Chapter 7: Satanic Panic

At the very beginning of the chapter, I had a little trepidation about Perry referring to giving the benefit of the doubt to the victim as unfortunate. In the current cultural climate where we are moving towards acknowledging and giving justice to the survivors of sexual assault and sexual abuse (i.e. “MeToo” movement), I had difficulties embracing the idea of children erroneously describing abuse. I immediately thought of the ramifications of ignoring children’s reports of abuse. I’m assuming that watching the video of more than 140 ‘Sister Survivors’ of sexual abuse accept the courage award at the ESPYs (https://www.youtube.com/watch?v=W9hu5HLoSzM) contributed to my reaction. The speakers’ description of the invalidation they experienced was maddening; however, my perception of Perry’s comment changed as I continued through the chapter.

During Perry’s description of Gilmer, TX, I was confused by the mentioning of it having the highest illiteracy rate in the nation. It would have made sense if there was more context, but the statistic seemed to be stuck in between two sentences and not addressed. I have a feeling the literacy rates had some significance in relation to the story, but I couldn’t figure out the source of the significance. I have a few theories. Perry mentions the multigenerational nature in which sexual and physical abuse and ignorance are passed down. As we learned earlier, the brain of a child experiencing abuse is not going to develop properly, and illiteracy could be a result. I’m not sure of the prevalence of abuse in Gilmer, but if a large portion of the adults in Gilmer had been abused themselves, this MIGHT contribute to the high illiteracy rate. The part that struck me most in this section was Perry’s comparison of the passing down of physical and sexual abuse to the way families pass down Christmas recipes. I found it to be a gut-wrenching representation of the damage abuse can impart.

Additionally, I was struck by the utter lack of evidence for the efficacy of “holding therapy” and the conviction of Sergeant Brown. Perry mentions that the foster parents and CPS caseworkers didn’t know about the dangers of the so-called “therapy”.  I had to remind myself that not everyone knows how to operate Google Scholar. Moreover, 1 in 4 of the people in Gilmer couldn’t read. But still, it’s difficult to fathom that the foster families didn’t realize what they were doing was abusive. I also found myself very frustrated when the special prosecutor ignored every piece of evidence that cleared Sergeant Brown. I’m assuming that the special prosecutor could have seen a non-affiliated cult member murder Kelly Wilson and still arrested Brown. Both examples demonstrate the ability of panic to cloud peoples’ judgment and ignore apparent truths. The phrase “witch hunts” in the last sentence of the chapter reminded me of reading and watching The Crucible in Junior High. In the same way the people of Gilmer acted out of fear of the Satanic Cult, people in the Salem Witch Trials acted on hysteria out of fear of witchcraft.

References:

ESPN. (2018, July 18). ‘Sister survivors’ moment of solidarity accepting Arthur Ashe Courage Award | ESPYS 2018 | ESPN [Video file]. Retrieved from https://www.youtube.com/watch?v=W9hu5HLoSzM

Chapter 6: The Boy Who Was Raised as a Dog

Despite the heart wrenching neglect faced by both boys, Chapter 6 made me feel the most hope and joy of any of the chapters. Based on the title of the book and chapter, I had an idea of what the chapter would entail, but the description was still haunting. The physical effects of the unintentional neglect Justin experienced were astounding. Dr. Perry mentioned that Justin didn’t stand or walk because he didn’t have anyone to steady or encourage him, but I thought about it from an even more basic, physical nature. Despite Justin being let out of his cage daily, I cannot imagine it was enough for his legs to develop enough strength to stand, moreover walk. Any muscle his body might have built, likely atrophied from lack of use. I also pictured an attending physician showing Justin’s brain scans to a group of residents or interns, without any other information, and asking them to diagnose the patient. I can only imagine their reactions when they found out his age. Fortunately, Justin did not have Alzheimer’s disease and his condition could improve.

I laughed a few times throughout the chapter; the first time was during the story that led Dr. Perry to realize Justin had the capacity to change. I loved Perry’s connection between a primitive sense of humor and his ability to connect with others- not to mention the story was funny. As Perry began to help Justin access his capacity to change, the phrases of “patterned, repetitive experience” and “safe environment” surfaced. I noticed the same phrases being used in the description of Connor’s treatment. Dr. Perry’s treatment reminded me of many of the concepts in Attachment Theory. At the end of the chapter, he mentioned the ability of children to feel a certain level of competence and mastery when they have a “nurturing ‘home base’”. Home base is a common term used in Attachment Theory. From what I understand, it sounds that Dr. Perry was trying to create “secure-attachment relationships” for the two boys. Previously, the boys had experienced inconsistent, unpredictable attachment- either avoidant, ambivalent or disorganized- and their schema of relationships developed based on their early interactions. Through consistent, repetitive stimulation, the boys were able to adapt their schemas.

