by David Cohen
How else to put it? Comparisons are invidious, of course, but still. In 1996 The New York Times reported on what, for want of a less anthropocentric term, it characterised as a singular perversity of aggression among young male elephants in South Africa’s Pilanesberg National Park. In an entirely uncharacteristic act, the paper reported, these calves were raping and killing rhinoceroses. What could it mean? Elephant researchers discovered that the younger animals were suffering a form of chronic stress brought on by the lack of dominant adult male elephants to keep them in line. (The older bull elephants had been kept out of the park because of their weight and size.)
Sure enough, when the web of familial relations by which young elephants are traditionally raised in the wild was reintroduced, the youngsters quickly settled down and the problems ceased. It doesn’t require an acrobatic psychological leap to draw a human parallel. Indeed, if a child in the womb were to choose just one factor about his parents that would most help him stay out of places like Epuni — with available options including wealth, elite education, sporting prowess or a particular skin colour — the best choice he could make is that his parents will stay together. In the United States, 70 per cent of boys in juvenile hall were raised in father-absent households, as were around the same percentage (the figures shift slightly depending on the survey) of younger murderers, rapists, dropouts, suicides and runaways.
According to yet another American survey, published in Village Voice, a boy raised in a father-absent environment is five times more likely to commit suicide, 10 times more likely to abuse chemicals, 14 times more likely to commit rape and 20 times more likely to end up in a correctional facility. One of the major reasons for this is because father-absent boys are statistically less able to delay gratification and show impulse-control over anger and sexual activity, leading in turn, almost ineluctably, to a weaker sense of conscience, according to E.M. Hetherton and B. Martin, contributors to a report on therapeutic interventions for pathological childhood disorders.
THERAPEUTIC INTERVENTIONS. BY THE MIDDLE OF the 1970s Epuni was nuts about them, falling for their trappings with much the same velocity as Ali’s opponents were hitting the canvas. At one time it had been enough for the institution to provide shelter and schooling, offer a bit of respite for the young and the restless. No more. Epuni had long been charged with offering some kind of credible assessment of its wards, and if a quarter of those suffered some moderate to serious psychiatric disturbance — as was believed — then the institution needed to be in on the therapeutic act. Social Welfare expected no less.
Part of the institution’s problem, and really the problem of any of the country’s residences, though, was finding people remotely qualified to offer any credible psychological assessment. Up to a point this was a factor of the professional psychiatric culture at large. In New Zealand, as in Australia, psychiatrists by a ratio of four to one, according to a 1972 report published in the ANZ Journal of Psychiatry, preferred the trendier areas of neurosis and psychosis to the comparatively unglamorous world of working with young people. The same study found that as many as one-third of all psychiatrists preferred not to work with kids at all, believing as many seemed to that they were simply lost causes, dim-witted to a degree, even beyond help.
Same as it ever was. Go back if you will to a celebrated address on the subject of juvenile delinquency given in 1921 by Dr W.A. Potts, a medical adviser to the Birmingham Justices. In his address the good doctor announced that 37 per cent of all cases he had examined in Britain showed the offenders were mentally defective, which he went on to define as those who might be classified as ‘idiots, imbeciles and feebleminded’. While Dr Potts allowed that some cases he examined might be explained by physical suffering or circumstance, the overwhelming condition as he saw it was innate mental retardation.
Yet it would be surprising if anyone who worked for any great length of time at Epuni entirely bought into such blithe assessments. Few may have harboured upbeat expectations that many of their wards would ever join the ranks of the middle class. But that was always a different matter to whether such kids were stupid.
A more relevant issue for Epuni in the 1970s seemed to be finding the right therapeutic intervention to sort out problems that were believed to lie solely in the realm of mental dysfunction.
