Chapter Nine
I had to give up.
Giving up, however, wasn’t the obvious decision it appeared to be. An extraordinary degree of manipulation underlies many cases of elective mutism. In almost all instances, it is unconscious behavior, but it is manipulation nonetheless. So a child bursting into tears isn’t usually enough to deter me. Even with a child who doesn’t appear manipulative, to stop at the first sign of tears tends to reinforce the mutism as a successful defense. So stopping wasn’t a decision I took lightly. However, given Drake’s age, I was very concerned about putting him under too much pressure. Moreover, all along he genuinely had appeared to be trying. Thus, it seemed wise to go with my instinct to stop.
So I said, “You’ve been working very hard. This isn’t easy. I know.” He had pulled Friend across and sat, face buried in the fake fur of the tiger’s head.
Taking a tissue, I leaned over to mop him up. “You did try hard, didn’t you?”
He nodded.
“Here, come here.” I opened my arms. He and Friend came willingly onto my lap for a hug. “Don’t worry about it,” I said. “Don’t feel bad. When it’s time, it’ll happen.”
After taking Drake back to the ward, I returned to the observation room and started to rewind the videotape. It was a puzzling session. Drake had given me the impression of trying so hard. Right from the visit out in Quentin, he had not seemed fearful, obstinate, withdrawn, or in any other way unwilling to comply. He had always appeared focused and genuinely enthusiastic for what we were doing. So why hadn’t my methods worked straightaway?
Popping the tape out of the machine, I took it back to my office to play it on the VCR there. Helen was in the room when I came in. A tall, slim, quite elegant woman in her early fifties, Helen had a tenderhearted, maternal approach to working with the children, which was quite different from my more pragmatic methods. When I put the tape in, I said, “If you have a sec, would you watch this with me?”
“What a cutie!” she cried, seeing Drake on the screen. “How absolutely adorable. And look that big toy tiger!”
We then watched the tape in silence.
The advantage of videotaping sessions was that it allowed the opportunity to go back and see all that was missed. For me, occasionally this could be quite a lot, because I have quite an extraordinary ability to focus on what I am doing. The plus side is that I seldom miss even the subtlest cues from whatever I am centered on. The minus side is that I can miss everything else. Indeed, I had become the subject of much good-natured teasing after one video showed me so absorbed in how quickly and accurately a child was doing an eye-hand coordination task that I failed to notice he had climbed entirely out of his chair and up onto the table on all fours while he was doing it. The tape showed me effortlessly adjusting my positioning to follow the child as he moved across the table and eventually back down into his chair again and during this whole time I’d never realized the boy had left his seat. My colleagues found this hysterical. And, needless to say, I now greatly appreciated the opportunity to see what I’d missed by viewing the session videos!
Consequently, on this occasion I was expecting to see clues in Drake’s behavior that I had overlooked during the session. With Helen’s added perspective, I hoped it would become clear to me why I’d failed to get him to talk and how I needed to adjust my approach for our next time together.
What I saw, however, was … nothing. Nothing at all different from what I’d perceived during the session itself. Drake came in eagerly. He engaged well with me, seemed attentive and interested in what we were doing, appeared motivated to try what I asked of him. And he did try. Again and again. What the videotape made clear was how hard he’d applied himself right from the beginning and then the heartbreaking decline of his mood when he did not achieve what I wanted. Watching it, I was relieved I’d stopped when I did.
I looked at Helen when the screen turned to snow.
“He can talk?” she asked.
“Yes.”
“Because that’s my first impression. The boy can’t speak. You’re sure he speaks? He’s not deaf or anything?”
“No, he’s definitely not deaf. And yes, I’m sure he speaks. He talks at home to the mother. The big question mark in my mind remains bilingualism. He may be speaking only Italian to her,” I said.
“Have you tried speaking Italian to him?”
I grinned sheepishly. “If I knew Italian …”
“Yeah, well,” Helen conceded. Then she added, “But if it were bilingualism, wouldn’t he at least be able to repeat the words for you, even if he couldn’t use them himself? Or wouldn’t he try to use the Italian word or something?”
“Not if he’s electively mute.”
Helen sat back in her desk chair and slowly shook her head. “Then I’m no help. I didn’t see anything there you didn’t see.”
Turning off the video recorder and monitor, I returned to my desk and started to go through the telephone messages that had piled up. While most were the usual communiqués with other professionals over the various children I was involved with, one came from the hospital’s geriatrics department. Geriatrics? Curious, I lifted it out of the pile and dialed the number.
The phone was answered by a geriatric social worker named Joy Hansen. Ah, she said in a bright-sounding voice, what she wanted to talk to me about might be “a bit of a stretch” but she wondered if I’d give an opinion. My name had come to her via Dave Menotti, she said. She and Dave had been having coffee in the hospital cafeteria and she’d been discussing a case with him. He suggested perhaps I’d have some insight.
Intrigued, I asked for more information.
Joy had a patient named Gerhardine Sharple, who was currently in the stroke rehabilitation unit, housed in a nearby medical complex. Gerhardine, known as Gerda, was eighty-two. She had been in good health and living independently up until five weeks earlier, when she had had a massive stroke. After the initial stay in the hospital, she was then released to the rehabilitation unit and seemed to be making a reasonable recovery. However, there was an ongoing problem with her speech. Strokes often interfere with the language center in the brain, causing loss of communicative speech, which is known as stroke-induced aphasia. In Gerda’s case, she had recovered certain elements of speech almost immediately. In particular, she was capable of responding appropriately if she was asked simple, concrete questions. However, in spite of intensive speech therapy work, two problems remained. One, while she had demonstrated the ability to respond appropriately to questions, this did not mean she always complied with the request. And two, she produced no spontaneous speech whatsoever.
Joy said Gerda had been widowed many, many years before. She had been living alone in a small isolated farm. The house, a two-story clapboard of the sort commonly built at the turn of the twentieth century, stood amid ancient, half-dead cottonwoods and was surrounded by miles of sagebrush and little else. Although the emergency services had found things clean and tidy, the property was dilapidated in the way of the rural poor, and a haven for small animals. More than a dozen chickens ran happily in the yard, a goat was in the half-collapsed barn, and sixteen cats shared the house. Indeed, Joy said, Gerda seemed a stereotypically reclusive “cat lady” and, as a consequence, she had had little contact with
