The Forgotten Future: Adolescents in Crisis was written to assist parents, just like yourself, to better understand and navigate the confusing and often exhausting mental health care system.
I have worked for more than twenty years as a registered nurse in inpatient child and adolescent psychiatry, and I have met many wonderful young people and parents along the way. Working in Connecticut, Alaska, and Virginia, I have been fortunate to have met patients from every socio-economic class, race, religion, ethnicity--every group in this great land. And I've found that the kids from all over our country are pretty much the same. Just kids
But while working with these troubled kids, I have come to question whether the treatment which most of them are receiving is truly of benefit. And wonder whether we might do better.
The Forgotten Future: Adolescents in Crisis will permit you, for the first time, to have a look into life inside the locked doors of a modern adolescent psychiattric unit.
You can decide for yourself whether this is what you want for your child. Or do you want better?
The following excerpts are from The Forgotten Future. After you have a chance to read The Forgotten Future in its entirety, please drop me a line and let me know what you think.
--Deborah
YOU CAN BUY IT NOW! The Forgotten Future: Adolescents in Crisis (ISBN: 9781432719357) by Deborah Clark Ebel, R.N., has just been released. Order it at Barnes and Noble.com, Amazon.com, or your favorite online bookseller. You can also special order The Forgotten Future at your favorite neighborhood book store.
A portion of the author's earnings from all retail sales of The Forgotten Future will be donated to the National Children's Advocacy Center in Huntsville, Alabama.
Return to this site often for frequently updated information about the author and children's mental health issues.
This page was last updated 06/29/2008.
The Forgotten Future:
Adolescents in Crisis
Chapter 7
Food for Thought
Anyone who has spent any amount of time around teenage boys knows that they like to eat. A lot. The hospital where I had previously worked provided three well-balanced meals every day and, in addition, kept a fully-stocked patient kitchen on the unit. There was decaffeinated coffee, tea and soda, assorted fruit juices, cheese, crackers, bread sticks, peanut butter and jelly, puddings, fresh fruit, Popsicles, dehydrated soups, and microwave popcorn available for snacks. Two evenings a week, the cafeteria staff sent up a special treat, such as trail mix, ice cream and toppings for sundaes, or vegetables and dip.
Oak Haven had a different philosophy. Although the meals served by the cafeteria were adequate, both in taste and portion, the patients’ kitchen was kept barer than Old Mother Hubbard’s. Every evening, the cafeteria staff sent up exactly enough small containers of juice and two packages of crackers for each patient for bedtime snack. The crackers were individually wrapped, bulk-purchase, and tasted like sun-dried cardboard.
With two sons of my own, I know most kids usually eat more than six dry crackers between supper and breakfast, and, at more than $1,000 a day, most parents could reasonably expect their child to have more than that, too. I don’t mean shrimp cocktail or finger sandwiches, but a piece of fruit or some fresh bread and peanut butter and jelly would be nice.
The kids were hungry between meals. They complained, and I had to admit that they had a point. So, Jackie and I made it our personal mission to improve the unit snack situation. We actually thought it would be a fairly simple and straightforward task to requisition food to the unit kitchen for the kids. Nothing fancy, just basic stuff that kids like to eat.
We were wrong.
Our inquiries and requests were passed from person-to-person until, ultimately, we had spoken to half-a-dozen people, none of whom would give the go-ahead to improve the situation, and none of whom could explain their reluctance to give us what we wanted. Finally, they either got tired of hearing from us, or maybe we just contacted the right person, but we eventually found out why the kitchen didn’t stock food on the unit for the kids.
“The staff will eat it,” the clerk said simply.
“Excuse me?” I didn’t think I had heard him correctly.
“If we leave food in the patients’ kitchen, the staff will eat it or take it home and the patients won’t get it anyway.”
“You must be kidding.” I could tell by the dour look on his face that he wasn’t, but I had to pursue this. I couldn’t believe what I was hearing. “You don’t honestly think the nursing staff wants to do their grocery shopping in Oak Haven’s patients’ kitchen do you?”
He most certainly did. That explained why they always took such care to send up exactly the same number of cookies and juices as the number of patients. The unspoken message was, “Don’t you gluttonous, overfed staff think you’re going to pig out on cookies at Oak Haven’s expense. No siree, not gonna happen. We got your number. You got sixteen patients? Then you get sixteen cookies. Period.”
