by Gwen Adshead
Given her history, the judge wanted a review of Sharon’s mental health, and I was instructed to see her again. When I read the notes, it appeared that, sadly, she had not had any therapy or help since we last met. This was unsurprising to me, and a familiar catch-22: local mental health services wouldn’t get involved with her because Sharon had no severe mental illness diagnosis, while maternal mental health providers said they could help only if she was still looking after a baby. I knew that a few boroughs in London had specialist therapy groups to catch patients like Sharon; I’d set one up myself many years earlier and had seen how helpful they could be. But this option wasn’t available to her either.
The lack of access to care in cases like this is so maddening and frustrating, for at least two reasons. First, within the landscape of offending in general, it is unjust that those who might benefit most often cannot get the most basic treatment. It is especially galling in the case of someone as young as Sharon, whose problems were potentially treatable and who might well bear more children. Meanwhile, other abusive people, including those in prison, are regularly offered interventions to look at the harm they do – indeed, they are expected to engage in treatment programmes if they want probation, as I’ve referred to in cases such as Ian’s and Lydia’s. Why not abusive mothers who have had their children removed? It could be an automatic adjunct to care proceedings. Maybe this is how a culture which places so much emphasis on mothers being ‘good’ pretends that bad ones don’t exist.
Second, if Sharon didn’t get the care and treatment she needed, I felt pretty certain she’d continue to get pregnant over and over again, in a chaotic and unplanned way. The risk to her babies would persist, and the trauma of the court’s intervention might repeat again and again. She wouldn’t be alone in this: about a fifth of all cases where children are removed from their mothers are recurrent care proceedings, with many of these ‘repeat removals’ involving mothers who had been in the care system themselves as minors.5 I am aware of one local authority which took nine children away from the same woman, due to her continuing risk. The tragic impact on her and the children, as well as the stupid waste of taxpayers’ money and the court’s time, could have been averted with therapy and possibly some long-term contraception, if she had been willing, but no help was available. On a positive note, there is now a wonderful charity called PAUSE, launched in London in 2013, which is filling important gaps in supporting women whose children have been taken into care.6 It has expanded over the years, but it is not available everywhere.
*
When she burst into my office for our second meeting, Sharon wasn’t tearful, distracted or full of teen attitude; she was enraged. She refused to sit down when invited and instead paced the floor in the small space, desperate to unload her frustration. ‘It’s like this is a fucking police state, the bastards … Everyone’s against us!’ A red flush crept up her neck and her eyes blazed. I let her go on. ‘Jake says they’re trying to wear us down, you know, and we have to fight. You have to help us. My lawyers said you would help.’ I raised my eyebrows but chose not to comment on that. Instead, I asked her, ‘How does Jake feel about the baby?’ Sharon sat down abruptly. I saw that her phone was glued to her hand, as ever, but she focused on me, her anger still at boiling point. ‘You think he doesn’t want him? He was gutted when they took him off us. You should’ve seen him – I thought he was gonna kill someone.’ I told her I was just curious to know if he was excited about being a father, if he would welcome a chance to help her raise their son. ‘He’s chuffed,’ she said quickly, ‘chuffed to bits. Comes from one of those big Irish families, so he’s really good with little ones – loves his mum and all that.’ Perhaps she thought that all she had to do was become a mum and she’d be loved by him too. She wouldn’t be the first woman to make that mistake.
Her solicitor had told me that Sharon was willing to co operate, but I found she was still reluctant to answer my questions, and much like the last time, mostly eager to bad-mouth various officials and medical professionals who had been ‘useless’ and lied to her. There was one moment when she seemed to open up, after I asked her what she and Jake had named the new baby. She didn’t respond right away but swiped at her eyes with the back of her hand. Then she busied herself sending a text and pretended she’d forgotten my question. I felt a wave of great sadness and hopelessness come over me.
