The Boy Who Was Raised as a Dog (6 page)

“Well, she knew him,” Stan explained, “She both spontaneously said he did it and later identified him from a photo array.”

I asked if there was any additional evidence, thinking that maybe the little girl's testimony wouldn't even be necessary. If there was enough other evidence, perhaps I could help him convince the prosecutor that testifying posed too great a risk of further traumatizing the child.

Stan explained that there was indeed other evidence. In fact, numerous types of physical evidence placed the perpetrator at the scene. Investigators had found the girl's mother's blood all over his clothes. Despite having fled the country after committing the crime, the man still had blood on his shoes when he was arrested.

“So why does Sandy have to testify?” I asked. I was already starting to feel pulled to help this child.

“That is part of what we are trying to figure out. We are hoping to have the case postponed until we can either get her testimony by closed-circuit
TV or make sure she is ready to testify in court.” He went on to describe the details of the murder, the girl's hospitalization due to injuries she'd received during the crime and her subsequent foster care placements.

As I listened, I debated whether or not to get involved. As usual I was overextended and extremely busy. Plus, I'm uncomfortable in court and I hate lawyers. But the more Stan talked, the more I couldn't believe what I was hearing. The people who were supposed to help this girl—from DCFS to the justice system—seemed clueless about the effects of trauma on children. I began to feel that she deserved to have at least one person in her life who might not be.

“So, let me go over this again,” I said, “A three-year-old girl witnesses her mother being raped and murdered. She has her own throat cut, twice, and is left for dead. She is alone with her dead mother's body for eleven hours in their apartment. Then, she's taken to the hospital and has the wounds on her neck treated. In the hospital, the physicians recommend ongoing mental health evaluation and treatment. But after she's released, she's placed in a foster home as a ward of the state. Her CPS caseworker doesn't think she needs to see a mental health professional. So, despite the doctors' recommendations, he doesn't get her any help. For nine months, this child is moved from foster home to foster home with no counseling or psychiatric care whatsoever. And the details of the child's experiences are never shared with the foster families because she is in hiding. Right?”

“Yeah, I guess all of that is true,” he said, hearing the unmistakable frustration in my voice and how terrible it all sounded when I described the situation so bluntly.

“And now, ten days before a murder trial is scheduled to start, you become aware of the situation?”

“Right,” he admitted, sheepish now.

“When did your office get notified about this girl?” I demanded.

“Actually we opened the case right after this happened.”

“No one in your office thought to ensure that she had some mental health support?”

“We tend to review cases when they come up for their hearings. We have hundreds of cases apiece.” I wasn't surprised. The public systems working with high-risk families and children are overwhelmed. Oddly enough, during my years of clinical training in child mental health I had little introduction to the child protective system or to the special education and juvenile justice systems, despite the fact that more than 30 percent of the children coming to our clinics were in one or more of these systems. The compartmentalization of services, training and points of view was staggering. And, I was learning, very destructive for children.

“When and where can I see her?” I asked. I couldn't help myself. I agreed to meet Sandy in an office at the Court the next day.

I was somewhat surprised that Stan had called
me
for help. Earlier that year he had sent me a “cease and desist” letter. In four long paragraphs I was told that I must immediately provide justification for the use of a medication called clonidine to “control” children at a residential treatment center where I consulted. I provided the psychiatric services for the children at the center. The letter said that if I could not explain what I was up to, I must immediately stop this “experimental” treatment. It was signed by Stan Walker in his official capacity as attorney with the Public Guardian.

After receiving Stan's letter, I contacted him to explain why I was using this medication and why I believed it would be a mistake to stop. The children at this residential center were among the state's most difficult cases. More than one hundred boys had been placed in this program after “failing” in foster homes due to severe behavioral and psychiatric problems. Although the facility accepted boys from seven to seventeen, the average child in the facility was a ten-year-old who had lived in ten prior “homes,” meaning that for most of them no fewer than ten parent substitutes had found them unmanageable. Easy to stir up and overwhelm but very difficult to calm down, these children had been a problem for every caregiver, therapist and teacher they had encountered. Ultimately, they'd get kicked out of foster homes,
child care settings, schools and sometimes even therapy. The final stop was this center.

 

AFTER REVIEWING THE records of some 200 boys who were then living at the center or who had been there in the past, I found that every single one of these boys—without exception—had experienced severe trauma or abuse. The vast majority had had at least six major traumatic experiences. All of these children had been born into and raised with chaos, threat and trauma. They were incubated in terror.

All of them had been evaluated multiple times both prior to and during their stay at the center. Each had been given dozens of different DSM diagnostic labels, primarily attention deficit/ hyperactivity disorder, oppositional-defiant disorder and conduct disorder—just like Tina. But shockingly, very few of these children were viewed as “traumatized” or “stressed;” their trauma wasn't deemed relevant to diagnosis, much like in Tina's case. Despite lengthy histories of domestic violence, repeatedly interrupted familial relationships often including the loss of parents to violent death or disease, physical abuse, sexual abuse and other overwhelmingly distressing events, few had been diagnosed with post-traumatic stress disorder (PTSD). PTSD did not even make it into the “differential diagnosis,” a list included in the case report of possible alternative diagnoses with similar symptoms that each clinician considers, then rules out.

Post-traumatic stress disorder was a relatively new concept at the time, having been introduced into the DSM diagnostic system in 1980 to describe a syndrome found in Vietnam veterans who, upon returning from their tours of duty, often experienced anxiety, sleep problems and intrusive and disturbing “flashback” memories of events that took place during the war. They were frequently jumpy and some responded aggressively to even the most minor signals of threat. Many had terrifying nightmares and reacted to loud noises as though they were gunshots and they were still back in the jungles of Southeast Asia.

