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?”
“Ten?”
“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.
Okay, but I’m really not collecting a lot of fees. I work for a state-funded agency. And while I think Alice Miller offered a wonderful perspective, I think she was also rather reductive and mother-blaming.
hmmm. i just noticed that my comment registered that i posted my comment at 2=something A.M., and it was at 7:20 a.m., here in the SF Bay area…as a detective, I notice these silly things. LOL
I’m not sure what you’re getting at, Paige. I didn’t even post this piece until after 6 a.m. and I posted your comment as soon as I read it. WordPress is always a few hours ahead. Peace.
The state-funded and county-funded places are often the very worst, as these are the very hotbeds of severe abuses of all kinds for alllll of those who are suffering – no matter what their suffering may be – those who have been alienated, disenfranchised, compromised – persons. They hire naive people to do the ‘work’, and their pedo rings and financial scams are well-documented and known nationwide (primarily by detectives and so-called, ‘conspiracy theorists’. Your average D.A., Chief of Police, County Director of Child Psychiatry, and other institutions, too…these public institutions help support the lesser abuses – that is, the ‘therapy’ that is administered.- the jails, prisons, and mental health institutions are ALL the hotbeds for the elite to collect their Fee$, and to grease the whells of their appetites – all at the same time.
And those who know it, are deemed crazy or evil – just for calling a spade a spade!! This is the whitemans WAY! Everything is table-turned. Topsy-turvey. The violence of silence.
Hmmm. It’s pretty easy to pick on the therapist and the system, harder to actually help a neglected, abused, and disturbed child. Pauline is trying to help Daisy, and she’s made some pretty astute observations regarding her situation. It just sounds tragic to me, but I think Daisy is better off being in care and getting help and attention than living on the streets or with an unstable caregiver. Pauline, you have a tough job, and it sounds like miracle recoveries and results are rare. It’s admirable to get up every day and try again. Peace, indeed.
wow…this conversation is almost as interesting as the article which was great and “especially” (Paigie, this is for you) because white therapists (among others of various skin shades) will read this story and learn from it about the inherent cultural biases and blind spots that exist in the mental health field. The author is bravely admitting to her own learning curve and trajectory in realizing the many fundamental flaws and limits in the “system”. You are directing your venom too directly on the wrong “pawn” in the oppressive Big Pharma conspiracy. You are showing little or now empathy which at the end of the day is still necessary to bring to bear to fix broken human service systems of care even if they are hopelessly corrupted by what you see as a racial problem and greedy capitalistic profit motive. Translation: Your anger and outrage is understandable. What is your realistic solution? PS I will support anything beginning with a human sacrifice involving Donald Trump, Dick Cheney, Dr. Drew or televangelists with mega-mansions behind their mega-churches, both black, white and “green”….the color of money.
This IS an interesting conversation, Cliff. I think part of the problem is that therapists who work at these types of facilities, and social workers who work for Child Protective Services, are ridiculously overworked. I’ve worked with tons of social workers and probation officers and I have to say that I’ve been impressed with almost all of them. No one is trying to keep kids from their parents; it’s the opposite, we’re trying to get kids home as long as home is appropriate. And NO ONE is in this field because of the money — LOL! I think the mistakes that are made in the child welfare department happen because professionals are neck-deep in paperwork and cannnot possibly keep up with the intricacies of every kid on their caseload. But that’s not the social worker’s fault, it’s the lack of funding to the child welfare system. And the situation is getting worse, unfortunately, with all the budget cuts.
I made it clear that the naive, and in your words, ‘pawns’ as you put it – are greasing the wheels of this sick, sick, system, itself. They are blind to it, as they are stuck in this system, itself, blindly as if in a fog, a hallucination of sorts. The whitemans world, thinking, being.
I’m not here to assuage anyone’s feelings. Nor am I in the least UNkind – in the opinion of those who share my perspective, too, that is. And we are growing in numbers now these days, too…indeed.
We need new virtues in this era, now. “Strong voices, many voices” – these are the words of MY elders, now. This is the medicine of my people, too: ‘story-telling’.
Everytime we blog or tell one another what we posted online, etc., , our hearts BEAT because we know that telling the truth involves an element in danger, for the whitemans ways hate us – by and large, oh great creator, YES! Our growing courage now….we are only now just beginning to stir the real $tew. As it was prophesied long ago.
A special ‘thank you’ to you, Captian! Your remarks were warm and welcoming and added a balance – and also added the warmth that was lacking from me, too. ….Like I wrote, I’m not here to assuage feelings when an issue (and every issue involves suffering persons who I know personally and who are abused by whitemans systems) ….when an issue cries out to my heart to answer, it is also from their hearts, the overload of THEM, who weigh on me. Heaven KNOWS THIS.
Blessings to all!
~Lt. Columbo aka Paige Turner
Paige, this is the eighth comment you’ve left on this post. The last four I chose not to post. I’m publishing this one only so I make myself clear:
You’ve made your point and you’re entitled to your opinions. I’m entitled not to publish them.
It is just like the whitemans ways
to remove him and her selfs from the genuine truth.
by removing the trail of truth, first and foremost
and then to speak or write a untruths, to replace the truth
as you declare it to me, here, explaining that my too many words
are nothing more than this: too many words
such rationale
to be nothing more than
some sort of unnecessary kind of ‘excess’, garbage.
those of us who see what is at work here
we know this is just more sheer nonsense
and I will spread the word, too.