‘Sharon? Do you want to tell me his name?’ I asked quietly. I was thinking of stories like Charlotte’s and all I had learned about how significant choosing a name is, for yourself or for another person. ‘Whatever,’ she said brusquely. ‘This is a bloody police state, you know. Taking someone’s baby away just like that for no reason.’ She was dry-eyed and cold now, her rage depersonalised: this terrible thing had happened with ‘someone’s baby’, a child she could not even name aloud. Perhaps that was a kind of self-protection in case she never saw him again. ‘Jake says this is all a big conspiracy,’ she added. ‘He says they hate us for putting up a fight.’
I asked if she felt safe where she was living now, with Jake. The words had barely come out when she interrupted, demanding to know what ‘they’ had told me and whether ‘they’ had ‘made shit up again’ about Jake hurting her or hitting her or ‘whatever’. I said we didn’t have to talk about it if she didn’t want to, and she nearly spat at me. ‘It’s all crap. Don’t believe a word of it.’ I thought it was time to diffuse the atmosphere a little and suggested she might need a little break. ‘Yeah,’ she grumped. I was about to get up and open the office door for her, when I realised what she meant. ‘Too right I need a break – we both do. Me and Jake, we’re tired of all these people and all your questions and all this shit. He’s our baby, and they’re not having him – we’ll get him back! I’m going to … I mean, we’re gonna get our own flat and all. The council will give us a nice place, Jake says, if we get our baby back. Write that down. Tell ’em. That’s what I need. A flat!’ She wagged her index finger at my notepad. ‘Go on, get that down.’
I did as she asked and included every word she’d said about her hopes and plans in my report. I came away thinking that her fight to be seen as a mother was as important to her as being in a relationship with this nameless baby boy. It seemed to me that she was not suffering the loss of her children so much as the loss of her social identity as a mother. So much flows from this – practical things like help with housing, as she’d hinted, but also a flow of cultural sympathy that accompanies a swelling stomach or a pram, in the home and in the community. She was smart underneath all that swagger and swearing; she knew that motherhood brought status. She’d had it before, and she wanted it again. This made me even more curious about her own experience of being mothered, but much as I tried, Sharon still refused to go near any questions about this, and I couldn’t force her. Sadness remained with me as I wrote my report and recommended again that she be offered therapy by someone competent to help her. I thought it was unlikely that I’d be needed in court or that I’d hear the result of the judge’s deliberations, and so it proved.
*
When my phone rang three years later, I had to struggle to recall where I’d heard the solicitor’s name before. Then the penny dropped: it was Sharon’s legal aid lawyer, asking me to see their client once again. Sharon was pregnant for the third time and back before the family court. Social services were considering an application for another prenatal care order, but she wanted to be allowed to keep this baby when it arrived. I couldn’t disguise my heavy sigh down the phone, but the solicitor interrupted me with a fervent ‘She’s come a long way, Dr Adshead.’ I murmured a polite ‘I’m sure,’ which sounded so doubtful that we both laughed. We joked that I was Eeyore to their Tigger in this case, but they wouldn’t let me off the hook, arguing how important my expert input would be to the judge, given that I had a baseline for comparison, having seen her twice before. ‘Tigger’ told me that everyone – the social workers, her guardian and the judge – thought Sharon was doing w
ell, but the court really wanted to know from me, ‘Can we trust the change we see?’ I wanted to be useful to the court – and I admit I was curious to see this change that others had observed.
