by Torey Hayden
Right from the onset, Drake appeared to make a genuine effort. He exhaled. He made noisy breathy sounds that didn’t approximate words, but nonetheless appeared to be authentic attempts.
Because he was so young and because he did seem to be working hard, I didn’t want to stress Drake too much by becoming more insistent, as I often did with older children. So I changed tactics. “Is this a dog? Is this boy sharing his ice cream cone with his dog?”
Drake grinned and shook his head.
“Is it a dinosaur? Is the horse eating his ice cream cone?”
Again, the cheerful shake of the head.
“Is it Friend?”
Drake laughed noiselessly and shook his head hard.
I went on through half a dozen other absurd possibilities until Drake seemed almost unable to control his hilarity at this funny game. Then I said, “What animal is it?”
He opened his mouth wide and leaned down close to the picture.
“What animal is this? Come on. Let’s use the word.”
He kept his mouth wide open.
I made my voice suddenly intense. “What animal is this?” Not anger, just focused no-nonsense intensity.
Drake got the message immediately. His laughter dropped away abruptly and he stared at the picture. Reaching over, he clutched Friend around the neck. His body began to rock slightly back and forth in the chair. His eyes remained fixed on the picture.
“What animal is this? Here. Now, Drake. What animal is this?”
Deep, noisy respirations.
“What animal is this?” I tapped the card more insistently. “Tell me what we have here. What’s this?”
He started to cry. This too was almost noiseless. He didn’t even whimper, but huge tears formed and rolled over his cheeks.
“I know it’s hard,” I said. “It’s hard and it’s scary when you haven’t been used to talking, but only the first time is so bad. Once this is over, it won’t be this hard again. What animal is this?”
A long moment of intensely expectant hesitation. Then he put his head down on the table and sobbed.
Chapter
9
I had to give up.
Giving up, however, wasn’t the obvious decision it appeared to be. An extraordinary degree of manipulation underlies many cases of elective mutism. In almost all instances, it is unconscious behavior, but it is manipulation nonetheless. So a child bursting into tears isn’t usually enough to deter me. Even with a child who doesn’t appear manipulative, to stop at the first sign of tears tends to reinforce the mutism as a successful defense. So stopping wasn’t a decision I took lightly. However, given Drake’s age, I was very concerned about putting him under too much pressure. Moreover, all along he genuinely had appeared to be trying. Thus, it seemed wise to go with my instinct to stop.
So I said, “You’ve been working very hard. This isn’t easy. I know.” He had pulled Friend across and sat, face buried in the fake fur of the tiger’s head.
Taking a tissue, I leaned over to mop him up. “You did try hard, didn’t you?”
He nodded.
“Here, come here.” I opened my arms. He and Friend came willingly onto my lap for a hug. “Don’t worry about it,” I said. “Don’t feel bad. When it’s time, it’ll happen.”
After taking Drake back to the ward, I returned to the observation room and started to rewind the videotape. It was a puzzling session. Drake had given me the impression of trying so hard. Right from the visit out in Quentin, he had not seemed fearful, obstinate, withdrawn, or in any other way unwilling to comply. He had always appeared focused and genuinely enthusiastic for what we were doing. So why hadn’t my methods worked straightaway?
Popping the tape out of the machine, I took it back to my office to play it on the VCR there. Helen was in the room when I came in. A tall, slim, quite elegant woman in her early fifties, Helen had a tenderhearted, maternal approach to working with the children, which was quite different from my more pragmatic methods. When I put the tape in, I said, “If you have a sec, would you watch this with me?”
“What a cutie!” she cried, seeing Drake on the screen. “How absolutely adorable. And look that big toy tiger!”
We then watched the tape in silence.
The advantage of videotaping sessions was that it allowed the opportunity to go back and see all that was missed. For me, occasionally this could be quite a lot, because I have quite an extraordinary ability to focus on what I am doing. The plus side is that I seldom miss even the subtlest cues from whatever I am centered on. The minus side is that I can miss everything else. Indeed, I had become the subject of much good-natured teasing after one video showed me so absorbed in how quickly and accurately a child was doing an eye-hand coordination task that I failed to notice he had climbed entirely out of his chair and up onto the table on all fours while he was doing it. The tape showed me effortlessly adjusting my positioning to follow the child as he moved across the table and eventually back down into his chair again and during this whole time I’d never realized the boy had left his seat. My colleagues found this hysterical. And, needless to say, I now greatly appreciated the opportunity to see what I’d missed by viewing the session videos!
Consequently, on this occasion I was expecting to see clues in Drake’s behavior that I had overlooked during the session. With Helen’s added perspective, I hoped it would become clear to me why I’d failed to get him to talk and how I needed to adjust my approach for our next time together.
What I saw, however, was … nothing. Nothing at all different from what I’d perceived during the session itself. Drake came in eagerly. He engaged well with me, seemed attentive and interested in what we were doing, appeared motivated to try what I asked of him. And he did try. Again and again. What the videotape made clear was how hard he’d applied himself right from the beginning and then the heartbreaking decline of his mood when he did not achieve what I wanted. Watching it, I was relieved I’d stopped when I did.
