Brittany: Portrait of a Cutter

“Can I see your arms?” I ask “Brittany,” who is sitting at the round table in my office, the table around which I meet with families, or play games with kids who don’t like to talk.

I sit in front of Brittany, in my desk chair. Her dark eyes, the most exotic cat eyes I have ever seen, turn to slits as she stares at me, trying to figure out if I’m someone she can trust.

This is my second session with Brittany. She’s a recent admission to the adolescent residential treatment facility where I work. She’s 15, a cutter, hospitalized eleven times. A year ago, she left her journal overnight at school, and the next day, the police and CPS (Child Protective Services) showed up at her mother’s door and removed Brittany and her brother.

Brittany’s family — her mother, her brother, her aunt, her grandmother, and the stepfather who had been molesting her since she was eight — are angry with her for spilling the family secrets. Her family is one of many in which “what goes on in the family stays in the family.”

CPS sent the kids to different foster homes. Brittany spent nine months with a foster mother she loved — “the only person I’ve ever felt close to” — until the foster mother couldn’t handle the cutting and suicide attempts any longer. So Brittany came here, where she drifts through the halls in a kind of altered-state slow motion caused less by her meds, I think, and more by trauma.

Brittany is in a chronic state of disassociation. In three years of working with emotionally disturbed adolescents, I have never seen any kid as far away, lost in the past, in the recesses of her own mind, as Brittany.

Any question I ask her is returned with a long, penetrating stare, the narrowing of the cat eyes, several beats of silence until she can form a reply. Sometimes her perfectly shaped lips widen into a smile and her face, always framed by a head wrap, brightens. Sometimes she just looks frozen. Her most common answer to any question I ask her is: “It doesn’t matter.”

Brittany slips her fingers under the long sleeves that cover her wrists, yet continues to stare at me through the slits of her eyes. Just a few minutes earlier, I had gone into her bedroom, shaken her shoulder until she woke up, and asked her to come to talk to me.

“Why do you want to see my arms?” she asks.

“Because Staff told me you’ve been in bed since your visit with your mother on Saturday. They said you seem very depressed, and you don’t want to talk to anyone.”

I watch her fingers moving under her sleeve as she scrutinizes me.

“How was the visit?” I ask.

“It was fine.”

“Then why have you been in bed for two days?”

She shrugs. “It doesn’t matter.”

“Yes it does,” I say. “How you feel matters.”

“I don’t know if I can trust you,” she says.

“That’s understandable,” I say. “This is only the second time you’ve met with me. You don’t have to show me if you don’t want to.”

We stare at each other for a few beats. Without taking her eyes off me, she pulls the beaded bracelets off her wrist, turns her arm over and pulls up her sleeve. I peer at the underside of her forearm. The skin is dark, smooth, unmarked.

She pulls up the other sleeve and turns that arm over. I examine the pattern of horizontal scars from her wrist to the inside of her elbow. I am surprised, and relieved, to see that there are no fresh gashes.

I sit back in my chair. She pulls down her sleeve. And she begins to talk.

She talks for a long time. She tells me that she doesn’t like going to sleep because when she sleeps she sees her stepfather’s face. So she stays up as long as she can, trying not to fall asleep. She tells me, in her own way, about the tacit agreement she made with her family, the agreement that she would sacrifice herself so they didn’t have to deal with their own problems, so nothing would threaten the family unit, the unit that is freakish and twisted beyond repair.

She tells me how hard it was to carry the secrets around, and that cutting her skin made her feel better, for awhile. But then she had to cut more and more to feel better for less and less time. Sometimes she had to push things further. Gashes so deep she was sent to the hospital. Swallowing a vial of Vicodin pills.

One of the many therapists she had seen over the years suggested that she keep a journal.

“She told me all my thoughts would be safe in a journal,” Brittany says. “That no one would read them. But that wasn’t true. I left my journal at school and my teacher read it, and she called Child Protective Services. My brother told me I did it on purpose. But I didn’t. I just forgot, and I left it at school.”

She tells me how her aunt, and her grandmother, and her mother, tell her she’s stupid and she won’t amount to anything. She tells me she hates the visits with her mother, she doesn’t want to go, but they’re court-ordered. On this last visit, her brother cried, and told her it was her fault he had to go to a foster home.

“It sounds terrible,” I say. “I wouldn’t want to go either.”

“It doesn’t matter. I’m used to it.”

There is a process known as projective identification, in which the client’s disowned feelings, the feelings that are intolerable, are projected onto the therapist. It’s a jolt, when it happens. You’ll be sitting there, having a conversation with your client, when a flash of anger courses through your body, or an immense cloud of sadness wraps itself around you as tears fill your eyes.

The first wave that hits me is the anger. I want to grab her by the shoulders and shake some sense into her. I’ve been doing this long enough so I know I’m feeling her feelings and not mine.

Except some of the anger is mine. How can you not be angry to see a life extinguished at fifteen? How can you not be angry when you imagine a 9-year-old slicing her wrists open because no one cared that she was getting raped night after night?

“So your family matters, but you don’t?” I say, with too much of a charge in my voice.

“It’s all right,” she says, as if she’s comforting me.

“It’s not all right,” I say. “Your parents were supposed to protect you, and they didn’t.”

