Arthur
A Cup of Tea
For two semesters of my fieldwork for the completion of my MSW at the University of Maryland School of Social Work in Baltimore, Maryland, I was assigned to Rosewood State Hospital for the retarded. This was before normalization theory and other progressive and humane theories got all but the most seriously impaired people out of such places and into group homes and apartments in the community. Occasionally people were placed in settings where they did not have the support they needed, but on the whole the progressive ideologies did lead to much more dignified living conditions for people who were mildly or moderately impaired.
As such large “hospitals” for the retarded went, rosewood was not a bad place. It was clean and people were free to come and go as they wished for the most part. But very little effort was made to see whether they could be helped to function with greater autonomy or normality in the community.
Arthur was one of the cases to which I was assigned. I was not sure what I was supposed to do with Arthur, so I simply decided to get acquainted with him and find out if he was distressed by anything.
It was almost immediately evident to me that he was not really retarded – at least not in the usual sense of the term. He was preoccupied with the time when things happened, and he could, among other things, tell me the date that any staff member he knew began working there. I asked him when I began working at Rosewood and when we first met. He was correct with both answers – but he was also correct about when my supervisor began working there. I didn’t know how he got this information but when I checked out, found it was accurate.
We met weekly and talked about all aspects of his life. Among other things, he reported complex and intense dreams – of the sort that would have impressed the Dream-King of all times, Carl Young. His talk was somewhat lacking regarding both emotion and indications of significance. He related facts about his life with accuracy, but, by and large, one fact did not seem to have either more or less importance than any other fact.
One thing that did seem to be important to him was continuity. He was concerned that each day be the same as every other day. It turned out that he was one of the original group of people whom Leo Kanner described as part of a new syndrome – which he called “autism.” And, of course, as is well known, a concern for sameness is a characteristic of people who were so designated.
Arthur was not, however, cold or distant from me, nor did he resist forming a relationship with me. In fact he clearly look forward to my coming to see him and we both enjoyed each other’s company.
Physically Arthur was moderately tall and of medium build. He was in his early 20s.
My belief at the time was that what Kanner called “autism” was caused by a failure of bonding between an infant and his/her mother. It seems clear that most of what is currently called autism derives from a neurological damage – among other things, probably from various poisons that are contained in the many vaccines given to infants and children.
Whether what is currently called “autism” is the same thing as the syndrome that Kanner defined is less than clear. My speculations on the subject are probably not of any great importance. I would note in passing, however, that there could be a variety of causes for a bonding problem between an infant and a mother. For my purposes here all that is necessary is to know that I believed early bonding issues were probably a factor in the difficulties Arthur had coping with the world.
Bonding has to do with cuddling and breast-feeding. I was interested in whether any corrective experiences could be provided to Arthur. He was too big to cuddle and I was not well equipped To provide breast-feeding. Still, I felt it was important to find some way to introduce a bit of oral sharing into our relationship. I chose hot chocolate. Whatever the truth about my speculations about breast-feeding and early bonding, the hot chocolate was a spectacular success.
I had a small device for bringing a single cup of water to the boiling point. In addition to this I brought a couple of packets of just-add-water-and-stir hot chocolate and a package of many marshmallows. We would spend the first 10 minutes or so of our session preparing 2 cups of hot chocolate. We had a little table between us on which to do these preparations. We did this with great care, making sure that we added just the right amount of marshmallows. When we then sat back, with our table of friendship between us, and we talked.
I told my Supervisor that I did not think that Arthur was retarded. It was then that he shared with me the fact that he was designated by Kanner as “autistic” – that he was, in fact one of the small group of boys that led to this formulation of a new syndrome. I think he not share this fact with me earlier because he is not want to prejudice me in my assessment of the case. He must also have told the director of the hospital that my assessment of Arthur was that he was not retarded – at least not in the usual sense of the term as it was used in those days.
The director of the hospital was concerned, and requested that I come to talk with him about this matter. I think he was afraid big stink about it. He didn’t want to pick up his newspaper one morning and read that Rosewood Hospital the retarded was confining people who were not in fact retarded. I suppose there could have been a small scandal about such a matter.
Specifically the director asked me if I thought Arthur did not belong in the hospital. As I recall I told him that if his mother wanted to keep him at home that might be better. If not, I was not aware of any facilities in the community that would be appropriate for him. There was no medicine or treatment that was going to substantially improve his basic capacities, and he was obviously not capable of fending for himself independently in the community. I felt that he was what might be called “functionally retarded.” Actually it seemed to me that Arthur was probably about as happy at Rosewood as he would have been anywhere. His basic physical needs were well cared for. He interacted on a daily basis with a group of people with whom he was familiar. And he was able to live by the unchanging, and therefore predictable and manageable, schedule that was so important to him. The director seemed satisfied with this.
I wrote a paper for my social casework course, And the professor of the course liked it. She had me read it through the class and it was well received.
My paper explained the concept of the self-world dialectic. My central thesis was that this was the basic issue that needed to be addressed with a person like Arthur. His basic problem was not that there was something wrong with his world, as such, but that he lived in it by himself. There was no shared world. Furthermore the first step to be attempted was not to draw him into the general shared world of society. It was certain he would resist this strenuously. What was needed was to build a bridge between his world and my world, and then for me to join him in his world. Then, if he became reasonably comfortable with this, it might be possible later on to get him to come over that bridge into my world and through me, into the general world of society.