She was five months pregnant when she came to my office for the third time. There certainly was a physical difference: she had the fabled second trimester ‘glow’ that some women experience; her skin looked healthy and her hair, now a natural brown, was thick and lustrous. A pleasant young man about her age dropped her off, introducing himself to me as Simon. He kissed her affectionately, saying he’d be back to pick her up when we were done. She stretched out her hand to shake mine, thanking me for seeing her again. This was even more remarkable than her physical transformation. She seemed to read my mind. ‘Bet you didn’t think you’d see me again, did ya? Bit different this time, right?’ It was indeed, I said, adding that as I recalled, she’d been very cross the last time we met. She nodded and gave a rueful smile. ‘Yeah, I’m sorry about that … Third time lucky?’ Then she launched into a speech which sounded a little prepared but genuine. She told me she was grateful the court had asked me to evaluate her again, and she wanted to explain how much things had changed so that the judge would give her and Simon a chance with this baby. As she spoke, I noticed she was resting her hands on the baby bump, as if holding it in place. She followed my gaze. ‘Oh, we felt it move this morning, little kicks, you know? Maybe it’ll happen again.’ I smiled, as you do when a pregnant woman shares that kind of intimacy, and it was easy to forget her history for a moment and feel warm towards her. Then she looked up at me, her face turning serious. ‘I do understand why everyone’s so worried.’
As we talked for the next few hours, it was the linguistic shifts I noticed most, even more than changes in her appearance and tone. There was a spontaneity and coherence to her speech and, notably, a total absence of swearing. Coherence in this context does not mean elegant prose; it refers to communicating with meaning in a reflective way. I often give trainees the example of the man who had killed some of his family members, and when I first spoke with him about it, he said, ‘It’s all been a terrible misunderstanding.’ On its own that’s a graceful and well-composed sentence; in the circumstances, it was jarring and bizarre, the words of a man who had no coherent story to tell and who was living in a parallel reality.
Sharon was now able to look at her past and acknowledge that other people had a right to hold a view that was opposed to her own. It was evident that she’d moved out of a distorted reality and denial into a more ‘live’ frame of mind, where emotions like humour and regret could exist. I wasn’t surprised to find that the big development in her life between this pregnancy and the loss of her last child was that she’d finally made it to the top of the waiting list for therapy. Within the NHS, a GP will refer you for psychological therapy, and you will be assessed and put on a waiting list. It can easily take two years to get to see a therapist, which is clearly a damaging and dangerous state of affairs, even if it gets little public attention relative to the outcry over waiting lists for physical health needs. Therapy waiting times got much worse in the wake of the front-line service cuts that followed the global economic crisis – unfortunate timing for Sharon. But this has been a problem for most of my career; the difference is that before the restructuring of the NHS, when norms from the world of business were imposed across the board, the medical professionals (as opposed to accountants) who ran mental health services had more flexibility. In cases judged to be sensitive or urgent, we could bypass rigid queuing systems, and we also had more clinicians available, many of whom were highly experienced. I can recall some gifted semi-retirees I worked with in my early years, brought in to support therapy clinics in the community; today, ‘efficiency standards’ (code for ‘younger, less trained therapists cost far less’) make that impossible.
The group for mothers that Sharon had finally joined had been set up by her local mental health service, and it sounded much like the one I’d run years earlier. I was so pleased by this news and encouraged her to tell me more. She admitted that when her social worker had first announced the ‘good news’ about a place coming up in group therapy, she had not been keen at all, mainly because she hadn’t known what to expect. But this social worker, Lisa, ‘really got me’, Sharon explained – I noticed this was the first time I’d ever heard her say something positive about any professional trying to help her. More than that, she sounded affectionate.
Lisa was just a few years older than Sharon, and she’d been supportive in helping her to get away from Jake, who’d become increasingly abusive to her after they lost their son. Sharon had found new housing and a programme to help her with her substance abuse problems, with Lisa’s encouragement and assistance – ‘Like a friend, you know?’ It occurred to me that this might be the first true friend she’d ever had. Sharon met Simon not long before the place in therapy became available, and with Lisa, he’d encouraged her to attend. ‘They ganged up on me,’ she laughed, ‘and finally I gave in.’ She had to go for an initial assessment by a lady therapist, she explained, and she felt understood by her. That positive interaction had helped her to take the plunge and begin going to the weekly group. She wasn’t the only one there who’d lost two babies, she told me, and she leaned in then, lowering her voice a bit. ‘You’ll never believe it, but one of them had FIVE! Five in a row, taken away.’
