Chapters 8 and 9

Chapter eight of The Boy who was Raised as a Dog features a seventeen-year old girl named Amber. Dr. Perry met Amber after she was found unconscious at her school. She had shallow breathing, a slow heart rate, and extremely low blood pressure. After she was taken to the hospital, her heart even stopped. The doctors in the ER ran many tests on her and found nothing wrong. She was simply unarousable. Dr. Perry then stepped in and began to ask Amber’s mom Jill about her life. It was from this discussion that Dr. Perry learned that Jill was a single mother was in a relationship about eight years ago with a man named Duane. Duane raped Amber from the ages of seven to nine. Once Jill found out about the rape she left Duane. Dr. Perry determined that the previous night Amber had answered the phone and it was Duane. He suggested a visit. Jill quickly took the phone and firmly stated that neither she nor Amber would ever have anything to do with him again. Dr. Perry also saw that Amber had been cutting herself and figured that she had entered a dissociative state and was essentially overdosing on her own opiates and the results were similar to a heroin overdose. Dr. Perry then suggested treating Amber with naloxone, an antidote for opiate overdoses. The other doctors eventually agreed to give Amber that drug and within two minutes Amber woke up.

Dr. Perry then began to talk to Amber and eventually became her doctor to help her with overcoming the trauma from earlier in her life. During therapy Amber eventually began to explain what would happen when she experienced abuse, and now when she thought about the abuse that happened to her. Amber said that she had been able to find a safe place in her head where she wouldn’t feel the pain anymore. Amber described being a raven, even though she wanted to be a more majestic bird. She described herself as the “Black Death.” The dissociative state that Amber experienced is another possible response to trauma. Some people become hyper-vigilant in response to trauma while other dissociate. From Amber, Dr. Perry and his colleagues learned a lot about the dissociative response to trauma. Even now, when something reminded Amber of Duane and her trauma she would dissociate. This was something that she was unable to control.

From this new knowledge of dissociative responses to trauma, Dr. Perry was able to find some possible drugs to help with unwanted dissociation. The drug naltrexone was first tried on a sixteen- year old boy named Ted. Ted had unpredictable fainting episodes that had no discernable medical treatment. Ted had been a witness to continual domestic violence in his house from an early age. Ted’s mother was beaten by his stepfather on a regular basis. It was so bad that Ted’s mom had been hospitalized many times from the abuse. When Ted got older he would try to protect his mom and was able to redirect his stepfather’s rage onto himself. Eventually, seeing her son being hurt, Ted’s mom left his stepfather. Ted’s fainting was caused by a dissociative response to anxiety in his life. The medicine stopped Ted’s fainting but he still needed therapy to help deal with the anxiety he experienced on a regular basis when he was unable to dissociate. Dr. Perry was able to help Ted find more productive ways to handle stress in his life.  The combination of the drug and the therapy Ted experienced, he was able to better handle stress in his life without dissociating.

Dr. Perry continued to work with Amber as well to help her learn how to cope with stress without hurting herself or dissociating. Amber saw herself as a black raven and she even got tattoos to represent how she saw herself. Amber later moved with her mom to Austin because of a job and no longer saw Dr. Perry. She later emailed Dr. Perry to tell him about her new tattoo that had no black in it. She also began to see herself as a blue raven instead of a black one. Slowly but surely Amber was able to work on her stress management and became a “healthy, productive young woman,” she went to college and graduated in four years.

Chapter nine of Dr. Perry’s book deals with an issue of Munchausen’s by proxy syndrome (MBPS). James, a six-year old boy had an interesting, and complex situation through which a judge referred James to Dr. Perry. James was adopted by his parents before his first birthday. Merle, James’ mother, described him as “incorrigible and uncontrollable” he supposedly repeatedly ran away from home, attempted suicide, and wet his bed. James was hospitalized many times, once after he jumped from the second story of a house. According to Merle, James was so terrible that she called CPS on herself claiming to be a worried neighbor. The final incident was an overdose that Landed James in the ICU. Many caseworkers and therapists believed that James had Reactive Attachment Disorder (RAD), which is marked by a lack of empathy and the inability to connect with others. The descriptions of James’ behavior by his mother seemed to fit a RAD diagnosis. There was a problem though, when James was in the hospital or a treatment center, he was very well behaved and didn’t express any of the symptoms of RAD. Even in school he was relatively well behaved.

Dr. Perry found that the behavior of James’ adoptive parents was very strange as well. They would often show up for appointments when they had been told not to and when Merle was interviewed she seemed entirely focused on herself. Dr. Perry then met with James and really liked him. He seemed to behave appropriately and laughed and joked. Stephanie, James’ primary clinician, felt the same way about James. From these interactions with James, Dr. Perry determined that there was no way James could have a real case of RAD. They then started to look closer at James’ records and found many discrepancies. It turns out that almost every time that James was in the hospital, the staff there was suspicious of Merle. She continuously had strange reactions to what was going on with James and never expressed any real concern about his wellbeing.

With this information, Dr. Perry realized that many of the accidents were not initiated by James. He didn’t jump from the second floor; he was pushed. He didn’t try to swallow a bottle of antidepressants; he was forced to swallow them. The doctors determined that James was only sick because Merle was making him that way. Merle framed James as “difficult” with “behavior problems” and any attempt by James to escape his situation was seen as evidence those problem behaviors. It was through the discovery that James’ parents were deliberately deceptive. It was from this information that the doctors concluded that Merle had MBPS, a disease where a person attempts to make another person sick in a ploy for attention and support. Merle lived for the attention she received for having a “sick” child. If Merle had been let to continue with her behavior, James would have probably died.

From Dr. Perry and his teams’ recommendation, James and his siblings were removed from Merle’s home. A jury later agreed that the children had been abused by their parents and their rights were terminated. James’ continuous actions that had been viewed as disruptive behavior were actually cries for help from other people. This case taught Dr. Perry the importance of listening to the child he is working with regardless of what other adults say about the situation.

These two chapters reminded me about our class discussions about disability. Though they do not seem explicitly related. I have found that often people do not trust the word of a child when they are abused. It almost seems as if many adults think that these children somehow have less value than other adults. It seems easy for adults to try to diagnose children with diseases, to stigmatize them, simply because they may have different challenges in life or they have different opinions than their parents. No one thinks it’s all right for a child to be abused but often these children’s voices are not heard. Their age makes their opinion matter less. This should not be the case. In Luke 18:15-17, Jesus states that the kingdom of God belongs to the children and that one must approach the kingdom of God like a child in order to be able to enter it. Jesus places so much value in children that I think is missed in society today. These chapters remind me that God’s ideas of value are often the opposite of what we believe them to be.