“No, I’m not kidding. We’re not supposed to keep stuff up in the patients’ kitchen because staff will use it up.”
It took another week’s haggling, but with input and assistance from the nutritionist as well as backup from several journal articles concerning the caloric and nutritional needs of adolescents, the cafeteria manager finally acquiesced and advised us that, henceforth, we would be permitted four loaves of bread per week and two jars each of peanut butter and strawberry jelly. Individual packets of saltine crackers would be available, as well as microwave popcorn, and, if the unit staff was willing to pick it up, we could even have fresh fruit three times a week.
The cupboards were still awfully bare for a unit full of teenagers, but it was a beginning. We staff, however, had to give our solemn promise not to touch so much as an apple.
* * * *
The kids stared as Charlie exited the elevator. He might have been a rather nice-looking fifteen-year-old, but he suffered from some endocrine problems and, as a result, looked sort of, well … monkey-like.
He was small statured, and his closely-knit eyebrows formed something of a furry bridge across his face. A soft, dark down covered his cheeks. His voice was husky, and he always sounded like he needed to clear his throat. Even his doctor described him as looking like “some character out of Kubrick’s A Clockwork Orange”.
His parents had seen an Oak Haven promotion on the Internet and had brought him to the hospital hoping to get help with his increasingly aggressive, sometimes violent, behavior in the home. In addition to his angry outbursts toward both parents, he had threatened his brother with a meat cleaver. His parents didn’t understand the dramatic changes in their formerly quiet, good-natured elder son and feared for the safety of their family.
Charlie was accompanied by his father and brother, and we sat together in one of the interview rooms doing admission paperwork. His dad struck me as extremely concerned about his son. Charlie, himself, was eager for admission because he realized things weren’t going well at home and he wanted help “to change”. He wanted to be normal and like other kids again.
I couldn’t help but notice that Charlie’s thirteen-year-old brother was already three or four inches taller and well on his way to becoming a handsome young man. His brother was pleasant and articulate and obviously very concerned about the changes in Charlie. The physical dissimilarities between the two boys were dramatic, and I wondered how much of Charlie’s anger and aggression were fueled by the changes in his brother and the rapidly-widening gap between them.
The family understood the no-visitors/no-phone-calls-for-twenty-four-hours rule, but Dad promised Charlie that both he and Charlie’s mom would be in to visit as soon as it was allowed. I assured him that we would take good care of Charlie and then allowed them a few minutes to say good-bye.
While they were talking, I shifted papers and wondered how the other kids were going to react to and treat Charlie. When Charlie and his dad and brother had stepped off the elevator, I saw a couple of kids nudge each other and barely cover their laughter behind their hands. Sometimes they could be caring and understanding of kids who were different, but at other times, and more frequently, they were cruel and hurtful. Knowing the group of kids we had as well as I did, I expected the latter. I sincerely hoped Charlie would be helped more than harmed.
* * * *
Thirteen-year-old Carl thought about dying. Not just occasionally. Constantly. Obsessively. He planned his own death and the methods by which he would achieve it. He talked about it to anyone who would listen.
He idolized Kurt Cobain. Cobain of the musical group Nirvana. Cobain, who depressed and despondent, placed a shotgun to his head and pulled the trigger. Carl said he talked to Cobain and wished he could be with him. He said he didn’t remember a time when he didn’t think about dying.
When he was eight, he asked his sister to drown him in the family pool.
At nine, he tried to hang himself.
On his thirteenth birthday he took an overdose of sleeping pills.
And, just recently, he had gone into a public rest room at the mall and impulsively dyed his hair to match Cobain’s. Now he was talking about getting a gun. A shotgun.
His parents were terrified.
* * * *
“Yes ma’am, I did. Thank you very much.”
I had just asked our new admission whether she had eaten dinner before coming to the hospital. She was so polite that I was taken aback. In a world where I was regularly called every abusive and degrading name that the imagination can conjure, it was a shock to be “ma’amed”.
When I was fourteen, I moved from the southern United States to New England. Born and raised in the South by southern-born parents, “Yes ma’am” and “yes sir” rolled from my lips like butter off a hot biscuit. It was an automatic response and didn’t require any forethought whatsoever. The way I had been raised, to omit the ma’am or sir was rude and carried with it the likelihood of reprimand from any adult within earshot.