One of the sections I found most interesting was the discussion of the course of development for a baby’s rhythm. I had never considered this crucial aspect of development. I enjoyed the section on the soothing impact of a mother’s heartbeat, because a similar occurrence happens in puppies (I promise I don’t think children are dogs; I just really love dogs). My grandpa was a vet and he would always tell us to put a clock in a puppy’s kennel at night to keep it from whining. I didn’t understand why for the longest time, until my dad told me that it mimics the mother’s heartbeat in the womb. I thought that was brilliant and I wonder if putting a ticking clock in/near a baby’s crib would soothe the baby. I haven’t heard of it being done before, so it may not work the same.       

Chapter 5: The Coldest Heart

After sitting with this chapter for a little while, I am still bursting with an array of emotions. Out of any social work setting, I have always thought that I would have the most difficulty working in a jail or prison. This chapter reaffirmed my belief. As I read Dr. Perry’s description of the crime, my body filled with anger. I’m not sure if anger is even a strong enough emotion; it was more like rage. I can usually stomach the cases when a person is assessed as “legally insane” and unable to tell right from wrong. However, I get stuck when an individual knew what they were doing. Based on previous chapters, I assumed a description of severe neglect or abuse would follow the account of Leon’s crime. My gut reaction - the limbic area of my brain- and my research-oriented brain - aka my prefrontal cortex – started battling it out when the chapter ended.

I had the stereotypical thoughts: “not every neglected child murders and rapes” and “how would I feel if the victims were someone I knew?” On the other side, my brain was thinking: “did his genetics and environment create a perfect storm?” I have a difficult time accepting Leon’s actions as inevitable. However, many of the things that would have changed Leon’s path were out of his control. Leon only received punishment, he never came to understand the relationship between people and pleasure, and the programs he was put in only worsened the situation.

I have seen the effects of putting a group of “troubled” adolescents together for extended periods of time. Dr. Perry uses the word “troubled” to refer to disturbed children with behavior problems, but I’m referring to behavior disturbances, as well as self-harm, depression, anxiety, etc. Adolescents benefit from hearing peers in similar situations talk about their experiences. The loneliness or ostracization they feel can be lessened by knowing they aren’t the only ones going through the difficulties. The downside is what Dr. Perry describes as children “egging each other on” and “modeling” behaviors. I witnessed more than one instance of these type of behaviors, whether it be a patient egging on another to fight or one patient self-harming and two or three self-harming soon after. After reading the chapter on behavior therapy, I wonder how reinforcement played a role in Leon’s life and the patients I worked with.

Normally, positive and negative reinforcement is used to reward positive behavior and encourage people to continue to engage in the behavior. However, I’ve noticed that when only punishment is used, the “bad” behavior can be reinforced. In the case of Leon, he only received attention, albeit negative, when he lashed out. I don’t mean to refer to Leon as an animal, but I notice a similar pattern with my roommate’s cat. If I start ignoring Cheddar, he will do something he knows he isn’t supposed to (e.g. knocking over water bottles, scratching the couch). Even though the attention I give him is negative, he knows he gets my attention when he starts engaging in one of those behaviors. More recently, I’ve tried to ignore him whenever his acts up and start petting him when he stops. We discussed in class that positive reinforcement is much more effective than punishment. I would imagine the increase of positive reinforcement and affection early in Leon’s life would have worked wonders. I would hope that even implementing positive reinforcement in preschool would have been helpful. It’s easy for me to say teachers should focus more on positive behaviors, but I’m not the one who has to manage 20 kids in a classroom by myself. I think it’s easy to blame teachers for yelling at their students, but the way the system is set up doesn’t always allot them time to build genuine relationships. I get irritated with my own cat when I’m trying to do something; I can’t imagine trying to implement behavior modification and teach 20 children at the same time.