Maurie was keen. His antennae told him that the cultural changes afoot were ripe for integration into the programme. He went methodically to work. The Epuni chief had always been a whale for the briefing paper or official memo. Now he looked for a reliable source of information on the workings of the juvenile mind, and quickly seemed to find one in the notion of ‘reality therapy’, a concept based on a set of ideas first advanced by the American psychotherapist William Glasser involving personal choice, responsibility and ‘transformation’, which in its simplest form simply meant encouraging people to live in the here and now. All well and good, but the idea lent itself not only to a school of literature that continues until the present day, but also to a raft of extrapolations and applications, not least the perception that those undergoing the therapy were often to some degree crazy. Maurie became smitten with Glasser’s most famous book, titled Reality Therapy and published in 1965, currycombing screeds of it into the institution’s manual and circulating them among the housemasters in the hope they might press these ideas into service. Unfortunately, perhaps, few of the typically unskilled administrators seemed to understand what the technique actually was, let alone how it might be applied or administered.
But it was easy enough for anyone to follow the precepts of another of the principal’s therapeutic discoveries, ‘sleep therapy’, which essentially involved shutting the wards in their rooms for as long a period as was practically possible. Initially, the idea may have been reasonable, or at any rate understandable. A couple of kids arriving at the institution in a state of chronic exhaustion, perhaps, who needed to recoup their natural resources by sleeping off a police chase, parental breakdown or whatever, might require some additional rest not only for their immediate peace of mind but also, who knows, later life. According to one school of thought, sleep is a kind of bank account that all of us invest in when we’re young and draw on during adulthood’s abrupt awakenings and departures.
Over time the practice took on a slightly obsessional edge, with inmates spending increasing periods of time in bed each afternoon. Howe thought it was a necessary and useful practice; his supervisors at head office were less impressed. ‘For your information,’ one wrote, ‘I can tell you that I have never seen or heard of the general habit of resting all children irrespective of age every afternoon. I have visited hundreds of institutions in many countries over the past 25 years. I have not supported … this practice.’ The order was sent out for sleep therapy to be discontinued.
Another proposed innovation was ‘sexual therapy’, the idea for which had initially been put forward by Howe’s offsider, Joe Bartle. ‘A large number of boys passing through Epuni Boys’ Home have been found to be suffering from sexual confusion,’ Bartle told him in a memo. Bartle put the issue down to one of two things: lack of knowledge about ‘normal’ sexual development, or else ‘apparent or potential difficulties relating to confusion in sexual identity, e.g. homosexuality, bisexuality, transvestitism, festishism’.
Bartle proposed that a programme be established involving ‘suitable autoio-visual [sic] aids, reading material and work books’ along with carefully handpicked participation from ‘outside agencies’. Once again the suggestion was nixed by head office.
‘Art therapy’ was yet another big deal. As an instructional handbook put it, the treatment’s benefits were at least fourfold. One was that it allowed a boy to therapeutically deal with issues of grief. Another was that it helped bridge his inability to form one-on-one relationships. Third, it improved cultural understanding — and also improved sexual identity. Given the right amount of time, a familiar setting and the correct materials (clay, paint, brushes, crayons, paper and pencils
), it would help create what the handbook suggested would be an environment ‘in which it is safe to be male!’ As for the instructor:
Art therapy gives … a chance to see the boys from a different viewpoint, which can help them come to a greater understanding of how to deal with their clients’ situations. Clients often express things in Art Therapy which they may not express elsewhere. For example, if a boy’s Case Worker is male, and the boy is having problems with his father, he may transfer feelings about his father on to the Case Worker and, initially, feel safer in expressing those feelings to the Art Therapist.
Whew!
Whatever criticisms might have been levelled at forcing kids into bed or getting them to throw paint at a canvas every now and then, nobody was being actively harmed as far as could be told. These practices were hardly in the league of the more controversial therapies the department did sanction at Epuni.
