Today is the second installment in a four-part series of stories tracking Marcus, a severely emotionally disturbed 6-year-old, as therapists try to map the landscape of his troubled mind.
Therapist Sarah Thibault strides down Spofford’s cinderblock hallways, her soft-soled loafers silent on the tile.
From outside, the building — low-slung, wood, set on a green expanse in south Kansas City — looks like a ski lodge.
But at any one time, the nonprofit residential treatment center is home to four dozen children age 4 to 12 years whose mental and emotional problems are so severe that “when they end up here,” says Joe Beck, director of therapy services, “it means all the other traditional stuff has failed.”
Average stay: 5½ months in one of five dorms including “Kiva,” reserved for the youngest children, most in kindergarten, none older than 7.
At 25, Miss Sarah, as the colleagues and kids call her, is prim and congenial. She wears wire-rimmed glasses and is guided by a spiritual duty so deep that, in college, she worked with Romanian orphans. When she returned home, materialism so disgusted her she gave away her clothes except what fit in a single suitcase. She made her own wedding dress, buys no more than $50 in clothes a year and drives a faded ’87 Oldsmobile Cutlass whose passenger door sloshes with water when it rains. Her husband, Gil, helps the poor at the Kansas City Rescue Mission.
“I feel like I’m doing what I’m called to be doing,” she would say.
She has a recent degree in social work but she’s also young, nervous and barely tested. With 10 children in her caseload, she prays at night for wisdom.
“All the time I feel like I don’t know what I’m doing. I feel so very less experienced than the other therapists.”
She approaches Kiva’s entryway, a heavy metal door with a single square window. Through the window she can see a common room with speckled industrial carpeting, chairs and tables. Here the kids draw and watch TV, scream and act out.
Around the room’s periphery are five cinderblock bedrooms for 10 children. Single beds, plain dresser, vinyl mattresses with cotton sheets printed with Superman, Mickey Mouse, Dora the Explorer.
Some of the children have never had a room. A few have never slept in a bed or been taught to wash or brush their teeth. All are disturbed: attention deficits, attachment disorders, self-mutilation, anger, violence.
For two months, one profoundly difficult 6-year-old has been living inside Kiva making little progress. Now, new to the case, it’s Miss Sarah’s turn. She steps through the door.
“Marcus, Miss Sarah’s here!” a dorm worker calls out.
Marcus looks up and sees her smiling at the far end of the dorm. He puts down his Legos and shuffles toward her along the carpet. His eyes look tired, but his face is emotionless, inscrutable.
He walks past his Kiva dorm-mates:
A 6-year-old boy who once tried to strangle his sister, leaped from a moving car and watched his mother stab his heroin-addicted father in the chest. The first-grader has been on 13 psychiatric medications.
A 5-year-old brother and sister, abandoned by their drug addict mother. Their tantrums can last two hours. The girl makes herself vomit. She wets her bed. The boy threatens to kill himself.
The girl with the wide eyes and frizzy hair screaming “I’m ugly!” is Holly O’Neal, 7, bipolar, oppositional defiant and struggling to feel a true emotional connection. Kyler Lair, 6, is obsessed with guns and shows no remorse when he hurts other children.
One first-grader scratches until he bleeds. His father had sex with him on videotape.
Then there is the smallest child, brutally abused.
When the police raided his home, a methamphetamine lab, they discovered him and his brother so purple with bruises they rushed them to the hospital. The boy punches himself and once pulled out a chunk of his hair. For discipline, he begs to be beaten. He is in preschool.
The therapists have no illusions. They can’t cure these children. But maybe they can save them by giving them a chance. Maybe they can find the right combination of medicine and insight and family therapy to help them cope, moment to moment.
The task this afternoon, like gentle exploratory surgery, is to dig as deep but as carefully into Marcus’ thoughts and emotions to find the fear or pain or anger that possesses him. Once found and identified, maybe then Sarah can treat it.
“Are you ready, Marcus?” she says.
Miss Sarah clasps Marcus’ hand in hers and walks down Spofford’s hallway to the play therapy room.
