PRISM, Volume 1, Part 10
PRISM, Volume 1, Part 10
Dangerous Dwarf Proudly Presents
George C. Chesbro's
PRISM: A Memoir as Fiction
Volume One: "Dark Engine"

Published by Apache Beach Publications

Click here to purchase Prism

Copyright © 2001 by George C. Chesbro. All rights reserved.
Reprinted here with by permission of the author.

Installment #10

So much for good omens.

I feel I have established good rapport with my class of the most troubled and dangerous children at Arkmount Children's Psychiatric Center, and I consider my first two days to have been relatively uneventful. But on Wednesday morning I arrive at Little Ark to be told that Helma had been taken to Nyack Hospital during the night. Helma, who had laughed so loudly each time I reminded her that her Alternate School Program contract stipulated she "not ingest non-FDA-approved substances," the very bright girl who seems to understand that how she behaves---in Little Ark in general, and here in Shangri La in particular---in the next few months before she turns eighteen will determine whether she will be released to a halfway house or locked up in Big Ark, emerged from the toilet the night before to calmly announce to the cottage staff that she had just swallowed a bottle of cleaning fluid. Taking her to Nyack Hospital to have her stomach pumped was, of course, a forced move, but Helma has pulled this kind of stunt several times in the past, and the staff in the Emergency Room at Nyack was not amused. They are thoroughly tired of her. After this latest episode of blatant self-abuse, I suspect it will be some time before Helma is allowed to come up to class again. She is currently being kept on the cottage in a locked room with an aide, officially "in isolation," which means that no one but her therapist and the cottage nurses can even speak to her. Isolation is the most punitive measure that can be taken against patients in Little Ark.

I am both baffled and intrigued by Helma's behavior. Her clear appreciation of her situation and her apparently sincere desire to act in her own best interests is obviously not sufficient to prevent her from continuing to commit---with good cheer, even---suicidal gestures. In a way she reminds me of my son, who also seems unable to control his self-destructive impulses. She also reminds me of Alan's mother. And she reminds me of myself, the way I used to be. I can definitely relate, and I will make a note of this in my prism journal when I have the time, and if I have energy left at the end of the day to write anything.

The "star" of my show, the most difficult patient in my class for me to handle, is turning out to be the child I would have considered the least likely candidate two days before, the tow-headed, blue-eyed, diminutive, homicidal Roy. Roy is not normally explosive and not nearly as dangerous as the stocky Adam or the lithe, lightning-quick Lance. But unlike Adam and Lance, Roy, behind his baby face and beneath his beguiling smile, is unremittingly hostile and absurdly demanding of my attention. He is a master of passive aggression. His favorite trick is to plop himself down in my chair, or in one of the padded chairs in the room reserved for the Therapy Aides. Roy, of course, knows that students must not sit in these chairs, and the Boys Town Psycho-Educational Model dictates zero tolerance for any aberrant behavior. Consequently, no matter what else I am doing at the time, working with another student or otherwise engaging in some activity that does not involve Roy, I must stop and turn my attention to Roy, first demanding that Roy immediately remove himself from the chair. Roy will simply remain seated and smile at me. Following the PEM protocol, I award Roy one hundred negative points, and Roy is to take out his PEM point sheet and record them. Roy will continue to sit and smile. More negative points are awarded, and again Roy is directed to take out his sheet and write them down. When a total of three hundred negative points have been awarded and Roy has neither recorded them nor removed himself from the chair, I have no choice but to call for the Crisis Intervention Team. The CIT arrives and hauls Roy back to his cottage. Naturally, this is what Roy wants, for as the only patient on the cottage during the day he will receive the undivided attention of the cottage staff

Roy's PEM contract stipulates that he follow rules, and this kind of behavior will prevent him from being returned to the hospital's regular school program. But I have quickly come to the realization that Roy's behavior is perfectly calculated, not the result of a sudden emotional squall. He has performed the same act for the last three days---sitting in my chair, refusing to comply with an order, not accepting negative points, being taken back to his cottage. The problem with getting Roy to follow the terms of his contract is that Roy does not want to get out of ASP. It is turning out that the patient with the simplest contract, essentially avoiding removal by the CIT for five days, is going to be the most difficult to move back to the regular program.

Since it is my job to modify each patient's behavior to the point where he or she can leave our isolated quarters, Roy views me as a problem, perhaps even an enemy.