Chapter 4: Skin Hunger

As someone who wants to be an eating disorder therapist, I was intrigued and skeptical of the term “infantile anorexia”. I had never come across the term while researching in the past. The psychologist’s hypothesis that Laura was secretly purging and exercising at the age of 4 was chilling. After reading the chapter, I researched the term to find out if it was an actual term or if the psychologists were just looking for something novel to publish. I found the diagnosis in a few scholarly journal articles (Chatoor, 2002 & Chatoor, 1989), but it does not have the same characteristics of the DSM-V diagnosis of Anorexia Nervosa. Infantile anorexia does not require the distinctive fear of weight gain and disturbance in body shape. Under the current DSM-V, infantile anorexia might fall under the category of Avoidant/Restrictive Food Intake Disorder (American Psychiatric Association, 2013, p. 334).

Despite the apparent validity of the infantile anorexia diagnosis, Laura does not appear to fit the criteria (Chatoor, 2002). Even though she doesn’t fit the criteria, I found it interesting that Virginia had a few of the parent characteristics associated with infantile anorexia including insecure attachment with her own caregivers and low interpersonal reciprocity with Laura (Chatoor, Egan, Getson, Menvielle & O’Donnell, 1988). Unfortunately, the recommendations of the eating disorder psychologist in Laura’s case were the exact opposite of what she needed.  

The notion that baby “cuteness” is an evolutionary adaptation was fascinating. I did not know that our brains reward us for interacting with our own children. Personally, I just think babies stink, which seems contradictory to my brain reward system being stimulated. However, my friend recently had a baby and she says it is completely different with your own child. She even said she likes the smell of her baby’s spit-up. I may or may not ever have children, but I find it comforting to know I am programmed to not think my own child’s natural smell is gross. Sadly, Virginia’s wasn’t programmed to have emotional affection for her child because of her own childhood. I was glad Virginia was able to develop an affectionate relationship with Laura by observing Mama P. and learning what it felt like to be mothered. I would imagine this concept of modeling could be very useful in parent trainings.

I loved the quote at the very end of the chapter comparing Virginia and Laura’s emotional development to learning a foreign language. I started to wonder what speaking the language without an accent would look like in this circumstance. I found the quote difficult to fully digest because of the finality of it. Would Virginia and Laura really ALWAYS be scarred by the lack of emotional connectedness in their first few years of life? I think I may have initially took the quote to be more black and white than it was intended. The mother and daughter may always speak the language of love with an accent, but that doesn’t mean they wouldn’t be able to speak it.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Chatoor, I., Egan, J., Getson, P., Menvielle, E., & O'Donnell, R. (1988). Mother—infant interactions in infantile anorexia nervosa. Journal of the American Academy of Child & Adolescent Psychiatry, 27(5), 535-540.

Chatoor, I. (1989). Infantile anorexia nervosa: A developmental disorder of separation and individuation. Journal of the American Academy of Psychoanalysis, 17(1), 43-64.

Chatoor, I. (2002). Feeding disorders in infants and toddlers: diagnosis and treatment. Child and adolescent psychiatric clinics of North America.

Chapter 2: For Your Own Good

Towards the beginning of the chapter, I had a difficult time understanding why the prosecutors wanted Sandy to testify. I’m not an attorney, but the evidence against the accused sounded very strong. However, I do know a little about eyewitness testimony from my Cognitive Psychology professor. He testified in court several times regarding the effectiveness of eye witness testimony. Despite the story taking place 28 years ago, Dr. Perry still knew that Sandy’s testimony could be deemed unreliable and it would likely hurt the case. Dr. Perry mentioned how narrative memories have a tendency to “fill in” the “expected”. In my class, this concept was called false memory. Here is a video based on an experiment that demonstrates how false memories are created: https://www.youtube.com/watch?v=D5sk504Yc94&pbjreload=10

The phrase “children are resilient” is true, but only sometimes. The overuse of the phrase leads people to believe that children will be okay without support no matter what happens to them. However, as I learned in my Human and Behavior in the Social Environment class, children need buffers when they are repeatedly exposed to stress. In class we learned that resilience was the result of both internal qualities and buffering relationships. I learned that just one secure relationship can create resilience. The relationship can be an extended family member, a teacher, a coach, or anyone who forms a positive connection with the child. In Sandy’s case, Dr. Perry served as a buffer and appeared to help her develop resilience. However, we don’t know if Sandy would have developed resilience without the buffering relationship. Resilience is not an innate quality and some children do not have buffering relationships to counteract the prolonged activation of their stress response systems.