Among the few people who would not be interviewed for this book was Alan Frazer, the Australian-based psychiatrist who used to provide a lot of Epuni’s external psychiatric expertise as well as helping out occasionally on Saturday mornings as the institution’s general practitioner. ‘In view of Epuni Boys’ Home being a very sensitive issue over the last few years,’ Frazer wrote in response to my interview request, ‘I am loath to become involved.’ However, he did suggest that his past writings on residential care could be of some interest, in particular a lengthy paper he had authored, Psychiatric Needs of Disturbed Social Welfare Children and Adolescents and Consultative Psychiatric Practices in Social Welfare Institutions.
Frazer’s work makes for illuminating reading. Among the immediately interesting aspects are its recurrent descriptions of boys ‘poor in communication skills’ and ‘unable to communicate their thoughts, feelings, and observations. Some of the adolescents,’ he wrote, ‘appear not to have learnt some of the basic rules which regulate communication. This process seems to have impaired learning and socialisation in many cases.’
Although he allows that it would be all too easy to misdiagnose these kids as psychotics rather than youngsters with specific learning disabilities, the study is short on clues as to what these deeper issues might be. Descriptions like these crop up a lot in the Epuni case notes, and not just those signed off by Frazer. A typical example — taken almost at random from more than 100 files of former inmates — apportions the blame for one boy’s erratic intelligence tests on ‘some brain malfunction’ that had affected his emotional faculty, causing him to suffer an ‘inability to perceive or analyse whole situations’; in addition, it was felt that ‘his inability to handle everyday social situations’ was also a powerful deficit. Frazer remarks on the ‘intelligence and specific learning disabilities’ suffered by other wards; such factors, he posits, are ‘probably traceable back to the parent-child relationship’.
What’s most evident in all this talk about poor communication skills, lack of empathy and odd behaviours is that these descriptors neatly fit the diagnostic criteria of an entirely different developmental disorder: autism.
Autism was first described in 1943 by Leo Kanner, a child psychiatrist at the Johns Hopkins University in Baltimore, who spent five years studying 11 children possessed with an ‘extreme aloneness from the beginning of life’. Kanner borrowed the word ‘autism’, derived from the Greek autos, meaning ‘self’, from the Swiss researcher Eugen Bleuler, who had used it in another context some three decades earlier.
Unbeknown to Kanner or any of his American colleagues, the same condition was being studied simultaneously in Europe, where it was identified with the same term only a year later by Hans Asperger, a Viennese paediatrician, whose name is sometimes applied to a ‘high-functioning’ version of the neurological malady. Today the condition is estimated to afflict as many as one in every 100 children, with boys up to four times as likely to be affected as girls.
Among the behaviours most linked to the disorder are poor language and social skills, and a propensity for repetitive, frequently obsessional behaviour and self-injury. Autistic kids will often repeat the same words or phrases over and over, or immerse themselves in weirdly narrow interests.
No two young autists are the same. Some will manage to lead relatively ordinary, even intellectually exceptional, lives, while others may require a lifetime of constant support. But what such youngsters share, both men saw, is an iron-walled detachment from the physical environment and an indifference to other people, along with profound difficulties with communication and imaginative play. Put another way, in the words of Frazer’s case book, such individuals are almost always ‘poor in communication skills’ and all but ‘unable to communicate their thoughts, feelings, and observations’.
Clinicians since Kanner have debated the degree of conventional intelligence possessed by autists. The historical assumption has usually been that most of them exhibited some mental retardation. But this has been somewhat superseded by more recent research by the likes of the University of Cambridge’s Simon Baron-Cohen, who has shown that a great many scholars may themselves be autistic. (Baron-Cohen, along with the mathematician Ioan M. James of the University of Oxford, made scientific headlines in the early 1990s by arguing that at least three of the well-known personality traits of Einstein and Newton — obsessive interests, difficulty in social relationships, and profound communication problems — suggested that these men were autistic.)
One of course should avoid the popular fetish for offering long-range diagnoses of supposedly autistic people. But the overriding point here seems to be that the malady requires a little lateral thought on the part of others when it comes to defining intelligence. It also requires a particular form of understanding and support from the wider community.