After being removed from class in the morning, Roy is allowed to return after lunch. I stop him in the hallway and point to the array of cartoon faces taped to the wall outside the classroom entrance, ask him which figure best expresses how he feels at that moment. As he does each time we go through this routine, he grins broadly and points to the "angry" face. I ask him if he can tell me why he is angry, or who he is angry at. Still grinning, Roy points to me. Slightly taken aback, I ask him why he is angry with me, and he explains that it is because I have told him he can leave the Alternate School Program.

When I think about it, Roy's attitude begins to make sense to me. Being placed here in Shangri La means that he has few if any privileges in the hospital, but he does not care; what he most craves is constant attention, not privileges which he might be expected to enjoy independently, and here he gets it. He has no friends in the hospital, and most of the other children loathe him. In my class, even when he's being trundled back to his cottage strapped to a stretcher, he's mostly being fussed over or tended to by adults. I award the boy one hundred positive points for "expressing his feelings," which he records on his sheet. Then I reassure him that nobody will force him to leave my program until he feels he is ready. He seems pleased.

Although I have assured Roy that he will not be forced to leave ASP against his will, the boy, perhaps deeply mistrustful like all sexually abused children, seems determined to insure that he stays where he is; his aberrant, defiant behavior continues unabated. Day after day we go through the same routine; he sits in my chair, refuses to move when told to do so, refuses to accept negative points, gets taken away by the CIT. Then, just when I have about become convinced that Roy is beyond reach, I begin to notice some subtle changes in his modus operandi. In the past Roy has been sent back to the cottage almost every day, usually fairly early in the morning, and he has remained there throughout the day. He is still getting taken away in the mornings on most days, but now he has begun returning after lunch. After one incident, the cottage nurse calls me to explain that Roy's outburst may have been caused by the fact that he was mistakenly not given his usual post-breakfast medication.

On another occasion Roy asks me if he may voluntarily go back to his cottage for extra medication because he is feeling "weak and angry." It is the first time Roy has ever expressed a reason for his behavior, the first time he has ever taken steps to pre-empt an outburst before it occurred, and I am not only surprised and most pleased, but I am touched. I award Roy one hundred points for expressing his feelings, and ask a Therapy Aide to escort him back to the cottage.

I believe I have misjudged Roy, and his behavior may not be as cold and calculated as it appears. When not calmed by heavy doses of medication his mind boils with fear and anxiety. He is a boy who has had his rectum torn too many times by adult penises, his mouth flooded with their semen, before he was finally abandoned.

The boy continues to voluntarily remove himself from the classroom when he is feeling particularly stressed, angry or anxious, sometimes into the "bullpen" of the hallway to pace, other times walking back to his cottage with an aide. I don't know if he will ever be able to string together five full days of "following rules" without the CIT having to be summoned, but I am now convinced that he is motivated to change, and he is making some progress. He has opened up a window into himself through which others can glimpse the torment that drives him.

I believe that Adam and Lance are also making progress. Their situations are quite different from Roy's inasmuch as both boys are highly motivated to leave the strict confinement of ASP, a placement they find highly embarrassing. For both of these patients it is as much a problem of psychopharmacology as behavior modification as their doctors struggle to find the right combinations and dosages of drugs that will help them help themselves to control their explosive behavior.

Lance, still shaky and full of rage, is ready to go off at any moment on most mornings and in the early afternoons, but he seems to grow calmer as the day progresses. He has still not opened up to his therapist as to his motives for burning down his school, and he vehemently denies ever being sexually molested by his stepfather or other family members - arson considered to be symptomatic of such trauma. He has an important court date approaching, at which time his future will be determined - whether he will spend more time at Little Ark, with eventual transfer to another, less confining institution, or be imprisoned in a Detention for Youth facility.

Adam's situation, like Helma's, is growing increasingly desperate. The family that has expressed interest in adopting this fifteen-year-old is still willing and waiting, but this could change. The parents have two small children of their own, and the Little Ark psychiatrists' failure to bring Adam's dangerously explosive behavior under control is making them increasingly anxious. Adam, at his own request, is being given increasingly larger doses of pyschotropic drugs, primarily Thorazine, but the larger doses are not working; while his explosive rages have been contained, he has become glassy-eyed and his demeanor zombie-like. He sleeps---or, to be more precise, is unconscious---most of the time he is in class, and this is not acceptable. The doctors plan to try a new combination of drugs, but it will be some time before it can be determined how Adam will react to them.

Read the next installment.

Copyright © 2018, Hunter Goatley. All rights reserved.
Last updated 25-MAR-2018 21:42:47.38.