I looked at Helen when the screen turned to snow.
“He can talk?” she asked.
“Yes.”
“Because that’s my first impression. The boy can’t speak. You’re sure he speaks? He’s not deaf or anything?”
“No, he’s definitely not deaf. And yes, I’m sure he speaks. He talks at home to the mother. The big question mark in my mind remains bilingualism. He may be speaking only Italian to her,” I said.
“Have you tried speaking Italian to him?”
I grinned sheepishly. “If I knew Italian …”
“Yeah, well,” Helen conceded. Then she added, “But if it were bilingualism, wouldn’t he at least be able to repeat the words for you, even if he couldn’t use them himself? Or wouldn’t he try to use the Italian word or something?”
“Not if he’s electively mute.”
Helen sat back in her desk chair and slowly shook her head. “Then I’m no help. I didn’t see anything there you didn’t see.”
Turning off the video recorder and monitor, I returned to my desk and started to go through the telephone messages that had piled up. While most were the usual communiqués with other professionals over the various children I was involved with, one came from the hospital’s geriatrics department. Geriatrics? Curious, I lifted it out of the pile and dialed the number.
The phone was answered by a geriatric social worker named Joy Hansen. Ah, she said in a bright-sounding voice, what she wanted to talk to me about might be “a bit of a stretch” but she wondered if I’d give an opinion. My name had come to her via Dave Menotti, she said. She and Dave had been having coffee in the hospital cafeteria and she’d been discussing a case with him. He suggested perhaps I’d have some insight.
Intrigued, I asked for more information.
Joy had a patient named Gerhardine Sharple, who was currently in the stroke rehabilitation unit, housed in a nearby medical complex. Gerhardine, known as Gerda, was eighty-two. She had been in good health and living independently up until five
weeks earlier, when she had had a massive stroke. After the initial stay in the hospital, she was then released to the rehabilitation unit and seemed to be making a reasonable recovery. However, there was an ongoing problem with her speech. Strokes often interfere with the language center in the brain, causing loss of communicative speech, which is known as stroke-induced aphasia. In Gerda’s case, she had recovered certain elements of speech almost immediately. In particular, she was capable of responding appropriately if she was asked simple, concrete questions. However, in spite of intensive speech therapy work, two problems remained. One, while she had demonstrated the ability to respond appropriately to questions, this did not mean she always complied with the request. And two, she produced no spontaneous speech whatsoever.
Joy said Gerda had been widowed many, many years before. She had been living alone in a small isolated farm. The house, a two-story clapboard of the sort commonly built at the turn of the twentieth century, stood amid ancient, half-dead cottonwoods and was surrounded by miles of sagebrush and little else. Although the emergency services had found things clean and tidy, the property was dilapidated in the way of the rural poor, and a haven for small animals. More than a dozen chickens ran happily in the yard, a goat was in the half-collapsed barn, and sixteen cats shared the house. Indeed, Joy said, Gerda seemed a stereotypically reclusive “cat lady” and, as a consequence, she had had little contact with neighboring farms.
She did have a family, but they were widely dispersed. Her daughter, married to a Spaniard, had been living in Spain for decades, and her son lived half a continent away in Detroit. Joy had contacted the son, whose name was Edward, and said he seemed distant and largely unconcerned. He had taken the news of his mother’s stroke with a disgruntled moan and characterized Gerda as “difficult.” He said he’d tried on two or three occasions to get her to see that the only real way he could take care of her in her old age was if she moved to Detroit where he and his family lived. Gerda had flatly refused. She was even unwilling to consider selling the house, he said, even though she could get a good price for that property, because it was a desirable location for rural development. He’d pointed that fact out to her several times. Why did she want to keep it? It was far more space than one person needed and starting to get very run-down because she couldn’t afford the upkeep and was simply past being able to do any of it herself. But his mother was difficult. She would never compromise to make it easier for anyone to help her. He was a self-made man, he explained. He’d pulled himself up from nothing. Got a good education, married into a good family, started a successful business, and really had made something of himself, but it hadn’t been easy. It was still hard work. He couldn’t just drop things to be at his mother’s beck and call.
The daughter was even less involved. When social workers had entered Gerda’s house after the stroke, they found photographs of the daughter, her Spanish husband, and their two children, but there was no way to tell when the photos had been taken. They couldn’t even find reference to the daughter’s name in the house. This was possibly not due to any purposeful removal but simply because Gerda did not seem to be a “keeper.” Her house was immaculately clean, in spite of all the cats, but also spartan. Joy had obtained the daughter’s name—Anna—from Edward, but this was clearly not a close family. He and his sister, who had returned to the States only twice since her marriage twenty-three years earlier, had no more contact than Christmas cards.
So that was the situation, Joy said. Social Services were now dealing with Gerda’s immediate future. She could only remain in the rehabilitation unit as long as it was apparent she was actually in the active stages of rehabilitation. For most stroke patients this lasted three to six weeks. In the doctors’ opinion, Gerda seemed to have made this initial recovery. Now decisions on her future placement had to be made, such as how much longer would she need full nursing care and would she be able to resume an independent life eventually? Could she care for herself in an isolated location such as her own home? At the moment, assisted care seemed more appropriate, or, indeed, full-time nursing home placement. Of course, all of this required money. A decision needed to be made, which would most likely entail selling her house to finance assisted-living arrangements.
