Choice.

She sat across from me, dabbing at her eyes with a tissue.  She'd been doing that almost continuously throughout the interview.  Not long after selecting the chair in the office that was furthest from her parents, she'd pulled up her knees and hugged them as she talked. 

I asked her questions.  Lots of questions.  What do you do for fun...what do you do to make yourself feel better...what do you do when you're mad, angry, or sad?

"Get high."

I asked her who she talked to when she felt like she needed to talk.  She said that she used to call her best friend, or her aunt, but then her mother took her phone away, and when she complained, her mother said, "You can talk to me."

Her mother, for the record, disagreed with anything anyone in the room said. The girl said she was closest to her father, mom said, "No, you're not, you're closest to me".  When the kid said, "Dad understands me more" and Mom said, "No, I do."  Mom always made these assertions loudly, and stridently, frequently interrupted everyone in the room, talked over people, and answered questions were weren't asked of her. 

At one point I turned to mom, and said in a gentle, friendly tone, Do you see what you just did there?  Just now?  I asked your daughter a question, and you answered it.

Mom looked surprised.  "I thought you asked me."

Nope, I said, smiling.  I said your daughter's name, and looked away from you, to her, and you answered. 

Mom was recalcitrant.  "Well, I thought you were talking to me," she mumbled.  Then she pouted a little. 

I asked mom what she thought would help this problem, and she launched into a lengthy description of how bereaved she was when her mother died, 7 years ago.  I waited patiently, and then asked the same question again.  Same answer.  Finally, I said, I'm not really hearing how you think this problem can be solved.  Mom finally said that she had learned to solve her problems, so she thought her family should solve theirs the same way.

Later, I told daughter, in private, that her screen was positive for depression.  She dabbed at her eyes.  "I didn't think I was depressed," she said.  I also told her that results of another screening showed that she was in danger of developing a substance abuse disorder, based on her feelings and attitudes.  I asked her, You've been crying the entire time you've been in here.  Does it surprise you to hear that you were depressed?

"No, I just thought that, you know, I was reacting like we all do--trying to get over living with my insane mother."

I think, based on what I've learned, and the results of your screening, that you would benefit from residential treatment here...just to have a chance to get out of the house, to think, maybe to learn to make good decisions, but I want to know what you think.

"What difference does it make?  It's not like I have a choice."

It makes a huge difference, and you do have a choice.  In our state, at your age, you have the right to refuse, unless your life is in immediate danger.  I recommend it, just for you to have a chance to get away, but we also have a day treatment option, which doesn't involve living here. 

She stopped crying for a second, and started at me, astonished.  "I get to choose?  I never get to choose anything."

Well, you get to choose this.

Mom, for the record, was furious.  In the waiting room, she said, "I thought that if I told you to lock her up, you'd do that.  Why does she get to choose? I know what's best for my daughter."  Daughter lifted her head up, and walked out of the room.  She was going to come to day treatment.  We'd shook on it.  Or banged knuckles, whatever that's called. 
Dad looked relieved, and walked out with his daughter, his hand on her shoulder . He didn't really think his daughter needed to be locked up either. 

Mom, well, she's still pissed. 

I hope she's able to get some help managing that.

,..

Just Today.

Just today, he was brought in because he was hitting himself in the head, and wouldn't stop. He wasn't screaming, or yelling, or being disruptive--according to his teachers, he's actually a sweetheart, but in the past couple weeks his performance had been declining, and then today, he started hitting himself in the head.  When his teacher grabbed his hand, he looked her straight in the eye and said, "I need to make the mumbling go away."

The voices had been getting louder over the past couple weeks, and it's like, really hard to learn Algebra when someone is constantly mumbling at you. Try it. So he got the idea to hit himself in the head. He figured that would do it. He's right, actually. Hit yourself in the head enough times, and everything stops.

Also, there were shadows following him. That is to say, he could see menacing shadows out of the corner of his eye--

--How did you know they were menacing?

"I just do."

So he's being followed by menacing shadows. That he knows are trying to hurt him. He walks very, very fast, so they can't catch him, to get away, to be safe. Same reason he hits himself in the head. To be safe.

The olanzapine helps a little.  I asked him if the voices say anything to him in particular.

"Not really. I mean, it's like I can almost just make out what they're saying...but if I stop, they stop. They only talk when I'm doing stuff."

Insight is what is used to describe whether someone with a psychotic disorder understands that the voices aren't real. I once had a client tell me that the entire time she was in therapy with me, voices would tell you to stop listening, and yell "NO!" and sometimes, they'd say, "she's lying to you." However, she knew they weren't real, so she just ignored them. Maybe this kid will reach that point and realize that none of it is real--the shadows, the voices, the belief he was being followed.

But today....

Today he's doped up on all sorts of stuff, so that he won't hit himself in the head, and he thinks the voices are real, and he can make them stop.

Today, he also thinks that if he tries hard enough to make out what it is they're saying to him, then he can do what they want and maybe then they'll stop.

Today, he's only thirteen, and he just wants the voices to stop.

....

The right to parent.

This week I saw a kid who was just the biggest liar ever. Holy cow, he was fun. I interviewed him for about an hour before he finally started to relax and actually cracked a smile.

