I consistently find myself anticipating maliciousness in the
caregivers for the children Perry describes in each case. The chapter’s titular
phrase evokes mental imagery of a child locked away in a basement for years, avoided,
chained, fed scraps, and intentionally abused and neglected by a psychopathic
or sociopathic adult figure. A horrific crime that would have made the news and
may have been depicted on a late-night television show. Certainly, these atrocities
happen and the victims hopefully find the support and care they need. However, Perry’s
book offers a potentially more unsettling perspective: that many well-meaning, driven
adults have children or unexpectedly become caregivers and do their absolute
relative best to raise them without protective factors like sufficient parent
education, knowledge of child developmental needs and milestones, or help from
an attuned community of peers and extended family. I braced myself for the
worst, expecting to feel anger toward Connor’s nanny and Justin’s caregiver, Arthur.
Instead, my heart broke for these adults and I considered the kind of care and
attention that they needed as caregivers and likely missed out on as young
children.
This being said, it is immensely more difficult to find
forgiveness within myself for the medical professionals who worked with the young
children and caregivers in each of the cases (even with the knowledge that
these cases are decades old). Between the lack of consideration for a young
patient’s essential developmental needs, doctors who failed to consult with
mental health professionals immediately after a young and clearly traumatized patient
like Justin was admitted, and these professionals’ unwillingness to overcome their
own inherent biases toward “difficult-to-treat” patients, it was almost impossible
to empathize with their struggles. The disdain that the PICU system as a whole
held for Justin was exemplified in one nurse’s words: “Just wait a minute and
he’ll be screaming and throwing things again.” After Perry’s differential
approach to interacting with Justin succeeded, this professional invalidated Justin’s
clear potential to heal. I may not have been able to keep my cool as
effectively as Perry was in this moment. For me, these feelings and thoughts signal
a need to overcome the biases I have within myself about doctors and various
components of the medical system. It is clearly just as important to simultaneously
intervene in and treat this larger “caregiving” system as it is to work
directly with the smaller systems of community, caregivers, and the child.
I appreciated Perry’s explanation of how the neurosequential
approach to therapy evolved from the growing understanding of how the brain
develops and is impacted at a young age by trauma and neglect. Utilizing
treatment approaches that meet a young client’s developmental needs that were initially
neglected in infancy and early childhood greatly appeals to me. However, I am unsure
of how to effectively meet a young client who has experienced trauma where they
are in this particular way without conducting the extensive kinds of
assessments Perry models in each chapter. Experimenting with different
therapeutic activities, games, play, and art when working with youth may currently
be the best approach when lacking detailed information about a client’s
childhood or a specific neurosequential assessment tool to determine areas of
functioning that a client may need most help with.
The enormity of the sociocultural and institutional factors that Perry has been describing in the last few chapters really came together for me in chapter six. I, too, was anticipating much more malice in these cases - and, in a confusing and unfortunate way, I'm almost disappointed that malice, it turns out, is not as common an etiology as I had expected. In some ways I would almost prefer that it were malice that caused these traumas, because then at least it could be treated as a more-or-less isolated incident; but the reality is in fact much more malicious, that the traumas that the children of the last few chapters suffered (chs. 4, 5, 6) were almost entirely due, I would argue, to systemic flaws in our very culture, and were augmented by flaws in our major institutions, such as healthcare and even the family unit. It is incredibly disheartening to see examples, plain as day, of how the institutions we trust with our very lives fail so many people on such a regular basis, and in ways that are so easily preventable with the right adjustments - and that these are the systems with which we will be interacting throughout our own careers.
ReplyDeleteFor myself, I was unable to find much sympathy or empathy for the caregivers rather than the medical staff - though I don't excuse the medical staff and have plenty of disdain for their behavior and callousness. But I also see where it comes from. I know what it's like to be on the hospital floor, even on the PICU (though the PICU that I know is not the pediatric intensive care unit, it is the psychiatric intensive care unit), and to feel like there is just nothing you can do for someone in that environment, that there simply isn't enough time in the day or resources in the hospital to give a patient what they would actually need to get better. And that's a hard reality to face.
I do trust that trained medical and clinical professionals will do their best with the knowledge that they have. Now that we have knowledge that they did not have at the time, let's not repeat their mistakes.
Carly,
ReplyDeleteI really appreciated some of the insightful points you mentioned in your blog post because it elicited some further reflection in myself. First, you pointed out that most of these case studies would potentially involve readers, such as us, to immediately judge and despise the caretakers that allowed the mistreatment to happen, and yet, just as you said, that rage subsided when we were elucidated on the circumstances. This allowed me more understanding and compassionate to the conditions of these individuals where in. I wonder if Perry was intentional in his selection of cases in this book because he wanted his readers to move from anger to understanding so that he could focus more on the complexities of trauma and his approaches. Either way it has been healing reading this book, since I too, have had the opportunity to become more open and understanding to what people story are before making any assumptions of their intentions.
Lastly, you are spot on, with uncertainty about our approaches as social workers with youth where we don’t have access to all of the client’s past history, including traumatic experiences, or level of attachment with their caregiver. How do we even begin to set a treatment plan with youth if we don’t have a full psychosocial assessment right? Our work often times is very nuanced, especially working with kids, because each of them or uniquely wonderful human beings. The little information that we have access to, however, just as you mentioned, has to be sufficient to tailor our interventions with students. One of the most important things that I try to teach or model with students (that I’m sure you do too) is that safe attachment to an adult, and honestly you can’t go wrong with that, even if they students do have secure attachment. However, most of the students that I work with, often times need that safety fostered with an adult, then the other therapies follow.