by Torey Hayden
She was sitting up in bed. Her breakfast tray had been removed, but the little adjustable bed table was still pushed across in front of her.
I don’t know what I’d expected but it was something different than I saw. She looked unexpectedly young. Or, I suppose said better, she looked unexpectedly “not old.” Her hair, which was completely white, had a yellowish cast that could almost have been mistaken for a pale blond, and it was loose around her shoulders. And long. Longer than mine. No doubt she normally wore it pulled up in a bun, and such a style would have given her a more predictable little-old-lady look, but the way it was here now, parted on the side—long, loose, and straight—she seemed ageless as an ancient sculpture. This sense was enhanced by her skin. Though it had the fragile crepeyness of age, she had few wrinkles, especially across her forehead, which was smooth to a point of being almost waxy looking. She was of obvious northern Germanic heritage, with pale eyes and prominent features. Although she was not overweight, her bones were big and blunt, giving the impression of a tall, sturdy woman.
“Hello,” I said. “My name is Torey. Joy Hansen has asked me to come see you. I work with people who have problems speaking. I’m not a speech therapist, so I won’t be doing those sorts of things with you. My work is more with people who are able to talk but find it hard to do so.”
Pulling over a plastic chair that was next to the wall, I sat down. Gerda regarded me. Her gaze was straightforward but not at all readable. I couldn’t tell if she was pleased at a new face, if she was appraising me, or, indeed, if she was simply watching me because I moved.
“How long have you been at Oakfield?” I asked.
She continued to gaze at me. Seconds passed, feeling like minutes. She didn’t respond.
Thinking perhaps this was the wrong kind of question, that age and the stroke as well as simply the loss of normal routine might make it difficult to recall how long she had been in, I changed to: “How was your breakfast?”
She gave me the same unflinching, unreadable stare.
And it was the unreadable aspect that was making things difficult for me. I was accustomed to being able to discern more information nonverbally than I was getting here. I genuinely could not tell if she was refusing to speak or if she was unable to speak or even possibly that she was not hearing me properly. Her expression was not so blank as to give the impression of nobody home, but there was a definite possibility that whoever was in there was not turning the lights on.
“What did you have for breakfast?” I asked.
She looked away then. It was done slowly, giving the action ever so faintly a feeling of misery.
Had the food been awful? Or something she loathed? Or was she simply fed up at having one more stranger in her room demanding stupid information from her?
“You must be tired of all this,” I said. “All of us coming and going. All of us keeping you to our schedules and our activities. When I was in the hospital, that’s what I remember as being the worst part. I especially hated the mornings. It’s so hard to sleep at night because they leave so many lights on and make so much noise, but then just when exhaustion finally takes over and you go to sleep, in they come at 6:30 and wake you up again. And for what? They’d always get you up, just so you could wait. I always thought, ‘Why don’t they leave us sleeping in peace?’”
She looked back as I said that, and her look was not guarded this time. I could easily read the quiet despair.
“All this change must be very upsetting for you. Has anyone talked to you about it?” I asked.
Gerda looked at me a long moment. It was a deep, searching look, and then slowly she shook her head. A sigh followed. Then she lay back in her bed and turned away from me.
“That’s what I’m here for,” I said. “Because what you’ve gone through is difficult and frightening. And if we can talk about it, perhaps we can put some things right.”
Silence.
More silence.
It wasn’t “working” silence, which was the kind of silence I could manipulate to bring words from reluctant speakers, nor was it the kind of silence that was my trick in trade because I’d learned how not to be uncomfortable with it. This was just silence. Total and immovable.
“How would you like me to address you?” I asked. “Shall I call you Mrs. Sharple? Or is it all right to call you Gerda?”
No response.