My world I meant a complex structure of those patterns or habits of feeling, thinking and doing that we bring to the events of our lives. A central theme in my understanding of “world” was that the external world and the subjective pattern of perception (the “inner” world) and the external aspects of our world – are always found in combination with each other. We could never know the external world as it was in and of itself independently of the subjective patterns of thinking, feeling and doing that we brought to it, and the subjective pattern had no meaning except as ways of relating to the external world. W=(I, E). world is a photo of an inner (subjective) and an outer (and objective factors). The parentheses can never be broken open. Feelings, for example, do not float around in a vacuum. There always about something. This is what I meant by the “self/world dialectic.”
My view was (and and still is) that every living thing exists in a world. This is as true of groups as it is of individuals. If we are to participate in the life of a group, or have a significant relationship with and individual, it is necessary to enter into its world. We must think, feel and at least imagine ourselves acting as the other feels thinks and acts.
The issue with Arthur was not that his world was mistaken but that he did not live with in the shared world of his society. He was alone in his world. As a therapist I needed to ask what, if anything, I might do to improve this situation. If we could be satisfied with limited success, I thought it might be possible to first of all connect with Arthur in his world and then to gradually find ways to draw him out into the world of his society.
As I think back on my work with Arthur, I’m struck with how he related to facts. His mind was full of facts. He remembered everything. And that seemed to me to be a kind of intelligence. But the facts were not organized into patterns that were useful to him. He could never have constructed a picture of the world that would have enabled him to function successfully in it. He could repeat patterns of behavior but could not integrate events of his life into a functional image of how things work. Novelty presented him with special difficulties, which is why he avoided change and situations in which unforeseeable events were likely to occur. In a sense what I found as I entered his world is that he lived in a very impoverished world. It was fact heavy – and meaning deficient. That is what I meant by functionally retarded.
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I let me illustrate what I mean about the importance of living in a shared world as opposed to living alone in a private world. I use another person I worked with – whom I will call Barbara. I began seeing her an individual play therapy when she was about 10.
Almost anybody would have notice something odd about Barbara from their first contact with her. There was an awkward about her movements, and her facial expressions did not always seem appropriate to the situation. She didn’t “fit in.” She lived in her own world. Her peers identified her as being “mental” or a “retard.” But her problem was not that she was severely limited in her cognitive abilities. Her intelligence was more or less normal. She was the product of faulty parenting. She would be described in the contemporary jargon as having been quote emotionally abused. I have come to hate that term, “abused.” It reeks of moral condemnation. Barbara’s mother had problems of her own that would have made it impossible for her to bond properly with an infant, and it was therefore inevitable that she would have raised an attachment disorder child. I’m sure that had I been able to work with the mother I would’ve found her to be the product of inadequate mothering herself. Moral indignation directed at anyone would not help to provide the corrective psycho/social/spiritual experiences that Barbara needed. But there was no doubt that such experiences were needed.
Barbara’s foster mother provided her with a benign environment. The foster mother was naturally, focused on trying to get Barbara to perform in a more or less age-appropriate manner. She was not focused on providing corrective experiences for emotional injuries that almost certainly occurred in the first year of Barbara’s life. When we do not bond with those around us we do not enter into their world, and this is noticed by a child’s peers. When they labeled Barbara as “mental” or a “retard” that was their way of saying that she did not live in their world and was not “one of them.”
People who are not in our world are excluded from real social interaction. At best they are “handled” or “dealt with” in a non-hostile manner. But they are not recognized as real peers. With 10 or 11-year-olds if seriously attachment disorder children are included in the peer group at all it will be as a sort of mascot. They do not participate in the oneness of the group.
In play therapy Barbara’s mother showed up in the figure of a witch. The witch brewed a milk that was full of garbage. You can’t imagine how many horrible things that were dumped into that “milk.” The message was clear. The mothers milk had been poisoned. It did not contain those things that were needed for health and growth. The mother, in other words, had been unable to provide the nurturing that was needed. My experience was that always was severely disturbed children the image of the breast – and all that it means – was going to show up in some form or another.
Barbara did improve. In my assessment the combination of a benign foster home and play therapy provided some of the corrective experiences Barbara needed. We decided to have Barbara participate in the girls therapeutic camping trip. I was afraid that her odd mannerisms would give her away, and that she would be identified as “mental” or a “retard.” If that happened the most we could be hope for would be that she would be accepted as a sort of mascot.
At the very beginning of the trip– when it was time to climb into the canoes and begin to paddle out to the island that was our destination – Barbara refused to get into the canoe. She didn’t like the way it wobbled. It was not steady in the way that a bigger rowboat would have been. So we couldn’t begin.
The other children were furious with her. They asked me to take her home. When I said this couldn’t be done they started in on her. They told her in no uncertain terms she needed to swallow her fear and get with the program. The key issue here is that they had the same expectations for her that they would have had for any other child in the program. They were not perceiving her as a defective human being for whom special accommodations needed to be made. And Barbara wanted to belong, so, after some hesitation she climbed into the canoe and took her place. From then on she was one of the group.
I suspect that this canoe trip was the first time in her life that Barbara was accepted by her peers as a regular kid. One might object that the process that I am describing as healing has to do with conformity to the expectations of the group. What about her individuality? My own sense of this matter is that she would always be Barbara – a unique human being. But she needed to achieve a capacity for bonding with others before her individuation would have a firm basis.
First bonding. Then individuation.