So, when I visited a new “Yankee” friend one day and her mom asked if I would like something to drink, I quite naturally smiled and said, “Yes, ma’am, thank you”. Well, you would have thought I had called her, well, something other than ma’am, because she became beyond angry. She stepped back and sarcastically replied, “Don’t you ‘yes ma’am’ me, young lady. I don’t have to put up with your smart-mouth crap!”
That was how I learned that those outside the South sometimes use “yes ma’am” in a mocking and rude way, sort of like “Oh sure, your royal highness”. She assumed that that was what I was doing. Her daughter and I both tried to explain that politeness was part of my upbringing, but she would hear none of it. As far as my friend’s mother was concerned, I was rude, and that was that. Her mother never liked me after that.
I hadn’t met anyone as genuine and polite as sixteen-year-old Madison in a long time. She had a serious alcohol problem, drinking every day, just about all day. Heavy drinking. Hard-core drinking. She felt she had come to a crossroads and wanted to stop. Seriously.
I accompanied her to an Alcoholics Anonymous meeting one evening, where she spoke eloquently of the pain and problems her drinking had caused her family and the embarrassing and dangerous situations into which she had placed herself when she was drunk. She wanted to get on with her life. She said she wanted to go to college and become a teacher. She wanted to grow and be and do.
Oh. There was one other little problem. She was pregnant.
* * * *
William’s psychosocial assessment revealed a long history of exhibitionism and sexual perpetration on younger children of both sexes. We had assigned him to a private room for other kids’ safety and explained very clearly that such behavior would not be tolerated—and that included sleeping nude, which he insisted was the only way he could get to sleep.
William, sixteen, was reportedly sodomized at the age of eleven by a neighbor. While he denied ever having been molested prior to that time, that was hard to believe because his history of inappropriate sexual behavior with his siblings went back to his early childhood. It had to have started somewhere.
Some of the physicians’ history notes pointed to William’s continuing improper expressions of sexuality and included recommendations for extensive long-term therapy. Others saw William as simply misunderstood and suggested that he had been falsely accused. They considered it normal childhood exploration and downplayed its significance.
The family dynamics were fascinating. Extremely religious, William’s parents encouraged their children to keep to themselves rather than make friends in their school and community. They didn’t allow television in their home, nor did they allow the children to listen to commercial radio. When the children were in elementary school, the parents insisted that the children be excused from watching cartoons or fairy-tale videos, and when the children entered junior high, they did not attend family life classes. His parents preferred not to discuss sexuality with their children, but, when necessary, they euphemistically referred to anything sexual as “being unclean.”
There had been extensive sexual play between William and his siblings, both younger and older. When he was in grammar school, he had been interviewed by a community psychologist after a teacher expressed concern about his behavior. William said he had “no idea” why children would want to look at, or touch, each other’s “private parts”. He asked several times, “When can we stop talking about this stuff?” and abruptly shifted the conversation to ask if he could shave off his pubic hair when it grew in.
The sexual play between brothers and sisters progressed to mutual masturbation, oral sex, and intercourse, and resulted in the siblings being placed in several different foster homes. William’s sexual activity continued with children in the foster homes and in the neighborhood, and it was during this period of time that William was reportedly raped by a neighbor. At the same time, William’s parents continued to deny any knowledge of their children’s “unclean” activities.
Now that William was with us, though, I couldn’t imagine what we could even begin to do to help him in such a short time. I did know, however, that I was going to watch him closely.
* * * *
The quality of violence management training within psychiatric hospitals ranges from excellent to lamentable. Some hospitals design and conduct their own training classes, while others contract with local or national companies to provide training in the management of aggressive behavior. Staff members’ responses to patients’ threatening or aggressive behaviors greatly impacts the safety of the unit and everyone present.
It’s important that training include techniques for dealing with a wide range of potentially dangerous and aggressive behavior, from abusive language to agitation to property damage or physical attacks on others or self. All of the techniques need to be understood and practiced regularly in order to deal with problems safely and effectively. Ideally, staff will have an understanding of the causes of limit-testing and acting-out, as well as cues or signals that a patient’s behavior is escalating and that physical intervention may be required. Effective communication techniques and de-escalation methods should be stressed, as well as the appropriate use of physical and mechanical restraints such as the safety coat and wrist and ankle restraints. Safety of the patient should go hand-in-hand with the safety of staff.
