have not suffered addictions. The most severe addicts' histories—especially amongst women—are filled with childhood sexual abuse, loss of parents through divorce or death, witnessing severe violence, physical abuse and neglect and other trauma. Brain scans of those who've experienced trauma often reveal abnormalities in areas that also show changes during addiction. It may be that these changes make them more vulnerable to getting hooked.

While self-mutilation, too, is often seen as an act of rebellion or attention-seeking, in most cases it is probably better understood as an attempt at self-medication as well. Cutting releases brain opioids, which makes it especially attractive to those who have been previously traumatized and found relief in dissociation. Although anyone who cuts will experience some degree of opioid effect, the experience is far more likely to be perceived as pleasurable and attractive to those who have a sensitized dissociative response from previous trauma and are in emotional pain. The same is true of people who use drugs like heroin or Oxycontin. Contrary to popular belief, most people who try these drugs do not find
them overwhelmingly blissful. In fact, most people don't like the numbing sensation they produce. But those who suffer the after-effects of severe stress and trauma are likely to find the substances soothing and comforting, not deadening.

Curiously, stimulant drugs like cocaine and amphetamine replicate the other common natural reaction to trauma: the hyper-arousal response. Both drugs increase the release of the neurotransmitters dopamine and noradrenaline (also called norepinephrine). Both of those brain chemicals skyrocket during hyper-arousal. Just as the dissociative experience bears a physiological and psychological resemblance to the opioid “high,” the stimulant high is physiologically and psychologically comparable to the hyper-aroused state. In both stimulant “highs” and hyper-arousal, the person experiences an elevated heart rate, heightened senses and a feeling of power and possibility. That feeling is needed to fuel fight or flight, but it also explains why stimulants increase paranoia and aggression. Brain changes related to hyper-arousal may make some trauma victims more prone to stimulant addiction, while those related to dissociation may prefer opioids like heroin.

 

AS MY COLLEAGUES and I began to recognize how trauma affects the brain and body, we began to look for pharmacological methods to treat some of its symptoms. We hoped that this might prevent the children we were able to reach at an early age from developing problems like drug addiction and self-mutilation later on. We knew, for example, that opioid-blocking drugs like naloxone and naltrexone might reasonably be tried to blunt sensitized dissociation. We had already studied clonidine as a way to reduce hyper-arousal. Though Mama P. had, with some justification, been afraid that we might “drug up” the children she cared for if we used medications—or that we might decide that medications were all that was needed, and leave out love and affection—we found that the right medication can be helpful if used in the right context.

One of the first patients we tried naltrexone with was a sixteen-year-old boy named Ted. Like Amber, he had come to our attention because
of his physical symptoms, not his psychological problems. Ted had what seemed to be unpredictable fainting episodes; sometimes at school, he would pass out. As in Amber's case, medical tests revealed no discernable heart disorder, nor did he have a diagnosable neurological problem like epilepsy or a brain tumor that might cause such symptoms. Throwing up their hands and deciding that Ted was inducing unconsciousness in some kind of bizarre teenage attention-seeking gesture, the doctors who had ruled out these other problems called in psychiatry.

Ted was tall, rail-thin and good-looking, but he carried himself as though he were depressed: slouching, moving with little confidence, seeming as though he wanted to disappear. He didn't meet the criteria for depression, however. He didn't report unhappiness, lack of energy, suicidal thoughts, social distress, sleeping problems or any of the other classic symptoms of the disorder. His only apparent problem was that about twice a week, he would suddenly faint.

When I began to talk to him, though, I discovered that there was more. “I feel like a robot sometimes,” he told me, describing how he felt removed from the emotional aspects of his life, almost like he was watching a movie or going through the motions without fully experiencing what was happening around him. He felt detached, disconnected, numb: classic descriptions of dissociation. As I got to know him I began to find out what had prompted his brain to protect him from the world.

Starting before elementary school, Ted had been a continual witness to domestic violence. His stepfather frequently beat his mother, and this was not just the occasional slap or push, but rather full-on assaults that left her bruised, scarred and terrorized into complete submission. More than once, his mother had to be hospitalized. As Ted got older he began to try to protect his mother and found that he could redirect the man's rage from her to him. As he put it, “I'd rather get a beating then watch my mother get beat up.” Although it didn't happen immediately, it was seeing her child hurt that finally prompted Ted's mom to end the relationship.

But by this point, Ted was ten years old. He'd lived most of his life with the daily threat or actual occurrence of serious violence. He'd become
socially withdrawn and isolated. His teachers called him a “daydreamer,” noting that he often seemed to be “miles away” rather than paying attention to the class around him. However, he participated enough to get average, though not outstanding, grades. Even more so than Amber, he seemed to have discovered a way of fading into the background, recognizing that earning grades that were either too low or too high would bring him attention. He didn't care if the attention for high grades was positive, since he found any attention stressful, even threatening. Ted seemed to have made up his mind that the best way to avoid any potential for further abuse was to be invisible, to disappear into the vast undifferentiated gray middle. And, until he began fainting in junior high school, that's what he did.

I proposed a trial of naltrexone to see if it would stop the fainting episodes. As noted earlier, when people suffer extreme traumatic stress, their brains can become “sensitized” to future stressors, and it takes smaller and smaller amounts of stress to set the system off and prompt a full-blown stress response. As part of this stress response, especially when the stress is severe and appears inescapable, the brain releases opioids. By using a long-acting opioid blocker like naltrexone, I hoped to prevent these opioids from having an effect when they were released by his sensitized system, and thereby stop the fainting.