He has a bad temper, but still tells his mother that he loves her, for no reason at all. His mother, who'd taken them both across the country away from a life of physical abuse and neglect, figuring he'd heal on his own. He'd recently begun to turn his anger outward, until his school sent him home because they couldn't handle him any more.

He wanted so desperately for me to see how dangerous he was, but he's only ten, so he hasn't quite gotten that bravado down yet. He alternated between malingering and socially-desirable response sets. He stopped once to let me know there was an earring under my desk, and then told me that he likes being viewed as "scary". He brightened when I told him about the sports he'd get to play as part of recreational therapy.

He told me how he'd done every drug (he hadn't) and how he'd killed many, many animals (he hadn't). I guess, if you aren't sure you can make people like you, maybe you can get them to respect you and be afraid of you. If you're ten, and watch a lot of movies, that must look like a viable option.

How lonely he is. How devastating is abuse. We got him early. We can help him.

Meanwhile.

If you can't love your kid and raise them properly, fucking give them to somone who can.

...

Resiliance.

The kid sat across from me, slumped in his chair. He'd just heard from his aunt about how he argues a lot. And....that's about it. THAT was her big complaint. Then, as an afterthought, before she left me alone with him, she mentioned that he told her he wanted to die.

do you still want to die?

he shrugged.

"dunno."

then...

"I mean, I wouldn't do anything to myself. But maybe if, you know, I was walking in the street, and saw a bus coming down on me...maybe I wouldn't work that hard to get out of the way."

Why do you hate your life so much?

he thought about that.

"It's not that I hate my life. I just hate this life. I wish I had my old life back."

what was different about your old life?

He thought about that, too. "My mom used to be fun. I wish she was like she used to be. She used to do things. Now all she does is take her pills, sleep, and yell."

His mom doesn't work. She lives with various relatives. This month, she's living with an aunt, who lives on disability. Ms. Thing can't hold a job. Ms. Thing pulled him out of school because she's was mad at the school. He wished he could go back. He misses his friends.

He's pretty sure they're getting ready to move. Again.

He knows they're poor. He knows because his mother reminds him, daily, of how poor they are. Reminds him that if it weren't for him she wouldn't be so poor.

He shares a room with a cousin who is constantly stoned. He's tried it a couple of times. He likes how it makes him feel.

"Sometimes, when I'm really mad at her, I make her pancakes and put lots of syrup on them."

???

"then when she passes out in her food, she wakes up with it all over her. "

Who do you talk to when you're sad or mad?

"I used to talk to my mom. But now it's like a contest with her, and she has to tell me how much more she suffers more than me" He kicked the floor.

It's the eve of his 11th Christmas.

Merry Christmas, kid.

...

I broke my kid. Can you fix her?

She sat in the chair, slumped back, arms crossed, sullen.  Staired out the window.

"Have you ever had anything scary or really bad happen to you?"

Shrug.  "I don't know.  Maybe."

"When it happened, did you feel like you couldn't stop thinking about it?"

Shrug.

Her father had brought her in.  He sat across from me, with a tear tattoo under his eye.  He's in his 40s, and the tattoo is old, dating back to when it only met that one had committed murder. 

He was wearing one of those wrinkled cloth hats.  I don't know what they're called.  I see them on young musicians.  Except he isn't a young musician; he 's a former gang banger who seemed amazed that his kids were completely out of control.  He told me that he and his wife fought physically, binged on alcohol and crack cocaine, unti he was sent to prison when his daughter was seven.  While he was gone, his wife became homeless, and divorced him.  His daughter went to live with various relatives.  He got out 8 years later.

So why was here here?

"Well, she has a bad attitude.  Talks back, won't do her chores.  Sometimes she runs away and stays gone for more than a week. " 

Oh.  You THINK? He brought this broken girl in, and asked for super glue.  Actually, he asked for residential treatment. He's been putting her off on relatives for her whole life, and now when the real parenting begins, he can't handle it.  Child protective services just took his kid with his new girlfriend.  His other kids are all in prison, but "they're doing really well there".  Shit. He just needs, he tells me, time to get his head together.

He seemed, I shit you not, MYSTIFIED by his daughter's lack of respect.

"You know that her life has been pretty chotic, right?  You're aware that this causes kids to form maladaptive patterns of behavior?

It was his turn to shrug. "I made mistakes.  I can't help that. Can't take them back."

So then I was alone with Miss Thing.  She had makeup caked on, painted eyebrows, dark lipliner.  It took me 45 minutes just to get her to answer some questions. For fun, she "parties".  Likes to binge on Bacardi.  She spoke softly, and always seemed to be on the verge of tears.   She doesn't know of any other hobbies.  What are those?

Out of the blue, she said, "you know, sometimes, I wonder why my family can't be more like TV familes.  she said  "nobody is really a family for me.  Everyone just has their own life.  It's so fucked--sorry--messed up."

"Don't apologize.  You can say what you want in here."

Before she left that day, she asked to put her in treatment foster care. Asked for it.

She sounded tired.  How do you get so tired when you're only fifteen?

That's how much you've fucked up your family, Mr. oh, so cool man.  Mr. Scary tear tattoo man.

Strangers, unmet, are preferable to you.