New and inexperienced staff members at Oak Haven were often unprepared for working on the units, even after attending the required classes. Oak Haven’s notion of violence management training consisted of a once-yearly lecture and a couple of hours spent discussing ways to recognize common signs of agitation and potentially violent behavior in our patients. Leather wrist and ankle restraints were passed around the group to practice locking and unlocking, and staff was cautioned sharply what not to do because it could “cause us (Oak Haven) to get sued”. It was made abundantly clear that it was better for one of us to be injured than to cause a patient discomfort as the result of protecting ourselves. I must stress here that different hospitals have different levels of quality of violence management training, and most hospitals with which I am familiar do a better job than that indicated above.
Those of us who had worked in inpatient psychiatry for a while already had a pretty good idea of how to manage a violent situation with the safety of our patients as well as our co-workers and ourselves in mind. It wasn’t always as simple, however, for the newcomers. While many hospitals have excellent violence management training programs, working in a violence-prone environment anywhere remains hazardous for staff and for patients, no matter the caliber of staff training.
* * * *
Carl’s psychiatrist, Dr. Trudel, was new to Oak Haven, and it showed. His charting was clear and to the point and gave a clear, succinct assessment of the patient’s condition that included his rationale for continued inpatient placement. It was just the kind of documentation that made the state inspectors and boards of accreditation smile. More importantly, it gave the nursing staff information about how the patient was presenting to the doctor.
Dr. Trudel’s notes on Carl read:
October 4 – Patient is quite dangerous and manipulative. Very theatrical at times. Speaks of poisoning self with carbon monoxide.
October 9 – Patient remains quite deadly if he were to be released from the hospital. Borderline personality tendencies underlie antisocial, depressive and aggressive behavior with sadistic traits.
October 14 – Increasingly depressed and moody, obviously still dealing with major life issues. Not safe outside of the hospital. No goals. No interests.
October 20 – Remains a danger outside the hospital. Learning the treatment system. No identity, no sense of purpose and no more than hedonistic impulses. Thematic Apperception Test is FULL of themes of murder and aggression suggestive of conduct disorder.
October 24 – Patient states “I don’t think why die? I think why live? I can do whatever I want. Consequences are of no concern, as they won’t matter. We’ll all die eventually anyway.”
Even more interesting, though disturbing, was the social worker’s take on Carl’s family therapy session. “This whole family is just incredibly dysfunctional,” said Margie, delicately balancing her leather-bound Day Runner on one knee while trying to balance her coffee on the other. She turned a page, and the black liquid sloshed over onto her tailored wool slacks. She frowned at the spots and then chose to ignore them. “They’re pretty well off. Dad’s a lawyer with Morgan, Kelsey and Taylor, and Mom teaches a couple of classes over at the community college. Carl’s one of two children. He has a seventeen-year-old sister, and his parents had one other child who died of SIDS before Carl was born.”
I handed her a tissue. “So Mom and Dad must get really scared when he starts saying he’s going to kill himself?”
“Thanks. Yeah.” She put the coffee cup on the floor and dabbed at the spot on her pants with the tissue. “Yeah, well, anyway, he’s been doing this since he was little. It’s really weird. He has absolutely no emotional attachment to anybody in the family except his mom.” She wadded the tissue and leaned back in her chair. “Have you read his psych report?”
She didn’t wait for a reply. “It talks about how the whole family protects Carl from anything that might be disagreeable or stressful. Dr. Trudel used the phrase ‘protects and insulates’ to describe how the family indulges him.”
Margie shook her head and sighed, then continued, “He’s got a lot of power in the family. All he has to do is say he’s going to kill himself, and everybody jumps in to make things nicey-nice for him.”
“How sweet,” I said.
“Interesting, though. Mom is really blaming dad for all of Carl’s problems. Today, in the session, she was going off on dad because he spanked Carl when he was little. Not beat—spanked. On the bottom. She said Carl felt unloved and unwanted and it was all dad’s fault.”
“She said that in front of Carl?”
“Yes!. And Carl looked like he loved every minute of it.” She took a couple of sips of the hot coffee and put it back down on the floor. “Dad feeds right into it, too. Said he has to take the blame for a lot of Carl’s problems.”
“Great. It always helps to know who to blame,” I replied, facetiously. “How did Carl react to that? His dad taking responsibility for his behavior?”