During my general psychiatry training, I had worked with vets who suffered from PTSD. Many psychiatrists were, even then, beginning to
recognize its prevalence in adults who'd suffered other kinds of traumatic experiences like rape and natural disasters. What struck me especially was that, although the experiences that had scarred adults with PTSD were often relatively brief (usually lasting for a few hours at most), their impact could still be seen in their behavior years—even decades—later. It reminded me of what Seymour Levine had found in those rat pups, where a few minutes of stress could change the brain for life. How much more powerful, I thought, must the impact of a genuinely traumatic experience be for a child!

Later, as a general resident in psychiatry, I studied aspects of the stress-response systems in vets with PTSD. I and other researchers found that these veterans' stress-response systems were overreactive, what scientists call “sensitized.” This meant that when they were exposed to minor stressors their systems reacted as though they were facing great threat. In some cases the brain systems associated with the stress response had become so active that they eventually “burnt out” and lost their ability to regulate the other functions they would normally mediate. As a result the brain's capacity to regulate mood, social interactions and abstract cognition was also compromised.

At the time I was working with the boys at the center, I was continuing to study the development of the stress-related neurotransmitter systems in the lab. I was looking not only at adrenaline and noradrenaline now, but exploring other related systems as well: those using serotonin, dopamine and the endogenous opioids, which are known as enkephalins and endorphins. Serotonin is probably best known as the site of action for antidepressant medications like Prozac and Zoloft; dopamine is known as a chemical involved with pleasure and motivation involved in the “high” from drugs like cocaine and amphetamine; endogenous opioids are the brain's natural painkillers and are affected by heroin, morphine and similar drugs. All of these chemicals play important roles in the response to stress, with adrenaline and noradrenaline preparing the body for fight or flight, and dopamine providing a sense of competence and power to achieve one's goals. Serotonin's actions are less easy to
characterize, but the opioids are known to soothe, relax and reduce any pain that may be involved in responding to stress and threat.

After I'd recognized that Tina's attention and impulsivity-related symptoms were linked to a hyperaroused stress system, I had begun to think that medications that calmed the stress system might help others like her. Clonidine, an old and generally safe medication, had long been used to treat people whose blood pressure was usually normal, but sky-rocketed into hypertension when they were under stress. Clonidine helped “quiet” this reactivity down. A preliminary study using this medication had shown that it also helped decrease PTSD-related hyper-arousal symptoms in adult combat veterans. Knowing that the physical symptoms many of the boys at the residential treatment center exhibited were consistent with an overactive and overly reactive stress system, I'd decided to try clonidine on them with their guardian's permission.

And for many, it worked. Within a few weeks of beginning to take the medication, the boys' resting heart rates had normalized and their sleep improved. Their attention became more focused and their impulsivity was reduced. Even better, the boys' grades began to improve, as did their social interactions with each other. To me, of course, this was no surprise. By reducing the overactivity in their stress systems, the medication enabled the boys to be less distracted by signals of threat. This helped them become more attentive to both academic material and ordinary social cues, allowing them to improve their schoolwork and interpersonal skills (see
Figure 3
, Appendix, for additional details).

I'd explained all of this to Stan Walker after I'd gotten his letter. To my surprise, he withdrew his objections and asked me to send him some more information about trauma and children. Unfortunately, as I informed him, there was not much written on the topic at the time. I sent him some of these early reports and some writing I had done myself. Until this call I had not heard back from him.

 

THE NEXT DAY, as I prepared to meet Sandy, I tried to imagine the crime she'd witnessed from her perspective. Nine months earlier she had been
found covered in blood, lying over her murdered mother's naked body, whimpering incoherently. At the time she was not yet four. How could she go on, day after day, with those images in her mind? How could I possibly prepare her for testimony, and the confrontation of cross-examination, a threatening experience even for adults? What would she be like?

I also wondered how she had survived psychologically. How could her mind protect her from these traumatic experiences? And, how could any reasonable person, let alone someone trained to deal with troubled children, not realize that she needed help after what she'd been through?

Unfortunately, the prevailing view of children and trauma at the time—one that persists to a large degree to this day—is that “children are resilient.” I recall visiting the scene of a murder around this time with a colleague who had started a trauma response team to help first responders to crime and accident scenes. Police, paramedics and fire fighters often see terrible panoramas of death, mutilation and devastation, and this, of course, can take an awful toll. My colleague was justifiably proud of the services he had put into place to help these professionals. As we walked through the house where the victim's blood still soaked the couch and splattered the walls, I saw three young children standing like zombies in the corner.

“What about the children?” I asked, as I nodded my head toward the three blood-speckled witnesses. He glanced at them, thought for a moment, and replied, “Children are resilient. They will be fine.” Still young and respectful of my elders, I nodded my head as if to acknowledge his wisdom, but inside I was screaming.

If anything, children are more vulnerable to trauma than adults; I knew this from Seymour Levine's work and the work of dozens of others by then. Resilient children are made, not born. The developing brain is most malleable and most sensitive to experience—both good and bad—early in life. (This is why we so easily and rapidly learn language, social nuance, motor skills and dozens of other things in childhood, and why we speak of “formative” experiences.) Children become resilient as a result of the patterns of stress and of nurturing that they experience
early on in life, as we shall see in greater detail later in this book. Consequently, we are also rapidly and easily transformed by trauma when we are young. Though its effects may not always be visible to the untrained eye, when you know what trauma can do to children, sadly, you begin to see its aftermath everywhere.