has increased difficulty and anger regarding the separation, the records state, noting that he was very protective of his father and very angry at his mother, but he also showed separation anxiety when Cathy left the unit after visiting.
During the exam to determine his mental status, John Jr. kept looking out the window, distracted by children playing outside, and kept messing with the blood pressure cuff and reflex hammer. He moved around quite a bit, chanting “yes-no, yes-no,” or “no-no-no-no-no,” making faces in disgust and appearing annoyed at the questions.
“Everybody asks that,” the boy kept saying.
The doctor’s analysis: Patient’s peer relationships have always been poor, although he did make one female friend this last summer at mother’s house. He tends to antagonize other children, is very short-tempered, and has poor sharing skills... . His thought process was unremarkable with no evidence of psychosis. Cognitively, he had good comprehension, intact memory and appeared to be of at least average intelligence. His insight was poor and his judgment was fair to poor... . He often speaks with much bravado about this place, bragging that he knows it well (his mother is an NPI nurse), and bragging about his physical strength or other skills to defend against feelings of abandonment, confusion, low self-esteem, and lack of control in recent circumstances.
During his stay there, John was initially not very well liked by the other children, and he stayed on the periphery of their activities. Occasionally, the reports stated, he was quite violent towards his peers, sometimes hitting them or striking them quite impulsively. But slowly he was able to get along better with his peers and form friendships. His anger toward Cathy lessened, and he gradually accepted that he was going to live with her. Cathy came for family therapy, and although John Sr. was initially “unable” to do this, he spoke with the doctor at length by phone. He later came for several visits, and said he would take John Jr. every Saturday in the future.
Upon admission, John Jr.’s diagnosis was adjustment disorder with mixed emotional features, ADHD, with symptoms of major depression and chronic depression, known as dysthymic disorder. By the time he was discharged, his depressive symptoms were gone, leaving his final diagnosis as ADHD and adjustment disorder with mixed emotional features.
Although our evaluation at this time did not show that patient met criteria for either major depression or bipolar disorder, there is affective disorder as well as depressive spectrum disorder in the family, and this will be an area for evaluation in follow up as time goes on, the doctor wrote.
John Jr. seemed better upon his discharge, but the stability was only temporary. He was transferred to Zela Davis Elementary School, which had programs in special education, where he began acting quite bizarrely, barking like a dog and licking the chalkboard.
“Why are you acting like a dog?” Cathy asked.
“Because people like dogs,” he said.
Some twenty years later, when she and John Jr. were talking about events and emotional problems that could have led to his sexually violent behavior, he told her that between the ages of five and six, he’d been molested by a female family friend in Palmdale, who told him to lick her genitals “like a dog.”
They never discussed the connection to the doglike behavior he exhibited as a ten-year-old, but Cathy believed him after putting her own memories together. The behavior seemed to make more sense in that light. She didn’t think he made this claim for sympathy, because he didn’t mention it to her in that context. “This may seem weird because my son can be such a big liar,” she said recently, but at some point, “he tells me the truth.”
Jennifer Brandt, a friend of John’s from high school, told reporters recently that he’d confided in her that he’d been molested by a male family member as a child. But an ex-girlfriend, Jennifer “Jenni” Tripp, who said they had discussed her own molestation, said recently that he had never discussed this allegation with her, and it seems that he would have.
While this doglike behavior was occurring, Cathy took John to a behavioral specialist at Kaiser, who doubled his Ritalin dose over the course of a few days. The day he got the highest dose, the school nurse called Cathy and told her that John was hallucinating, seeing demons and was trying to stab himself with a paper clip he’d stretched into a point.
“Do you want me to call an ambulance?” the nurse asked. Cathy declined, saying she was only fifteen minutes away. She was going to pick up her mom, then take John to the hospital. If he was still out of control when she got to school, they could call an ambulance then. But by the time she got there, he was cooperative and said the nurse was lying about his hallucinations.
“They just wanted to get me into trouble,” he told Cathy, who took note of this early paranoia, which she said “became a part of his lifelong persona.”
She called Kaiser Permanente to read them the riot act for overmedicating her son, and again demanded that he be admitted. “You overdosed him! You gave him these meds!” she screamed.
This time, they conceded, saying she could take him to Los Altos, a children’s mental hospital. He stayed there for sixty days, during which time the doctors had to take him off all his medications for the first two weeks just to stabilize him.
“John has the most severe hyperactivity I’ve seen in all my years as a psychiatrist,” one doctor told Cathy.
They put him on an antidepressant she believes was Elavil and then discharged him. After being home for two weeks, even John Jr. could recognize that he wasn’t doing well.
“Mom, I need to go back in the hospital,” he said.
Cathy didn’t believe him, thinking he was seeking attention or exaggerating. “We’re going to try to deal with this without going to the hospital,” she said.
Two days later, after he had problems in school once again, she gave in and took him back to Los Altos for an additional thirty days, until they could adjust his medications properly. Although he seemed better able to concentrate on school with the Ritalin, the side effects outweighed the benefits. As a result, they took him off it for good.
Chapter 9
Cathy’s boyfriend Dan’s apartment was only a small bachelor pad and very cramped compared to the two-bedroom apartment Cathy and John Jr. had previously shared. So once John was released from his third hospital stay, he had to sleep on the couch. This arrangement lasted until they moved into a three-bedroom house in Carson.
From there, Cathy and Dan decided to move to the more rural area of Redlands in San Bernardino County for a couple of months. They enrolled John at the private Advocate School for severely emotionally disturbed boys, where taxpayers paid his tuition. He was placed into a seclusion room numerous times to prevent him from hurting himself or one of the other kids, prompting Cathy to jokingly call it “a prison school.”
After all these hospitalizations and behavioral problems, Cathy was depressed about her son’s prospects. For years now, she’d been struggling to stabilize him, hoping that he would reach some sort of plateau and be able to live a normal life, but she was finally starting to accept that this was never going to happen.
My child is not ever going to be functioning close to normal, she thought.
She didn’t give up on him, but she tried to deal with what was plausible rather than what she hoped was possible. A new psychiatrist
