by S. J. Finn
Alice, my next client, was nervous and had considered not coming. (The half an hour excuse thing had been an attempt to cancel.) Alice, now fifteen, had lived in foster homes since she was twelve. Every professional involved in her life had an instinctual sense that she had been sexually abused by her father prior to the foster care and at twelve she was, or so we surmised, too old for his taste so had been thrown out (possibly because she actually wanted the sexual attention she’d always been given). If this hadn’t happened, there was no doubt that something strange had gone on in that family house.
The session was low-key. I didn’t push Alice. She knew that twenty students were looking at her from behind the huge reflection in front of her, and it would have been better if she’d agreed to meet them first, as most clients did. (It is always better to see than not, the imagination an unruly force at the best of times.)
Afterwards, even though I had told the group the facts about Alice’s history while leaving out our speculations, they insisted she behaved in a sexualised manner and, because of that, she had been sexually abused. I wasn’t sure whether to be impressed or disturbed. The tendency to label and categorise, even to pathologise, is alive and well and way too robust. It wasn’t that they were wrong. It was their enthusiasm to treat Alice as a sum of her problems that didn’t sit well and, because of the clinical setting, the dry, perhaps incisive way I had delivered Alice’s story, I felt partly responsible. I finished the session with a caution.
‘Helping isn’t only about identifying problems. More often than not it means clearing a path, so someone can proceed. Without being able to go forwards, problems get stuck in dark corners. You’re right, Alice will probably be able to admit, if things go well for her, to having been abused. But if you see your clients as problems and not as people with possibilities then you’ll tend to miss opportunities for them to find their potential. You must respect the problems they present to you as theirs. It’s not your job to hang them up, to see people as the things that have been done to them. If you walk with them while they make their way over things, which is often time consuming, they will do their own healing.’
They looked at me, dumbfounded. I guessed they had always been told to be active and alert, to search for problems, to tease them out and attack them head on, to problem-solve. If they had argued the point, I may have capitulated. They didn’t. I nodded, wishing them the best of luck, and started to mutter TS again, like a child with a favourite nursery rhyme.
Rubbing its back along the window-panes;
There will be time, there will be time.
THIRTY-TWO
There were other words that kept me going in those days, when moments of calm in my routine at Marlowe Downs sent me slightly adrift, causing me to ponder what it was I was doing.
When I became worried of obsessive adherence to Tom Eliot, I remembered something of Borges.
Let no one fear in the bewildering night
that I will lose my way among the borders
The workload was growing to gargantuan proportions. Drowning not waving. A lifebuoy was of no help. I didn’t need to float, I needed to be hoicked out of a rolling swell. At times like these there was only bravado to rest against. I kept a smiling face even as a monster wave was looming.
I had forty-eight open cases. I was meant to be – under our new rapid-response, which had received a huge rap from the audit team – taking in one new case a week, and closing one to keep everything evened out. I decided to close five a week until everything was more manageable. Easier said than executed. When I contacted people to say I was closing their file, they came up with more problems. I regretted having embarked on the exercise and considered closing cases without informing the clients. I knew this wasn’t an option and went back to closing those I could and not worrying about the rest.
I began to turn down offers to sit on committees. Extra curricula activities were out. I was starting to harden.
One day, Eddy rang me, begging me to fill in for someone who had pulled out from being on a panel in a hypothetical. The occasion was the Annual General Meeting of the hospital’s psychiatry department and they wanted a representative from every discipline. I was to hold the flag for social workers. I reluctantly agreed, as I owed Eddy for small favours incurred over the two years I’d worked in the place.
He wasn’t there. In fact, I knew very few of the people gathered in the Milly Logan Lecture hall - the room I’d seen Celia come to grief in on my first day. What’s more, the women looked like headmistresses from the fifties, and the men like ancient cricket players. But I guessed they were all ex-mental health aficionados. The only person I did recognise in the audience, let alone on the panel, was a psychiatrist from another hospital whom I’d come to loggerheads with over a diagnosis they had given a child I’d been working with, when he’d been treated in their inpatient unit.
They had anointed the kid in question as having attention deficit hyperactivity disorder – not uncommon for a nine-year-old boy, especially one I’d had to catch and peel from his school roof one day. This overrode my diagnosis of adjustment disorder – a diagnosis I’d chosen because his mother had, I suspected, an undiagnosed personality disorder. (See how complicated psychiatry can be! And was I "mother blaming", I had to ask myself.) I was arguing that the adjustment disorder was in response to the mother’s personality disorder. But really the label of adjustment disorder – given that we were required to diagnose every kid we saw – was a ruse on my part to choose the lesser of the diagnoses and to treat the kid rather than just medicate him, as is what ended up happening. Tagged ADHD, he’d been medicated and, since his behaviour had improved – the seemingly obvious fact that he wasn’t in his mother’s company when he was in their inpatient unit not having occurred to them – he’d been returned home after two weeks, only for his behaviour, despite the medication, to have returned to its previous level of naughtiness. Finally, another clinician had labelled him conduct disordered.