“Actually, Dad had enough sense not to say that in front of Carl. He asked to speak with me privately, and we talked for a few minutes after Carl left to come back up to the unit. He seems to have a little insight, but he can’t stand up to his wife or to Carl. That’s the problem. He went on and on about how he and his wife have always tried to remove anything from Carl’s life that might be unpleasant or that Carl wouldn’t like. Things escalate higher and higher every time Carl doesn’t like something.”
Margie picked up her Styrofoam cup and stood to leave. “Carl can’t take ‘no’ for an answer or stand any kind of frustration. When things don’t go his way, he threatens to kill himself or makes an attempt. I told Dad we’re afraid that one of these times he may actually kill himself unintentionally.”
He was a very scary kid.
* * * *
Ryan was a very angry kid. Considering his history, he had every reason to be.
He was fourteen, and with his extremely short-shorn hair and his propensity for wearing black—jeans, shirts and shoes—he projected hostility. He was a big kid, well over six feet and two hundred pounds. And muscular. He questioned every rule, every directive, every request. He didn’t want to be in Oak Haven in the first place, and since I was assigned as his primary care nurse, he took an immediate dislike to me.
It seemed to be an authority thing with Ryan. He didn’t like people telling him what to do. He didn’t like people even making suggestions about what he should do. Ryan viewed every exchange with an adult, in any role, as a challenge to his autonomy. We weren’t making any inroads because he refused to talk with anyone on the unit about anything.
The little we knew about Ryan came to us through history notes dictated by his doctor. Throughout his childhood, Ryan had been horribly abused, physically and sexually, by his biological father. The doctor’s notes went into graphic detail about the abuse visited upon Ryan, and as I read them, I tried to imagine how any human being could do such things to another, let alone to a child. His own child.
Doctor’s notes described the progression of Ryan’s abuse. “Ryan states that when he was younger his father began using him for sexual purposes by putting his hand on his leg and gradually moving up until his father reached into Ryan’s pants and began masturbating him. Before long, his father progressed to forcing Ryan to suck on his father’s penis until his father ejaculated. Eventually, his father moved on to raping Ryan, which occurred regularly. Ryan further reports that on more than one occasion his father took off his pants and sat on Ryan’s face, as Ryan says, ‘rubbing his butt in my face’. Ryan reports his father would then fart and defecate in his face and get up laughing.”
Incredibly, for a long time Ryan didn’t realize his father’s actions were abnormal, let alone bizarre. He had grown up with such behavior and had nothing to compare his home life to. He didn’t know things like that didn’t happen in every family.
When he eventually came to comprehend the extent of his father’s brutality, his pain was intolerably deep. As a way of protecting himself from the pain of his childhood, he grew angrier and angrier at the world and didn’t care who he hurt. Least of all himself. Indiscriminate sex and lots of heavy drugs were his daily fare, and his future seemed to hold more of the same.
This angry young man was the person who arrived at Oak Haven. Yet, while he pushed everyone away, including me, there was something there, a spark, a sort of inner strength that intrigued and challenged me. What I knew of his past was horrific, but, even so, I realized that we would never be able to fully understand what he had been through. He had somehow managed to survive but now seemed to be at a point where he would have to make a choice: either clean up his act and make some dramatic changes or continue on the way he was going and end up in jail. Or worse.
* * * *
Robin began report with our new patient. “April is thirteen, and she’s in room 410A. She’s Dr. Trudel’s patient, in with diagnoses of dysthymia, alcohol abuse, and parent/child problem. Her mom brought her in, um … I guess a family friend recommended Oak Haven after April was suspended for drinking beer on school property.”
I nodded and made a few notes on my report sheet.
“She’s been increasingly defiant and oppositional at home, and two days ago she got into a big physical fight with her mom. April says her mom beat her with a broom during the fight.” Robin turned her left elbow and pointed to an area on her arm. “She has some bruising and swelling on the elbow where she says her mom hit her.”
So far it sounded like stories I had heard more times than I could count: a kid acts out, the parent gets ticked off, and they come to blows. A parent hitting a child with a broomstick is never right, but I understood how at wits’ end the parents sometimes felt when they no longer had control over their child’s behavior. Many parents need to learn more appropriate ways of disciplining their children, but it’s especially difficult when those parents were themselves abused as children.