It is not unreasonable to suppose that the incidence of the condition at Epuni was no lower than in the general population, and possibly a bit higher if the case-book studies are any guide. Even more striking is the significant number of those cases that, rather than receiving the kinds of intensive intervention treatment and support that nowadays would be universally recommended for the condition, were simply punished, drugged or shipped off to psychiatric institutions.
Frazer himself had warned of the potentially disastrous dangers of misdiagnosis. In his paper, he wrote about the tendency to ascribe all ‘delinquent’ behaviour to what at the time were known as psychiatric diseases. Frazer inveighed against the temptation for unqualified people to prescribe some entirely irrelevant treatment. Still, there’s not a lot to suggest he actively discouraged the practice in every instance.
Tyrone Marks wasn’t autistic, and he wasn’t crazy, either, but he did bear more than the usual brunt of Epuni’s attempts at psychiatric evaluation when he first clambered into its ring. Seen in retrospect 30 years later, one can’t help but be struck by the punitive language of the reports along with the underlying confusion between routine behavioural issues and genuine mental illness. ‘This boy has not made any effort here to do something for himself, and has shunned any assistance or guidance from staff,’ one analyst pronounced. ‘He needs something firmer than we are able to offer.’
What to do? ‘Perhaps consideration should be given … to a period of psychiatric hospitalisation.’ So off they sent him to Lake Alice Hospital, a rural psychiatric facility near Bulls that at the time was held in considerable awe by the nearby youth facilities.
Despite the low rate of professional interest in child psychiatry, and the paucity of available psychiatrists, Social Welfare still managed on average to have around 90 of its wards in psychiatric care at any time during the 1970s. Lake Alice took the lion’s share of its junior cohort from nearby Wanganui and Lower Hutt, the two places where Tyrone spent a lot of his early welfare years. The reason for the unusual degree of activity in these two urban centres was the high regard that the respective youth institutions had for the brand of tough-love dispensed at the hospital’s child and adolescent unit, which specialised in shock therapy as a therapeutic technique and a form o
f punishment.
In the case of Epuni it is possible to trace this enthusiasm back to its earlier infatuation with reality therapy. The book of the same name makes much of the efficacy of hospital treatment for unresponsive clients. It conjures an ideal scenario in which a suitably respected therapist ‘deliberately takes a vigorous directive role and tells the group that they have the job of trying to handle him. He warns that he plans to be tough so that if they can handle him they will be able to handle almost anybody.’ Moreover, the work advises, it is important that such patients be shown no sympathy ‘because sympathy emphasises their unworthiness and depresses them even more’.
No doubt contemporary studies have more to say on this, but simple decency suggests it is a dubious starting point for dealing with troubled boys without any credible psychiatric diagnosis to begin with. In the person of the unit’s chief child psychiatrist, Selwyn Leeks, however, such ideas obtained enthusiastic purchase. Leeks’ preferred version of ‘aversion therapy’ involved using electroconvulsive treatment as a way of putting wayward young patients back on the straight and narrow.
Electroconvulsive therapy, or ECT, had been in use for many decades. The treatment was first introduced in the late 1930s as a last-ditch method of helping severely depressed adults by way of inducing a seizure. Then, as now, the efficacy of the shock treatment had never been definitively shown, and even at that point in its history it had already attracted its share of bad notices. Yet at no point was it ever intended to be used on anyone other than consenting adults, and then only under a general anaesthetic.
During Tyrone’s time in Lake Alice he was subjected to ECT as many as three times a week. The procedure, typically administered after the boy was first given a biscuit and a cup of tea mixed with a drug to stop drooling, involved strapping electrodes on his head with bandages that had been dipped in salt water in order to avoid leaving burn marks. Leeks oversaw the performance. Usually it would be given without anaesthetic and without niceties, although the doctor was always careful to make a point of explaining that what was happening was intended as a punishment, sometimes pausing between zaps to ask quietly, ‘How many times do I have to ask you to behave?’