This psychiatrist recognised me, but nodded civilly enough. He was a small neat man, dressed in country fair – moleskins and a checked shirt under a conservative blue tie. I remember feeling suddenly on the back foot. He had an air about him – a perched-up-high air, a hawk-looking-down-for-small-prey air.
I tried to forget that he was there as I looked around for Eddy. Cursing his absence, I sat alone through a meeting that meant nothing to me. Although they were attempting to romp quickly down the agenda, the business started to stretch into the hour and I waggled my leg with frustration, my head in my hands, thinking of all the other places I should be (home), all the other things I should be doing (carousing with Renny). And then we were being called to the front.
The panel were introduced, and I put on my ea-ger-to-be-out-of-there-but-nonetheless-eager face. The scenario was presented by a tall gangly psychiatrist also dressed in moleskins – trends are abundant wherever you go – who was suitably quick-witted and handy with the pun. A family had presented themselves at their local mental health service because one of them, an eleven-year-old girl, had stopped talking. Each member of the family was described and the assessment process began. The speech therapist spoke first. She was concerned about neurological problems, she said, and wanted to get the psychologist to test for cognitive functioning, which was duly done. The psychologist, another young woman, who could have found any amount of difficulties, reported finding nothing of significant concern and decided to make a referral to the psychiatrist for a family interview. The psychiatrist – who I had met, I realised then, a couple of times – floored me by saying that he suspected the father was sexually abusing the child. The discussion quickly veered off on a theme about undisclosed sexual abuse. The speechy and psychologist, OT and psych nurse concurred. This was such a leap in judgement I was miffed as to how their thinking had evolved. I began to squirm uncomfortably in my seat and had to stop myself from jumping in. (This was typical of me. I didn’t even know if I was right. I held back.)
&nbs
p; ‘And, Monty,’ Andy, the gangly psychiatrist doing the honours, looked at his card that listed the panel’s names. I sat up. who is heading up the adolescent inpatient unit, is approached by Maria, the psychologist who’s armed with her client’s near-perfect cognitive score, to see whether she’ll be accepted.’ Andy smiled, pausing for effect. ‘There’s one problem. Monty’s team at the unit is on work bans and their operations are severely curtailed. Monty, what’s your response to Maria?’
I gulped. There had been no mention of any union action, or that I was heading up an inpatient unit -something I’d never done. ‘Well,’ I fumbled, ‘seeing as it’s only work bans and we’re not on strike… we’re still accepting emergency cases.’ (I knew this from that exact situation having been played out at the unit some months earlier.) I went on: ‘And since I classify this as an emergency, seeing the girl’s looking down the barrel of selective mutism,’ (the words, in one of those truly lucky moments, presenting themselves rather inexplicably) ‘I accept her into the unit.’
‘So,’ he continued seamlessly, no flicker of doubt, ‘Catherine is admitted to the adolescent unit, to the great relief of Maria.’ There was a titter of amusement from the audience. ‘And. what happens in the adolescent unit?’
‘Even though Catherine,’ I said, ‘won’t speak, it doesn’t mean she can’t hear.’ (There was a chance this sounded smug, but it came from frustration. There were some people on the panel who seemed to be dallying.) ‘One on one, in a private room, she’d be spoken to about the choices she was making, about what she was hinging those decisions on, about other paths that could be just as provocative if she wanted to make a statement about unfairness or anxiety. She’d hear about how mental illnesses can develop from habits, about how action, or lack of action, can cause physical changes in the brain. She’d be told everything we know about why someone might choose the path she’s taken rather than deal with other scarier responses such as anger, sadness, the feeling of being hurt.’
I paused. I had been smart enough, surely.
Andy nodded. ‘And that’s actually what happens. Catherine’s family admit her to the unit and she slowly gets better under the hothouse treatment of the team. Monty, what’s your surname? I don’t have a surname written here.’
‘Montgomery,’ I said, embarrassed now.
‘Monty Montgomery,’ Andy smiled, his arm extending in a showy manner towards me as he turned to the audience, ‘completing our hypothetical tonight in good style.’
I had sat through excruciatingly dry details of AGM minutiae and silly responses to a rather straightforward diagnosis, then I had solved the case in three short minutes. I would have answered the same way if Andy had asked me before asking any of the other professionals on the panel. Despite my earlier talk about complexity in regard to the boy and his mother, psychiatry is often made more complicated than need be. If you treat the symptom rather than always concentrating on the cause, paths for recovery can be opened up. In other words, there’s more than one way in, more than one way to clear the deepest of problems.
I made a beeline for the door, thinking I’d paid Eddy back in full and notched up some credits. That was until I clocked the psychiatrist from the other hospital, his neat face nodding solemnly at me.
‘Congratulations,’ I heard him say as I swung past him, smiling amicably.
‘Thanks,’ I slung the word belatedly, surprise and genuine gratitude spiking my response. I couldn’t believe I found revenge so sweet. Why did I care what that man thought? But I did. And I couldn’t help but say to myself: Everything comes back, eventually! Life’s one big circle and it’s all a matter of hanging in there, backing up what you believe in.