‘What did you feel when you heard that?’ I asked. ‘It was f—’ For a minute I felt sure she was going to swear, but she stopped herself and found the word she wanted. ‘Amazing.’ ‘How so?’ I asked. She described how the mother of five had talked for ages to the group, describing a terrible cycle of pregnancy and care orders and courts and police, beginning when she was just sixteen. Finally, she’d broken down, ‘crying her eyes out like a baby’, and admitted that she just didn’t like being a mum. ‘I couldn’t quite hear what she’d said at first, and then she said it again, louder: “I don’t wanna be a mum, I don’t like being a mum.” Just like that, right in front of everyone. Amazing.’ She shook her head, eyes shining as she relived the moment. ‘What happened then? How did people respond?’ I asked. Sharon grinned. ‘People hugged her. It sounds crazy, I know, but it was good. We told her she was brave for saying it, you know? Then everyone starting clapping. Seems funny, I guess, cheering someone for saying that, but it made sense, I swear.’ It did, I agreed. Recognising reality is worth celebration, anytime.
I asked if she wanted to tell me anything else about the group. ‘Like what?’ A vestige of her former suspicion flitted across her face. ‘Anything at all,’ I said. She thought for a moment. ‘It was good to know I’m not a freak. I mean, nobody’s just born a good mum.’ I thought that never had a wiser thing been said, and I told her so. ‘Thing is,’ she went on, ‘I lost my mum and all, so young, and then when I had Thomas …’ She faltered as she said his name. It seemed to me she was as moved by compassion for her younger self as she was by the thought of the little boy she’d lost. Her next words could have applied to either or both of them: ‘I wish it hadn’t been that way.’ She reached for a tissue and blew her nose loudly. ‘It’s just that … you don’t have a clue how to be when a baby comes, you know? And it’s so hard to tell anyone. You feel—’ Here she corrected herself with an effort, switching to the first person, demonstrating that this was her story. ‘I mean, I felt, I don’t know … Every day, the baby was just crying and crying, and even if I fed him and changed him, he just cried and nothing I did would settle him. It was so hopeless and nobody seemed to get it and I felt so … trapped.’ I was trying to write down every word as she spoke. She waited, as if politely allowing me to catch up, or maybe it was just to take a moment to compose herself. Then she came close to an admission of past guilt, even if she swerved back to the second person. ‘I guess … you do anything you can think of to get some help. You’re desperate.’
I spoke carefully, knowing this was difficult. ‘Sharon, you didn’t want to talk about your childhood when we
met before. Do you think you could tell me a little more now?’ She stared at the floor for a bit, then looked up into my eyes. ‘I had to talk about all that in group, so it’s not as hard now. But not easy.’ I told her to take her time. She began with her father, who she said was an alcoholic; she thought maybe both her parents were, but she couldn’t remember much about her mother, who died several years before her father, when she was seven. ‘How old were you when your father died?’ She shrugged, and again I saw a flash of the angry teen. As the pain surfaced, so did the old anger. ‘Whatever. Thirteen? He was really sick, his liver packed up. But he kept drinking, or tried to. I looked after him for a while. It was f— It was horrible.’ I was sure it was. Liver failure can mean a slow, painful death – not pleasant for a young girl to see. I did not like to imagine that traumatised young teen, trying to cope alone. ‘He died after I went into care. I didn’t see him again.’ She said this without emotion, almost shrugging it off. Maybe it had been a relief.
‘And your mum?’ I prompted her, hoping she was prepared to go further. Sharon exhaled, then crossed her forearms low over her body, as if cradling her baby to protect it from some oncoming threat. She kept her head down, so that I had to strain to hear her. ‘I can’t remember much, but … there was an accident … I was with her. It was night. I don’t know why, but the car flipped over, our car … I was trapped in there with her. I think she died while we waited for help to come.’ She went on to tell me that the emergency services had taken hours to arrive, or so it had seemed, and she had to be cut from the wreckage.