“Now, this is where things get really complicated.” Robin leaned forward. “Dr. Trudel says Mom is really pissed at April. He says she alternates between distancing herself and going ballistic at April ever since April shot and killed her ten-year-old brother about a year ago.”
“Ummm,” I murmured, shaking my head from side to side and listening carefully. “That would complicate things. How’d it happen?”
“Well, April says that it was an accident, but I guess they’re not so sure. There were four kids in the family, and April says she always felt left out, like she wasn’t really a part of the family. This one afternoon her mom left April and her brother, Kyle, home alone and told April to clean the house. April was mad, and she locked Kyle outside. He kept trying to come in, screaming and crying and pounding on the door, so she took a gun out of a closet, worked the bolt action, aimed the gun at Kyle, and pulled the trigger. He was hit in the head and killed instantly. She says she only wanted to scare him.”
My stomach turned, and I looked up and around at my co-workers, trying to gauge their reactions. Howard had stopped writing and sat expressionless, chewing on the end of his pen. Jackie’s elbow was on the desk, supporting her head in her hand, eyes closed. I wondered how hearing of tragedies like April’s had become so commonplace to all of us that they were almost routine. Such stories no longer jolted or surprised, and I was dismayed to know that I had become so inured to tragedy that things like this no longer carried any kind of shock value. I reflected for the umpteenth time on how society as a whole seemed to be so unaware of the crisis in our midst, and I was saddened that I had no answers, that no one seemed to have any answers.
* * * *
Madison sat with her feet on the chair, hugging her knees and rocking back and forth. Her face was red, and an occasional tear ran down her cheek. I caught snippets of conversation, such, “What do you want me to do?” and “Why not?” and “What about Dad?” She was on the phone with her stepmother, Helen, and while it was obvious the conversation was unpleasant for her, the actual content remained a mystery.
Madison was approximately nine weeks pregnant, and when we had talked the night before, she disclosed that the father of her baby was Helen’s fourteen-year-old son. He visited every other weekend and appeared to fit in well in this blended family. Helen didn’t yet know the extent of her son’s involvement with Madison; all she knew was that Madison was pregnant. Obviously she would have to be told the truth soon, and I suspected that the news would be devastating for everyone.
Suddenly, Madison hung up the phone and burst into tears, covering her face with her hands. Jackie walked over and gently rubbed her shoulders and smoothed her hair.
After a time Madison looked up at Jackie and drew in a deep breath. “Can we talk for a few minutes? Down in my room?”
Jackie nodded and held out her arm to Madison who slipped into the hug and buried her head under Jackie’s chin. They turned and walked slowly toward room 406.
* * * *
Charlie’s parents visited regularly. A week or so after he was admitted, his father asked to speak to me. He said that he had noticed that a lot of the other kids never had any visitors. I had to admit that was true and told him that Charlie was fortunate to have parents who cared about him and showed it. All kids, even the toughest and most hardened, need to know that someone, somewhere, cares about them. We talked for quite a while, and it became clear that Charlie’s parents were painfully beginning to understand and acknowledge that their elder son might never live up to their vision for his future.
The hopes that almost every parent has for his child.
The dreams parents dare to dream for their children.
The hopes and dreams that most likely would never come to be, at least not for Charlie.
But they loved him unconditionally.
Charlie’s dad remarked that the next night was their younger son’s birthday and asked if it would be all right if the family brought in an ice cream cake to share with the other kids on the unit. I was delighted to learn that they wanted to involve the entire unit and assured him that the kids would love it.
On Friday evening, the family brought in an old Jim Carrey comedy for the unit, the birthday cake, and a huge box of microwave popcorn. The kids were excited, although I overheard a couple of disparaging comments about the movie being “stupid” and “boring”. We only allowed movies rated “G” and “PG”, but most of the kids had been viewing “R”, and in some cases, “X” movies outside the hospital for years. There were a few comments about watching a “baby” movie, but, for the most part, the kids were polite and kept it together. Three or four of the kids went out of their way to thank Charlie’s mom, and I heard a couple of them say they wished that their parents cared enough to do something similar.
When I returned on Monday following my weekend off, I learned that the weekend nurse had expressed concern about Charlie’s parents trying to “buy” Charlie’s acceptance into the group. She contacted Charlie’s doctor, who in turn called Charlie’s parents and asked them not to visit so often and especially not to bring in things for the other kids.
