Last Monday I arrived at work to learn that my 12-year-old client Daisy had to be restrained the day before. When told to change out of her dirty pants into a clean outfit for church, she trashed her room, put a belt around her neck, and tried to eat broken glass.
Normally, Daisy does little more than float through the day in a faraway stupor. With her round face, chin-length dark hair and spectacles, she reminds me of the Peanuts-strip character Marcie. She sits in my office, answering my questions in her soft voice, pushing her glasses up her nose. Pumped full of antipsychotic drugs, her once-average frame has ballooned over the course of a few months.
Daisy is challenging in session. Not because she’s a pissed-off therapy-hater, like so many of my clients. But because she has an odd, not-quite-there quality that I have a hard time connecting with. My questions usually fail to generate a meaningful conversation and when she leaves the session, I wonder if what we’re doing can evenly remotely pass for therapy.
She often appears at my door with a handmade gift: a necklace strung together with yarn, a plastic bottle filled with layers of brightly-colored sand. Usually, when I pass her in the hall, she sidles up next to me for a hug. When I leave in the evening, I hear a “Bye, Pauline!” and turn to see her waving at me as I walk across the lawn to my car.
So instead of sitting in the room, struggling to string together sentences, I’ve started walking her down to the corner coffee shop, where I buy her a cookie and myself a cup of coffee.
Not long ago, as we made our way down the hill, she turned to me and murmured in her soft voice:
“You’re like my mother, only happier.”
That’s when I decided that hugs count as therapy. She didn’t need a therapist, I realized. She needed a mother.
* * *
Over the past few weeks, Daisy has begun to decompensate. She’ll crawl under her bed, sobbing and shaking, refusing to get out or tell Staff what’s bothering her.
On one of these occasions, I went into her room to try to lure her out from under the bed. I almost gagged when I walked in, the stench of soiled clothes was so overpowering.
In staff meetings, when it came time to discuss Daisy’s case, Staff inevitably brought up the subject of hygiene. She didn’t really shower, they said, she just ran the water. Her hair was greasy, she didn’t brush her teeth. If Staff didn’t wash her laundry for her, she’d wear the same underwear every day.
“She smells,” a Staff named LaToya told me. “Could you please talk to her about her hygiene?”
* * *
One afternoon last week, as Daisy and I walked back from the coffee shop, I tossed out suggestions to improve her hygiene: A to-do list on her door? A new, scented body wash? A special outing if she took a shower every day for a week?
She shrugged. Exasperated, I finally asked:
“Daisy…what do you think gets in the way of you taking care of your body?”
“My mother didn’t shower very much,” she said.
“You mean she didn’t show you how?” I asked.
“We lived on the street. There was no place to take showers.”
My stomach dropped. I knew her mother was in her life only sporadically, but I had forgotten exactly why. The courts had stepped in long ago and her social worker was hoping her older brother could get his life together sufficiently to become Daisy’s guardian.
“That must have been so hard for you and your mother,” I said, trying not to sound totally lame. “But now you’re in a place where you can stay clean. How can we help you do that?”
“I need Staff to remind me,” Daisy said.
“Okay. Let’s go talk to them.”
* * *
“Daisy says she would like support from Staff to help her remember to shower and brush her teeth.”
I had invited LaToya into my office to talk to Daisy. I’d learned that kids have a better relationship with the truth the more adults you bring into the conversation.
“Oh, Daisy gets lots of support from Staff, don’t you Daisy? We get you up early every morning so you have plenty of time to shower.”
LaToya shot me a look, like, we’re all over that.
“But you don’t stay in the shower very long,” said LaToya. “I don’t think you’re washing your hair.”
“I am,” said Daisy, defensively.
“You washed your hair this morning?”
“Yes,” said Daisy.
“How many minutes were you in there?”
“Five,” said LaToya. “You were in there five minutes. You need to stay in at least for ten.”
Daisy stared out the window.
“Daisy reminded me today that she and her mother lived on the street for awhile,” I said to LaToya. “It was hard for them to take showers.”
“Is it time to go swimming?” Daisy asked.
“Now, Daisy, you’re not the first girl I know who was in that situation. That’s nothing to be embarrassed about.”
As LaToya talked, I watched Daisy push her glasses up the bridge of her nose. I wondered if her dodginess was a sign of prodromal schizophrenia: poor hygiene often precedes the onset of a full-blown psychotic disorder. Burgeoning psychosis would also explain the other-worldly ambience surrounding Daisy. And if that were the case, it was time to stop mining the streets for the source of Daisy’s hygiene problem.
“I’m sure your mother would be happy to know you’re some place where you can take a nice, hot shower,” said LaToya. “I mean, when you think of being on the street now, what do you remember?”
Daisy snapped out of her reverie and looked straight at LaToya.
“I remember the good times.”
I don’t recall exactly what transpired after that. I just know that LaToya burst into tears the second Daisy left the room. She talked about the time her nephew got high on crack and threw his son out a window, and how his son never wanted to stop seeing his daddy.
I thought about my own arrogance: the assumption that teaching a kid the developmental tasks of self-care was the conversation worth having.
But that wasn’t it at all. The only thing worth talking about was the meaning Daisy made out of being dirty. And why would she want to stop being dirty?
That was all she had left of her mother.