“My great-aunt was named Gerda,” I said. “I never met her because she lived in Germany, but I liked her very much. When I was small, she always sent me a papier-mâché egg at Easter with little gifts in it. Among the things inside the egg was always a tiny little wooden rabbit wearing lederhosen and playing a musical instrument. Each Easter it was a different rabbit with a different instrument. I have a whole orchestra of them now, each only about two inches high. So when I heard your name, it reminded me of my aunt. I cared for her very much. So, if you don’t mind, I’d like to call you Gerda.”
She had turned back to look at me while I was talking.
“Gerda’s a German name. Which part did your family come from?”
She didn’t answer.
“My family is originally from Emden. It’s on the coast, near the Dutch border. My grandfather grew up there. Gerda was his sister and she lived in Emden all her life.”
No response.
“Is your family from the north of Germany?”
She nodded.
“Which part?”
No response.
This conversation was hard work. Should I persist? Continue chattering one-sidedly? Ask more questions? Use the same direct, expectant techniques that had worked so well with the children? I was having a small crisis of confidence. What if she couldn’t talk? What if she felt under horrible pressure to do something she was physically unable to do? Who was I to be sitting here, trying to elicit speech from a stroke victim? I was overstretching myself and I knew it.
Unobtrusively, I tried to glance at my watch. My time was already up. I was supposed to be on the children’s unit in only five minutes’ time.
“I need to go now, because I work over at the hospital and I see I’m running late for my next appointment,” I said.
She had looked away already.
I felt bad saying that because it sounded as if I were trying to get away, so I added, “I’ll stop back, okay?”
She didn’t respond.
“Okay,” I said for her.
My next appointment was, in fact, Drake, and I wasn’t feeling a whole lot more confident about him. Ever since I’d left our unsuccessful session, he had been on my mind. I didn’t want to establish a nonverbal relationship with him, as this would make it more difficult to break the cycle of mutism; on the other hand, I also didn’t want to spiral into the kind of negativity that would make him fearful and unhappy in our sessions. If that happened, then anxiety would become the barrier.
Indeed, I’d been thinking quite a bit about anxiety in the interim, as anxiety lies at the root of elective mutism for many children. With some the mutism is a manifestation of social phobia. In these instances, the child tends to have an excessively shy personality and often comes from a family where one or both parents have also had a history of acute shyness in childhood, indicating that there well may be a genetic component at work. For other children, the anxiety seems to be more closely related to stage fright, to fears of performance and failure. With these children, the parents may be confident and outgoing themselves. Baffled by the shyness, they often put heavy pressure on the child to be more social, which exacerbates the problem.
Anxiety isn’t such an issue for the third major group of children displaying elective mutism. For these children, speaking is a control issue, and withholding speech is an expression of complex psychological problems similar to those found in anorexia or encopresis. These children tend to have strong-willed, perfectionistic personalities and often form tempestuous but symbiotically close relationships with a primary caretaker to whom they speak normally.
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br /> Drake, however, didn’t seem to fit any of these profiles. This left only one other group in my experience: those children who are mute in reaction to trauma. This group includes children who have had a sudden appalling injury to the mouth, often coinciding with the age when the child is starting to speak. One such little boy I’d worked with had caught and badly ripped his mouth on a playground swing. The fright of the accident stopped him speaking altogether for several months. Then latterly he would speak only when in the safety of his house. This group also includes children who have witnessed deeply traumatizing events and are literally shocked speechless, as in the case of another young boy who had witnessed his sister’s murder. Mostly, however, it takes in children who have been severely abused and are affected either by the trauma of the abuse or by the threat “not to tell.”
Severe abuse was already in my mind in regard to Drake, because in my research, his kind of mutism, which was very complete and excluded even close family members, had been a marker of serious dysfunction in the family; and, of course, serious dysfunction often goes hand in hand with serious abuse. I found this so sad even to think about. He was such a joyous little boy—lively, intelligent, eager to please—the kind of little boy I’d imagine anyone would be absolutely delighted to have. It was heartbreaking to consider he might be experiencing a whole other world behind closed doors. It was daunting to consider how to go about uncovering it.
