memoirs

Among the mishmash of memories from student years, the long march towards turning an unremarkable teen into a psychologist, a few memories stand out. One particular learning experience that I recall, somewhat hazily, occurred when I was an intern at University of Nebraska Medical Center in 1984. I was supervised by Louise Eaton, a psychiatrist in Nebraska at the University of Nebraska Medical Center, and by Gary Gaard, a very supportive psychologist. The client was a four-year-old girl with Down syndrome, very slight of build, with a bowl-like haircut, and almost completely mute. She could draw, though, and produced one of those tadpole-like drawings with two long lines dropping from a circle. The therapy style was a certain kind of play therapy in which you avoided any kind of evaluation. The idea was that praising did not help, since it implied the potential for criticism. So you avoided both.

Every day this four-year-old would serve me tea in the unit playroom. There were plastic cups, and we would carefully lay them out. She would pour tea for me, and I would make comments like, “oh, now you are pouring me tea, thank you.” Or, “now you are stirring the tea, and doing it carefully, and now you are putting the cup down, I like tea.” Dozens of sessions of having tea with M. occurred, and as soon as we entered the playroom she would get the tea set. After each tea session we would carefully put the cups away on a set of small shelves (lest the next clinician using the room complain). M. spoke rarely, if at all, usually in one- or two-word phrases, nor would she ever really look me in the eye. However, she seemed to enjoy the tea sessions.

Meanwhile, we would discuss the tea sessions in a group meeting each Friday. Louise Foster Eaton, a psychiatrist then in her early 60s (but seeming old to me then), supervised me, a warm and supportive mentor with a style that seemed hands-off and easygoing, sort of the way she was encouraging me to be with the client, never really evaluating or praising. I think she enjoyed hearing about the tea sessions, though, since she had come from a background where they had served tea.  Apparently, I was happy to hear, the child looked forward to the sessions, and parents reported she seemed more upbeat at home, occasionally speaking.  What does one learn from this: maybe that for an isolated child, having some sort of social interaction with a benign adults can be helpful, and that sometimes it is good to allow others to be  helpful, if it provides some reinforcement for them. The overseeing individual in the unit was Frank Menalscino, who had revised the guidelines for diagnosis while president of American Association for Mental Retardation (as it was name then).

At the same institution I worked with a four-year-old named J. J. was a “biter.” He was compactly built, with shaved blond hair and a cowlick in the front. “A biter” is not a clinical term, and there no doubt was some clearer way of describing whatever developmental or emotional issue was involved, but that was how he was described in staffing. Certainly it had an unnerving quality for staff. He had a powerful bite, and human bites can be painful. My job was to complete psychological testing and provide play therapy. I recall that in one session he took a bite out of my WISC-2 kit. There was a big semicircular row of teeth marks in the thick vinyl of my briefcase, with indents. It was a bite that probably could have taken off a pinkie. He was also constantly in motion. The only time he stopped was, I recall, when he was running at me and I let out a gasp of such fear that he stopped in his tracks. After the fact, my hope was that sufficient rapport had developed that he was uncomfortable seeing me frightened.  I am not sure what I learned from this client, except that aggression in children can be present in some developmental delays, a fact I later learned while working with several human services staff who had suffered bites.

A third client I recall from that institute was a musician, a compactly built man in his early thirties who at first was somewhat dismissive of me, but over time became a steady client. At that time, there was no test for HIV seropositivity. The French researchers hadn’t come up with it yet. So G. worried constantly, given his active gay lifestyle in the small area of Omaha where gay men met. It was a torturous time, with word coming in from New York and San Francisco of increasing deaths from an incurable, wasting disease. Obsessive worries, it seemed, preoccupied him. I assured him that he certainly appeared healthy at the moment, but to be careful and use precautions. He did most of the talking in sessions eventually, much of it worry about having acquired the virus, and still being active. I guess he trusted me somewhat--I had read a lot of Christopher Isherwood and Truman Capote.  With his permission, I presented the case, with pseudonym and disguised background, to the entire psychiatry department, and I recall the chief psychiatrist declaring that he was a histrionic personality, full of exaggeration.  This psychologist was known as a supersmart diagnostician and clinician. But that was a stereotype then—gay men with histrionic or affected mannerisms and features. I didn't think it really on point with what was going on with this person. When my internship ended, I moved away, losing contact with the client. I kept the notes of that therapy, with a pseudonym, for many years. I looked up the name years later, and he had perished in his late thirties.  In retrospect, he must have surmised that he was seropositive, at some level, or the lifestyle was so engrossing he had trouble abstaining.  I hope therapy provided some respite from whatever pain he was suffering.  At that time, being gay was so extremely stressful, particularly if away from urban areas, it seemed often accompanied by many secondary features--depression, suicidality, personality bent out of shape by harrassment and fear.