She gazes at me with those cat eyes. They narrow. Her shoulders sag, almost imperceptibly. Now the sadness hits me. I want to put my head down on my desk and sob. I pull myself away from my feelings a bit, the way I’ve learned to do over the years.

She stands up from the table. For a moment I think she’s going to pat me on the shoulder. Instead, she repeats her mantra.

“It doesn’t matter. I’m used to it.”

*          *          *

The next day, when Brittany knocks at my door, she looks like she wants to hit me. I tell her to come in, and she stands in front of me. I know exactly what she’s going to say.

“Why did you tell my social worker what I told you? It’s supposed to be confidential.”

“I am required to talk to your social worker every week, and report how you’re doing,” I say, a bit too clinically.

“I trusted you.”

“My job is to keep you safe. I told her I was concerned about you having these visits.”

Actually, I told her social worker that I was worried Brittany was going to try to kill herself if she kept having the visits. How could the judge order visits when there has been no family therapy? I asked. The social worker agreed, as chagrined and worried as I was. She could go back to court and try to get the judge to suspend the visits, but that would take awhile. We mulled over hte options. Should we try family therapy? Should we have the social worker who monitored the visits take a more active role?

“I have to have the visits,” Brittany says.

“Yes, but maybe we can figure out a way to give you more support, so you don’t feel so bad afterwards.”

“I don’t want to have family therapy.” She doesn’t yell. But she’s pissed, in her quiet, beaten-down way. “My mother will be mad, and I will be mad.”

“That’s okay. You can be mad. Your mother can be mad. But if you guys don’t start talking about what happened, you’re not going to get better.”

“You don’t understand the way my family does things,” she says.

“Well, I think I do,” I say. “It’s not your job to protect your mother, it’s the other way around. And if you don’t learn to speak up for yourself, you’re going to keep finding yourself in situations where you’re taken advantage of.”

My cheeks feel hot. I start checking myself. Is this the right approach? After two sessions, do I have enough money in the bank with this girl to speak this plainly, to expose my own sense of outrage? Have I just blown the alliance?

“It doesn’t matter,” she says. “I know how to deal with it. I have coping skills.”

I’m already in deep, so I keep going.

“Cutting? Going to the hospital? Is that really the way you want to live your life?”

“Nothing else works.”

“It will take a long time to learn different coping skills. But you can do it.”

Actually, I don’t know if she can. She’s been on the slow boat to suicide her entire life. But someone needs to fight for her.

“Why does everyone matter but you?” I ask.

“It’s just the way it is.”

“Who says?” I ask. I am palpably pissed. “Who taught you to think that way?”

She stares at me, silently fuming.

“I’m going to leave now.”

She walks out of the room, closes the door. I sigh, swiveling in my desk chair. My thoughts tumble over each other.

I don’t know how to be a therapist.

This was a great session, she got the anger out.

This was a terrible session, she’s going to go back in her room and cut.

I wish I didn’t have to work and could stay home and write a lifestyle blog.

*          *          *

It’s dinner time and I still can’t shake the session. Rarely does a kid get under my skin the way this one has. I can’t figure out why. Maybe because she’s so smart. Maybe it’s because of those eyes. Maybe because I recognize my teenage self in her, the teenage self who was stuck in the middle of a quietly dysfunctional marriage, with no one to talk to.

Over wine, I ask Atticus what he would have done in this situation. He’s worked with troubled families for over 20 years. Should I have called the social worker? Should I have let the visits go on with no intervention?

“It’s crazy that she has to have those visits,” Atticus says. “It’s re-traumatizing, sending a kid back to a mother who let her be abused.”

“What I do? The visits are court-ordered.”

“See if the social worker can set her up with a therapist at rape trauma center. You’re not trained to deal with this. I couldn’t deal with it. But she might be too far gone.”

I take a sip of wine, feel the warmth coat my throat, tamp down the fury bubbling inside me.

I am mad that some kids are doomed before they’re born, while other kids are born into charmed lives.

I am mad at those members of the 1% who sit on their yachts and in their golf carts, clueless about the lives those at the bottom of the 99% endure.

I am mad that some people will never get ahead, no matter how hard they toil, while others will fail up, effortlessly.

I am mad that people die because they don’t have health insurance, or because they don’t have air conditioning in a heat wave, or because they have the wrong skin color and cross paths with a bigot with a gun.

I am mad at the needless chaos of my ridiculous divorce, mad that I have to work full-time in a grueling job for so little money, mad that I have been so consumed the last nine years trying to fend off a vengeful ex — who is now off somewhere in Europe for two months, blissfully unaffected by anything except his own wants — and keep my head above water, that I haven’t been able to give my kids the childhood they deserve.

I am stupidly, pointlessly mad at injustice. It’s times like these that I wish I had religion, intelligent, irreverent, Anne Lamott religion. I wish I could believe that things happened for a reason, or that I could fix things that are broken.

I also wish I could come up with a decent ending for this post. I wrote and deleted variations of the same dumb sentence for half an hour. Then I went and took a shower, thinking the ending would present itself to me, the way it usually does. But I kept thinking the same pedestrian thing. So I guess I’ll just write it.

I wish that I lived in a world where everyone thought that everyone mattered.

Read here for Part II