I walked through the double doors, out through the large, blue-lit hospital foyer, its shopfronts closed for the night, one cafe still serving a few dour-faced parents of the infirmed. Outside, the night was all purple and gold, as if the yellow street lighting had bled into the blackness, mutating its colour. I waited for the tram, leaning against the steel rail, as cold to touch as the inside of a freezer. Already the good feelings were dissipating. “Full circles” was such a ridiculous notion – perhaps right for the small things, but get off the grass, I berated myself, your simple philosophy is threadbare; life is not a series of wins and losses, and nothing will come back full score. I clenched my jaw, searched hungrily for the tram. I was going to be late getting home to Renny once more.
THIRTY-THREE
Sometimes when Marcus was staying in town he would come to Marlowe Downs with me. I knew that children in the workplace weren’t "tolerated" in these modern days, but come on: it was a child facility, for pity’s sake, and surely preventing mental health problems in employees’ kids was important too. (For the most part, Marcus attended holiday programs that were run at the primary school around the corner from where Renny and I lived. He was always enthusiastic about going but I didn’t want to send him there all the time. It would be like going to school all year round. Added to that was the reality of my annual leave, which didn’t match the time put aside for school holidays, nor the fact that Renny wouldn’t have tolerated me spending all my holidays with him, and rightly so.)
Anyway, when Marcus came to Marlowe Downs he loved to tidy my office. He would carefully set the toys out. The zoo animals made up one display, the dinosaurs another. Pencils, pens and paper would be neatly stacked, as would all the board games, playing cards and my desk paraphernalia. It was like employing someone to give my office a facelift. He had a gift for it. After this happened a few times though, I found it a little disturbing. He preferred, it seemed, to clean my office rather than play with the toys themselves. Thinking I was reading too much into it and not wanting to knock anything that had to do with tidiness, I didn’t ask, and quelled any thoughts.
I brought films in for him to watch on the televisions around the place and he made some beautiful "trick books" for me. These would have mazes, quizzes, small crosswords and little poems in them. They were so cute. A lump of emotion would swell in my throat and tears would rise when he presented them to me.
On one particular day, the last day I took him to Marlowe Downs, he came to a team meeting and sat on the arm of my chair, his small, svelte body slinked around me, his keen eyes and ears taking everything in. The meeting was mostly business; only a few cases – all straightforward enough – were presented towards the end.
At the finish of the day we piled ourselves onto the tram.
‘I wish we were there already,’ he said.
‘You don’t like the tram?’
‘It takes forever,’ he complained, resting his head on my arm. I thought he might go to sleep but after a while he said, ‘What will happen to the boy who can’t do his shoelaces up?’
Indeed, in the meeting we had discussed a child who had what we call "pervasive developmental delays", one of the few conditions that falls outside the mad, bad or sad categories that are said to cover all kids coming into Marlowe Downs and any other service like ours. These kids stand out in a school setting but it’s a pity they don’t come to our notice earlier. Pre-school intervention programs have done a good job at picking these kids up, an important thing because these delays, if untreated, cause other difficulties for kids socially and academically. We treat them, but sometimes it is hard to make up for earlier, lost opportunities.
‘He needs some extra help to learn,’ I said lightly, ‘that’s all. He’ll be alright.’
‘Nathan in my class, he gets special help.’
I nodded.
‘He’s naughty sometimes. Ms H gets so angry her eyes bulge like big bubbles.’ He showed me. ‘But he’s been twice as good lately.’
‘Twice as good?’
‘Ms H says because he’s getting help he’s not so naughty.’
‘Ms H is probably right.’
‘I never want to be a teacher.’
‘Really? What I do is kind of like being a teacher.’
‘No, Mum, you help people,’
he said emphatically. ‘That’s not being a teacher.’
‘I think teachers would have something to say about that. They’re helping you by teaching you.’
But Marcus wouldn’t have it.
‘They don’t care what we think, they just tell us what to do.’
‘They have to keep the kids quiet so everyone can hear what they’re saying.’
‘Yeah, but they don’t have to be mean.’ He said this with such a bite in his tone that I left it, patting his leg as he put his head back on my arm.
I’d noticed this righteousness before. He’d been voted onto the student council recently – a tiny eight-year-old in office – and had gone to his first meeting with several things to put up for discussion. He wanted the school to grow vines along the steel fences around the boundary of the school, for privacy and to dampen the noise from the highway. It would also make the school look nicer, he’d told me. The other idea he had was to collect five-cent coins because they were annoying to most people and didn’t mean anything to their financial situation. This money could buy treats and fruit from the tuckshop so that kids who didn’t get those things in their lunchbox could have them.
When he had been telling me all this, I asked him how he’d been chosen as a representative.
‘We voted,’ he had said plainly.
‘Oh!’ After a moment I’d asked: ‘Who did you vote for? Did you vote for yourself? You know you can do that.’
‘I voted for Steven Manse.’
‘Is he your friend?’
‘No.’
I was curious. ‘Can I ask why you voted for him?’
‘Ms H said we should vote for someone we thought would be good at feeling important. Like they’d be good at it and not become a big head or anything. Steven is very quiet. He’d never become bossy or a big head. He doesn’t have many friends, I think ‘cos he’s so serious.’