After reading Sandy’s list of symptoms (p. 42), I thought Perry had just ripped the page out of the DSM-V for PTSD in children and stuck it in his book. Her symptoms were a mirror image of the current diagnostic criteria: intrusion symptoms, persistent avoidance of stimuli associated with the traumatic event, and alterations in arousal (American Psychiatric Association, 2013, p. 273). It’s hard for me to grasp that her trauma could be dismissed as inconsequential until the trial, but the underfunding of DCFS is no small secret. Additionally, not everyone has read the DSM-V and carries a copy around in their pocket. For someone who does not have knowledge of mental health or of Sandy’s past, he or she may have no idea of what was going on or how to help Sandy.

One of my favorite quotes from the chapter was in the section on the misinterpretation of traumatized children’s responses. Perry quotes a family therapist who said, “we tend to prefer the certainty of misery to the misery of uncertainty”. In this instance, Perry was applying the quote to Sandy’s behavior in foster care. I have always found this idea interesting. I have seen how the desire to be in a familiar state can drive people’s thoughts and behaviors, even if the initial situation is positive. The result is often subconscious self-destructive behaviors. People who have always felt depressed or anxious may seek out situations that reinforce the familiar feeling if they start feeling happy or calm. Happy and calm may feel uncomfortable.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Chapter 1: Tina's World

Before I even finished the first page, my brain started screaming: ETHICAL DILEMMA. After Tina crawled on Perry’s lap and tried to open his zipper, I wondered if he considered referring her to a female clinician. However, if he had referred her to a female clinician, Tina may never have had the chance to adjust her schema of men as sexual predators. In addition, Perry did remove Tina from his lap and did not mention any other sexualized behavior. Food for thought, would he have made a different decision if it was 2018?

I appreciated Perry questioning the conclusions of his first supervisor, Dr. Stine. As a clinician in training, I am inclined to defer to my supervisor’s seasoned opinions. Hopefully, if I was in Perry’s position, I would have had reservations about Dr. Stine’s Attention Deficit Disorder and Oppositional Defiant Disorder diagnosis, as well as his interpretation of Tina’s mother’s lateness as resistance. I learned in my DSM class that African American males are more often diagnosed with a psychotic disorder than a Bipolar Disorder compared to White males. Dr. Stine’s ADD diagnosis made me wonder if he would have been more likely to consider a PTSD diagnosis if Tina was a White child. In the same realm, would he have still considered Sara’s lateness as “resistance” if she was White?

As Perry discussed the probable changes in Tina’s stress response systems, I started thinking about what I’m learning in my Treatment of Substance Use Disorders class. Last week, we discussed how drug use affects neurotransmitter levels and the central nervous system. Studies have concluded that childhood sexual abuse is a risk factor for substance use problems in adulthood (Sartor, Agrawal, McCutcheon, Duncan & Lynskey, 2008; Shin, Hong, & Hazen 2010). As we discussed in class, nature and nurture should be looked at interactively instead of as a dichotomy. In this case, I was wondering how Tina’s exposure to childhood sexual abuse affected the neurotransmitters in her brain. Perry described the effect of stress on rats’ adrenaline and noradrenaline systems and how he observed similar behaviors with Tina. I’d be curious to know if Tina were to ever use substances if she would be more likely to use “downers” to counteract the overactivation of her stress response system.

I felt disheartened when I read that Tina had continued engaging in sexualized activity. However, it reminded me that not every story will have a happy ending. I won’t be able to help EVERY client and “fix” all of their problems. During orientation, I remember my biggest fear was failure. Failure has such a negative connotation; but if we do everything right how do we learn? I learned the most during my first field placement when I made a mistake and discussed it with my supervisor. Of course, it felt better to have a successful moment that resulted in my one-person dance parties. However, failing is a part of the process and my coworkers could only handle my dancing on occasion. 

  

 

References:

Sartor, C. E., Agrawal, A., McCutcheon, V. V., Duncan, A. E., & Lynskey, M. T. (2008). Disentangling the complex association between childhood sexual abuse and alcohol-related problems: A review of methodological issues and approaches. Journal of Studies on Alcohol and Drugs, 69(5), 718-727.

Shin, S. H., Hong, H. G., & Hazen, A. L. (2010). Childhood sexual abuse and adolescent substance use: A latent class analysis. Drug and Alcohol Dependence, 109(1), 226-235.