I felt badly for both Charlie and his parents. Maybe they were trying to ease the way for Charlie, maybe not. My impression was that they were two caring and concerned adults who genuinely wanted to reach out to kids about whom not many others cared.
But we existed in a world of dysfunction, where every behavior was pathologized and where there was a veiled reason for everything. There was no room for genuineness, no room for sincerity. No room for giving without expecting something in return.
After that, the family visited, but kept to themselves. It seemed to me that everybody lost, but most especially, the kids.
* * * *
Madison had more courage than I had seen in a long time. She also had an abundance of common sense, something sorely lacking in many of the situations with which we worked.
Her pregnancy had her caught between the proverbial rock and a hard place. Her stepmother had learned that her son was the baby’s father and adamantly refused to allow Madison to return home to carry the baby to term. She was convinced that to allow Madison to have the baby—even if she adopted out—would cause problems for her son and ruin his future. She droned on about how her son had plans for college and shouldn’t be, couldn’t be, burdened with a child who would be out there “somewhere”, how she wasn’t ready to be a grandmother, and that Madison should have kept her legs together. Madison’s father supported whatever his wife wanted.
We talked. Madison cried. She knew she couldn’t possibly bear the child without some sort of family support and felt she was being pushed into having an abortion that she didn’t want. Her stepmother and her father repeatedly told her that she was bad and thinking only of herself. I was sorry her parents didn’t realize what an exceptional young woman they had in Madison, and I was annoyed that they, or anyone, would condemn her for her pregnancy. As I told Madison, she had done nothing more than millions of other girls do every day, only she had gotten caught. She was pregnant.
We spent a lot of time talking. I watched her cry. I told her she shouldn’t ever let anyone tell her she was a bad person. We discussed how many young girls become pregnant on purpose in an attempt to prove their maturity or to have someone to love without considering the practical aspects of raising a child, thinking only of what they wanted at that moment.
She was a teen who was about as far from thinking only of herself as I had ever seen. Still, she was running out of options, running out of time. During one of our later talks I made a discovery that really aggravated me.
I had been wondering about the family makeup, about such things as how long the stepmother had been around, how long they had been married, how well did they usually get along, was she usually supportive—all things to try to get a feel for how things were at home. Then Madison told me that her father and “stepmother” weren’t married after all, but had only been talking about it.
Well, that’s okay, lots of couples these days aren’t married and that’s not for me to judge, anyway. I’ve seen some of those unofficial parents encourage and nurture far better than biological ones. But when I found out that Madison’s father had only known the “stepmother” for four months, yet was willing to put his only daughter out of the house in deference to his “wife”, I was stunned.
I had come to know a sensitive and sensible young woman who wanted to hurt no one, who only wanted to do what was right. She realized that she was still very young and couldn’t raise a child alone. She knew she couldn’t even carry the baby to term in order to adopt out without family support. She didn’t want to abort. She believed abortion was murder.
But as options closed off to her and she had to come face-to-face with the harsh realities of her situation, she finally and tearfully simply said, “I guess I’ll have to go along with what they want. I’ll have to get an abortion.” And that was that.
* * * *
We had a new admission coming, and from the crisis worker’s report he was going to be a handful. He had a long history of psychiatric and judicial involvement that made Oak Haven seem like Disneyland. From Ashley’s description, I just about expected Ivan the Terrible. Instead, Ashley showed up with a neatly-dressed, handsome fourteen-year-old named Nick.
Nick was pleasant and polite as we began the admission interview. He had obviously been through a lot of them before. He knew all the terminology and had all the right answers. He knew the right things to say and how to say them.
I liked him instantly.
My internal warning signals immediately went into overdrive. I was used to working with kids who were oh-so-charming and very adept at pretense and manipulation, especially with adults, and I knew he must have had a lot of practice. And when they are so charming, even professionals have to be very careful to guard against being taken in.
We got to the part of the interview where I asked about previous hospitalizations and placements. He had been at Longmeadow, Western Hills Hospital, a couple of state facilities—including juvenile detention—and a few foster homes. He hadn’t been at home for more than a month at a time since he was eight years old.
“Home” was his dad’s four-room apartment. After Nick’s mom died when he was seven, his dad was left to manage Nick and then thirteen-year-old Nadine. Their dad was a compulsive gambler who made frequent out-of-state trips to the popular gaming spots, leaving Nick at home in Nadine’s care. Nick was still a little boy who missed his mother and very much needed his father. He began acting-out at school and became more than young Nadine could handle at home alone.