In our circles, we are kinder in our prayers to all, no matter how ‘too principled’, clear, truthful, that we might otherwise seem while we are warriors in the world online, as we might speak out loud in meetings together, or, on blogs and such – about things of great significance, concern, to us.
please remove me from your email list, blog, etc.
Thank you.
~Paige Turner aka ~ Lt. Columbo
c/c file
Pagie, I have a lot of subscribers and it would be difficult to track you down. You can unsubscribe, however. There should be a link to do that at the bottom of the e-mail you get when I publish a post.
Sounds like Paige could use some therapy?
Good crimeny, Pauline…. how do you attract the crazies on here all the time? You’re entitled to write honestly and people can react honestly… until it becomes abusive. Online trolls are the worst…
Certainly not the first hostile person I’ve attracted! LOL.
Pauline… a touching and well-written article. I, too, have worked in the same type of field and know firsthand, that we are just trying to make a difference, given the tools and resources available. It has nothing to do with the “whiteman’s world”. Ridiculous. Thank you, as always, for something worth reading. I’m always happy to see your posts show up in my inbox!
Thanks so much, Sonia. It’s great to get another mental health professional’s experience.
I’m a psych geri nurse. I love how you write about your pts. You obviously care a great deal for them. I love my pts (usually with us ~15 days and frequent fliers). Some of them I get attached to, some make me want to pull my hair out, but all I care for. I know their behaviors are not necessarily their fault. It’s nice to see another health care professional look past the behavior and see the person. I often wonder what my pts were like before the psychosis or dementia set in. Psych is an amazing field to work in. I love what I do.
Glad you relate! And that you’re in the field as well.
I like your blog. The divorce topic is irrelevant to me but I read because you’re a good writer with a compelling story and you give good insight. Just a preamble to say, when you discuss your patients on your blog I feel weird. It comes off squicky as hell. Are your employers OK with this?
Good question. Not sure what “squicky” is. Because of patient confidentiality, I always use a pseudonym. Lots of therapists write about their clients, and this is common procedure. Also, my boss knows because she reads my blog!
Wow! What a thread. Unfortunately, your observations about Daisy make perfect sense. As open-minded as I strive to be, this posting was a double helping of humble pie as I have judged those who are less fortunate with unshared thoughts like- why don’t they go into the restroom at the public library and wash up?
Was thinking of this throughout the day and wondering if I was too judgmental. But if my therapist wrote about my situation in their blog, repeating or romanticizing our dialogue, I’d never look them in the face again. And if their superior backed them up, I’d run and never look back. “Squicky” means when you write about your patients, it seems like you use them to reinforce your own principles or to tell a fable. I guess it raises the question, my doctors can go home and blog about me as long as they call me “Duana”?
Yes, they can, as long as they maintain their patients’ anonymity. Irwin Yalom has made a living out of this. There have always been doctors and therapists who write about their patients. I’m not sure how that differs from any other writer writing about people they know.
So… harvesting patients for blog fodder is legal and you intend to exploit that.
Diana. Come on. You could make that accusation against anyone writing about anything. Writers write what they know. I write with a pseudonym AND I don’t identify my clients. I don’t see a problem with that but I respect that you have a different opinion.
Do your patients like these blogs?
Just asked a room full of people if they’d allow their therapist anonymously broadcast issues over their personal a divorce blog. I saw a lot of bugged eyes. No “yes”s so far.
Diana, I told you I write anonymously. I did ask a patient once if he would mind if I told the story of his therapy with me — as long as I changed his name — and he gave me his blessing.
I think you may have gotten the response you did because you framed the question in a pejorative way. This is the fifth, and final, comment of yours on this topic that I will publish. You’ve made your point.
Daisy doesn’t need a mommy as much as she needs serious therapeutic and medical help. Even the world’s greatest parent with all the resources possible can’t cure mental illness with hugs and hot meals. Pauline’s to be commended for her caring and nurturing,
I’m not a therapist, but I am a woman who occasionally has to deal with a mother who would not bathe if not reminded (and even then, there’s some pushback). I find it’s easiest to have the clean clothes ready, get her into the bathroom and sort of “supervise” the shower (hand her the shampoo; make sure the soap is fully rinsed), then take the dirty clothes away so she has to use the clean clothes. Is that a possible solution for Daisy?
That’s been done to an extent…although Staff doesn’t actually go in the bathroom and oversee the hair-washing. I could suggeest it though. Thanks for the input.
I will have to ask my therapist if she blogs about our sessions. Hopefully, when she is romanticizing our dialogue and handing out descriptives, I am really funny and bear a striking resemblence to Anjelina Jolie. If she is too honest, then I am being exploited;)
HAHAHA! I’m sure she’s just showcasing your inner fabulousness.
I thoroughly enjoyed your article (as I always do), but I have to say, the comments made me laugh out loud. Oh how crazy and naive the world can be! Therapists most definitely talk about their clients. They just do. Period. Sure, online is a bit more public, but you are always intentionally, very vague. I think the people you write about could likely I.D. themselves, but no one in their life could. Even staff at your work might not know which kid you are talking about (as you stated hygiene problems are pretty common for this demographic, as is homelessness and being separated from their mothers).