Joy sighed. As the social worker, she had spent time trying to explore these various scenarios with Gerda, and Joy’s overall impression of the old woman was not one of a stroke victim so much as a very depressed individual. Depression, Joy said, is common among elderly patients who lose their independence and suddenly find themselves sleeping in strange beds, eating strange food, and having to live according to strangers’ rules. Joy was accustomed to dealing with that, but in this instance, it was grossly complicated by Gerda’s lack of speech. Joy had consulted the gerontologist supervising Gerda’s case and told him that she felt Gerda’s mutism might be largely psychological, due most likely to depression. The gerontologist put Gerda on Zoloft, which, if anything, had made Gerda even more subdued.
This lack of speech spelled bad news for Gerda, Joy said. Whatever the reason, it gave the professionals grave concern regarding her ability to resume any level of independent living. Joy had tried to explain this to Gerda, tried to stress how important it was to work hard on talking with people in the rehabilitation unit because otherwise Joy wouldn’t be able to stop a nursing home placement.
I asked, “Have there been any psychiatric problems in her past?”
“No. But then, she’s of that generation. Her son said that Gerda’s parents were homesteaders. Part of the German immigration about the turn of the century. If people suffered psychiatric problems in that era, they just toughed it out. No one sought help.”
“And what have they done with Gerda’s animals?” I asked.
“I don’t know what’s happened to the chickens and things,” Joy replied. “The cats they put to sleep, I think.”
“All sixteen?”
“Social Services went in after the ambulance took her. There really wasn’t much choice.”
“Were the cats poorly cared for?”
“No. Not really. It was spotlessly clean there. And in fact, they found more cat food in the cupboard than people food. But there were just too many of them. No one could be expected to house sixteen cats during such a long period of hospitalization. Especially as she well might not come back at all. It just seemed the better thing to do. Kinder in the long run, you know? Sixteen cats are too many to re-home.”
I didn’t say anything in response to that. Joy sounded depressed herself about Gerda’s case. It was a sad story in so many ways—the lack of connection, the familial disinterest, the isolation, the loss of independence—one of those small heartbreaking stories of small, heartbreaking lives, of people who don’t really matter to anyone. What struck me as the final cruelty, however, was the decision to put her cats to sleep without giving her any say, without any warning, without any opportunity to change things. To Gerda when she found out, I’m sure it was as if they’d simply said, “We’re sorry but your loved ones were too much work for us while you were ill, so we’ve gassed them all.” And now she genuinely did have no connection with this world. No wonder she was depressed.
Joy went on to say that this was the point they were at when she ran into Dave Menotti. During their conversation together, he had mentioned my interest in language disorders and said perhaps I could offer an opinion on the extent to which Gerda’s poor speech was physiological or psychological. Would I be willing? she asked.
Ah, I said. This was all very interesting. And very sad, too, and I genuinely wished I could help. Unfortunately, I had absolutely no experience working with the elderly in any capacity beyond funding my college years as a nurse’s aide. I had never worked with language problems in anyone who was over sixteen. Indeed, my recollection of the academic literature was that there was very little information available regarding adult elective mutism. When such behavior occurred in adulthood, it tended to be associated with much more serious psychi
atric problems, such as schizophrenia or other psychoses, and was not usually treated as a disorder in its own right.
Down the phone line I could hear Joy make that soft click of the tongue, that faint noise denoting hopelessness. A small silence followed. Then she said, “You wouldn’t want to just have a look at her, would you? She’s in the Oakfield Rehabilitation Center. It’s only about three blocks from the hospital. If we could just get through to her, just get her to understand how critical it is she cooperates, if she wants any chance of an independent life. Dave thought maybe you’d at least have ideas.”
That evening I spent a couple of hours at the library on a nearby university campus searching for information on adult mutism. I found nothing except the references I already knew about regarding psychotic mutism and a few others regarding advanced Alzheimer’s disease or obscure brain tumors or anomalies. Joy’s plea, however, stayed with me. Consequently, I finally decided I would stop by on my way into work and see Gerda. Not because I had any qualifications. I didn’t and I knew I didn’t. And certainly not because I had any magic. Truth is, I had no real good reason. I did hear way back in my mind, however, what a mentor had said to me at eighteen when I had protested at being too ill-equipped to work with a seriously disturbed child: “When things are hopeless, nothing you do will make it worse. So it’s always worth taking the risk to see if just, just possibly something you do will make it better.”
Chapter
10
I walked down the long corridor of the rehabilitation center, dank with disinfectant and the steam-andmusk mix of institutional food and bodily fluids. It was early. Breakfast trays were only just being cleared away. In some rooms, nurses’ aides were still spoon-feeding patients.
Gerda’s room was second to last on the right. As I approached, I was aware of feeling nervous. What on earth would I do with her? I could hardly pop open my box and pull out the puppets or crayons.