Fed up, Nick’s dad called Child Protective Services, declared Nick uncontrollable and said he couldn’t cope with the responsibility anymore. Eight-year-old Nick was placed into his first foster home.
I sat in the desk chair as Nick sat on the end of the bed and continued a lengthy, yet fairly succinct, narrative of his various placements, concluding with his arrival at Oak Haven. Then he smiled and shrugged his shoulders. “Now I’m yours,” he said.
* * * *
Stefanie and Koryn had both been with us before. Several times. As a matter of fact, separately, they had each spent much of the past year with us, off and on. They were sisters, thirteen and fifteen respectively, but this was the first time they had been admitted together. This time we were holding them until we could find a permanent residential placement for them. They didn’t know that, though. They assumed that they would be discharged back home in a few days and they could promptly run away again. Both girls hated any kind of authority and asserted that they should be able to live their lives any way they wanted.
Koryn, the elder of the two, had been the first to run away. The first time was when she was twelve and she and her parents had argued over something long-since forgotten. Early on, her parents would call the police and seek their assistance in finding her and bringing her back home. After the authorities brought Koryn back home, there would again be arguments with her parents, she would threaten them, they would ground her, and she would run away. This cycle had been pretty continuous since then.
At thirteen, Koryn continued running away, despite her parents’ attempts to seek help from a therapist and from their minister. Her parents enrolled her in after-school activities, as well as her church youth group, but none of it made any difference. Koryn wasn’t interested in such things.
At fourteen, she casually mentioned to a teacher at school that her parents were abusing her. No specifics, no details. Just “abusing”. The teacher was required by law to report such an allegation to her superiors, which she did.
The school reported it to Child Protective Services, who investigated the family thoroughly. Neighbors were interviewed. Relatives. School officials. Church officials. Younger sister, Stefanie, and younger brother, Todd. After Child Protective Services determined that there was no validity to Koryn’s charges, the file was closed.
Her mother became depressed, and her parents argued over how to handle the situation. Koryn continued to run away and started to hang out with older kids. Drug users and other types. When she was fourteen and Stefanie was twelve, Stefanie ran away for the first time with her sister. Both girls disappeared for weeks at a time. Soon Stefanie joined her sister in making allegations of abuse against their parents.
The Child Protective Services investigatory process began again with a vengeance. Teachers. Clergy. Neighbors. Pediatrician. Friends. Family. Both parents were distraught. Same conclusion. File closed.
The girls continued to run away. Their father heard a rumor that Stefanie was staying in a crack house, so he went there himself, alone, to bring her home. He found Stefanie, but he also found her friends. He was beaten to a bloody pulp and left unconscious as Stefanie and her friends fled.
Feeling they had no choice but to place the girls in a safe place, i.e., a residential treatment facility, the parents and several adult friends found the girls and brought them to Oak Haven for their own protection until arrangements could be made to send them out of state. Both girls were placed on unit restriction and confined to wearing hospital pajamas and slippers. All clothing, including shoes, were confiscated and locked away in storage, lest the girls try to slip off the unit and back to the streets.
* * * *
The last admission of the evening was on his way up. He was fifteen, and six months previously he had shot himself in the head with an air-powered pellet gun. The little information we had indicated he had been a popular and extremely bright young man before his suicide attempt left him functioning permanently at a preschool level.
His parents were having trouble handling his angry outbursts at home and needed assistance in coping with the changes in their son. He frequently flew into rages and trashed whatever was close by. At school he was becoming more and more troublesome and had difficulty following directions. Some of his teachers were intimidated; some were frankly frightened. In addition to all this, he was clinging and touching others in sexually-inappropriate ways. The way a preschooler might, without inhibition or constraint, but with the stature and appearance of a young man.
We were to keep him for a couple of weeks and try to change some of his more overtly inappropriate behaviors. Then we would send him off to a rehab facility in one of the southern states where, we were told, they were doing some groundbreaking work with head injuries.
The whole thing was tragic, and I wondered what had driven him to shoot himself. Then, I heard a rustling and looked up to see a pair of beautiful brown eyes and the broadest grin I’ve ever seen. He reached across the counter to shake my hand. “Hi! I’m Timothy. Who are you?”