If Drake had any residual misgivings about his unhappy time with me the previous day, he didn’t show it. When I appeared in the dayroom where he and Friend were watching cartoons, he grinned broadly and jumped up.
“I’ve got something fun for us to do today,” I said, as we walked together down to the therapy room.
Drake smiled beguilingly. Honestly, the kid could have charmed ducks off water, as my grandmother always used to say.
Since he had become so upset the day before, I decided to choose a very different kind of activity. In the therapy room, I shoved the table back and seated us on the floor in front of the two-way mirror because I wanted to be able to scrutinize Drake’s behavior on the videotape afterward. Then I held up a bottle.
“Know what this is?” I asked, as I unscrewed the top. “Bubbles!” Lifting the little wand out, I blew through it, and a cascade of bubbles flowed between us.
Drake clapped his hands with delight.
I made bubbles several more times. Then I held the wand and bubble liquid out to him. “Here, you try,” I said.
He smiled joyfully at me.
“Here, like this.” I blew on the wand gently and a few bubbles came out. “You try.”
He smiled more.
I dipped the wand into the liquid and coaxed him again.
More grinning, but he wouldn’t try.
Getting up, I brought over a flat dish with a huge wand. I poured some of the solution into the dish. “What do you think is going to happen when I dip this big wand into the bubble liquid?” I lifted it up, pulling an enormous iridescent bubble from the water.
Amazed at the size of it, Drake jumped up and down with excitement. I whirled the wand and a basketball-sized bubble escaped and floated toward him, which he gleefully popped.
“It’s easy to do. Here, you try it,” I said and set the wand back in the dish.
Drake came over and took the wand from the liquid. His first bubble didn’t work, but on his second try, he managed to produce a series of bubbles each about the size of a baseball. One popped on Friend’s head, and this sent Drake into spasms of delight.
For several minutes, he was absorbed in making bubbles with the large wand. He played very uninhibitedly with them once they started to float, chasing after them, trying to loop them with the wand, kicking them, poking them. He repeatedly wafted bubbles over Friend and gleefully let them pop on the stuffed toy.
I watched him as he played. There was a rather jerky quality to his movements, which I hadn’t noticed in his usual activities. It caught my attention, but it was still very subtle. Not something I would actually identify as unusual.
It was intriguing to observe the attention he gave Friend. He was definitely more engaged in playing with Friend than with me. Throughout, he made absolutely no noise, which was eerie to observe. It felt almost as if real life had had the sound turned off, because the only noise in the room was the hushed slap of his sneakers against the floor. What gave it an almost surreal aura was that this was a scene of such gaiety. Capering after the bubbles, Drake gave the impression that he was laughing, giggling, whooping for joy as he played. However, he wasn’t even breathing audibly.
“Look here,” I said and reached in my bag of tricks. “I have a different kind of bubble maker. It’s a pipe. See? You dip it in the dish and then blow.” I demonstrated. Dozens and dozens of small bubbles tumbled around us.
Drake danced after them, batting at them with his hands.
“Here, you try.”
He grinned at me.
I loaded the pipe with bubble liquid. “Here.”
He continued to smile cheerfully, but he didn’t take it.
I gave a little puff of the pipe to create a small flow of bubbles, then held it out again. “You do it.”
Gleefully grinning, he slapped at the bubbles but still didn’t respond to my request to take the pipe.
At that point the penny did finally drop for me. If you behave very beguilingly, people don’t tend to force their will on you. Particularly if you are small and cute, to boot. Drake’s charismatic cheerfulness was an avoidance technique. Now, the question was, avoiding what?
Chapter
11
While I was blowing bubbles with Drake, I could hear a terrible commotion going on out on the ward. Yelling and crying was followed by the heavy sound of feet, which signaled extra staff arriving in an effort to control whatever was going on. My first thoughts were that the uproar would alarm Drake, because certainly it sounded frightening. He paused for only the very briefest moment in his exuberant enjoyment of the bubbles to listen; however, beyond that, he gave it no attention. My second thoughts, of course, were to wonder myself what was going on out there. It was pretty unignorable, so I was naturally curious.
No need to wonder long, however, because once the session with Drake was over and we came out into the dayroom, Nancy Anderson beckoned me over. “If you’re looking for your next one, she’s in lockdown.”
Cassandra.
“Lockdown” was the unit term for the isolation or seclusion room where children were placed when they completely lost control. It was a kind of ultralevel of time-out, used mainly when children became very violent and presented a serious danger to themselves or others. The seclusion room was a small cubicle—about six by six feet—with no furniture. The walls and floors were covered with a heavy-duty canvaslike material over a thin layer of foam rubber, so that a child could safely calm down and regain control without injuring her- or himself. In the old days, we called such rooms padded cells.
According to Nancy, Cassandra had been hyper all morning, bouncing around loudly and boisterously, constantly testing the patience of the staff and provoking the other children. Then she started “playing pterodactyl,” which involved standing on the arms of the dayroom chairs while shrieking loudly, her own arms outspread, and then leaping on anyone who walked past and pretending to tear at their clothes and skin.
Cassandra frequently pretended to be a vicious bird or animal. Needless to say, this was the kind of game that got old fast, because it was noisy and physical and often quite aggressive, but on most occasions she would stop when asked insistently enough. However, on this particular morning she “woke up really wound up,” as Nancy put it, and had been in trouble several different times already.
We’d noticed Cassandra had a tendency to zero in on children with weak or dependent personalities and would pester them ceaselessly, if not stopped. One girl named Heather had caught Cassandra’s attention in the morning. Heather was a dumpy, obese ten-year-old who
se problems included much very infantile behavior. Cassandra had somehow discovered Heather was afraid of birds, and this may have influenced her choice in becoming a pterodactyl. Whatever the reason, she had been harassing Heather with her screeching and flapping since before breakfast.
Early on, Cassandra’s behavior had simply been annoying, and she was told to stop several times and, indeed, put into ordinary time-out. Although paying lip service to the staff in regard to understanding why she couldn’t keep playing and professing to be in better control of herself, Cassandra persistently returned to playing pterodactyl, and it became more aggressive as the morning wore on. Latterly, she had been dashing about, climbing up on the backs of the dayroom chairs and launching herself in quite a dangerous fashion at whoever passed. When she managed to knock Heather heavily to the ground doing this, the staff snapped. Cassandra was told to go into time-out to calm down. She ignored them. Staff came over to take hold of her and make her comply when she lost complete control and started raging furiously. She simply “went off the radar,” as Nancy described it. Small and wiry as Cassandra was, she required five adults to hold her and get her into the seclusion room.
I was disconcerted by this news. The truth was, in the time she had been on the unit, Cassandra’s behavior seemed to be deteriorating. She was becoming more difficult and bizarre, not less so. The other sad truth was that Cassandra was proving an extremely difficult child for any of us to like. She was an emotional mercenary, bonding only so long as it served her and then moving on to the next person. She seemed largely unconcerned by what others felt, thought, or wanted. We were coming to realize she was a startlingly bright, perceptive girl. Unfortunately, she applied these abilities to seeking out people’s weak spots. She was particularly good at recognizing innocent attachments to things or sensitive feelings about weight, appearance, intellect, or skill levels, and she would exploit these heartlessly, saying deliberately hurtful or offensive things in an effort to get what she wanted. In day-to-day life she was unpredictably moody, swinging quickly between being loud and excitable one moment to being silent and withdrawn, or going from being friendly and caring to being calloused and spiteful. Moreover, Cassandra seemed to have little sense of accountability for her actions. If you confronted her about doing any of these things, her response was always “I didn’t do that.” Or “It wasn’t my fault.” Or, if really pushed, “I don’t remember.” As much as I wanted to remain open-minded about Cassandra, I had to admit the words antisocial personality and sociopath had passed through my mind more than once.