The room is tiny but homey — a narrow rectangle, carpeted, with a rocking chair at one end, bookshelves filled with bins of toys lining the length of one wall, and a one-way mirror for observation. Miss Sarah sits in the rocking chair. Marcus sits in a mini-chair at her knees looking up at her.
At Spofford Marcus may have as many as five therapy sessions a week: individual, family (some parents participate, some don’t) and any number of groups — anger management, peer relations, sexual encounters.
Psychiatrists check and re-check his and all the children’s medicines, and during the school year, children attend class at Spofford, taught by Hickman Mills School District teachers.
The foundation for most of the treatment is cognitive behavioral therapy, an approach that, in essence, holds that life is perception, that thinking makes it so. If children can change the way they perceive their lives and problems (cognition) they can change the way they react to it (behavior).
“A lot of children feel the way they feel because of their life circumstances,” said Lori Meyer, Spofford’s then-vice president of clinical services. “They can feel any way they want to feel, but it’s the way they choose to act that matters. They need to find that connection between their feelings and how they act on those feelings.”
When the children are not in therapy, Spofford reinforces “coping skills” to teach children to deal with the chaos of their own homes or emotions. They punch a pillow, press on a wall, count to 10, talk to staff, take a deep breath, go to a “safe place.”
Twice a day, dorm staff evaluate the kids’ behaviors and, next to their names on a white board in each dorm, they are given an evaluation of a “red,” “yellow” or “green” as both an incentive and a guide. Red means danger, green means go, progress.
When behavior goes bad, when they threaten or carry out violence toward themselves or others, they are put “on safety.” Staffers take their sneakers to keep them from using their shoes or laces as weapons, from hurting themselves, or from running too far. They are watched.
Marcus is getting reds and yellows.
“I thought we could start by reading a book today. Does that sound good?” Miss Sarah says.
One of the most arduous aspects of dealing with mentally ill children is delving into their true emotions. But what kids might not be able to express in words, they often express in play or through art.
“This is a book called The Way I Feel,” Miss Sarah says
Each page is a different emotion. She flips to the first, “Silly,” and the picture of a girl with a goofy face.
“What do you think she’s feeling there?” she asks.
“Mad,” Marcus says
“Mad?” Sarah says. She reads the text:
Silly is the way I feel when I make a funny face and wear a goofy, poofy hat that takes up lots of space.
Next is “Scared.”
I’m shaking because I’m scared, all alone in the dark at night…
“Tell me something you’re scared of.”
“Nothing,” Marcus says flatly.
“Nothing?” But Sarah knows he is afraid of something. “Spiders?”
Marcus is still.
“I like to smash them,” Marcus says, no anger, just explaining. “I’ll take a hammer and smash them in the head.”
“I’m scared of spiders,” Sarah says.
“You gotta get a hammer and smash them,” he advises. Sarah laughs.
“How was your pass this weekend?” Sarah says.
“My mom left me,” Marcus says, his voice gone flat and emotionless. He looks down at the carpet. “My brudder left me. They left me all by myself. I was all by myself crying.”
“Your mom told me it wasn’t good. What was that about?”
He refuses to talk.
She flips the page.
Happy, she reads.
“So when is there a time when you feel happy?" she asks.
“When my mom and sister was here, and my brudder,” Marcus says.
Sometimes I feel so very sad, Sarah reads.
Marcus interrupts. He is abrupt and cool.
“I don’t want to do that one.”
She tries again.
“No,” he says. Sarah changes her tack.
“What makes you angry?”
“When my brudder and sister hit me. When they kick me and punch me in the nose.”
“Anything that makes you angry here at Spofford?”
“How about when someone says something mean about you? Like, ‘Marcus, you’re so stupid!’ That wouldn’t make you angry?”
“That would make me hit them,” he says.
Minutes later, Sarah leads Marcus to the “sand tray,” a clear plastic bin of clean sand, surrounded by bins of plastic toys.
She asks him to use the toys to create a picture in the sand of the emotions from the book.
They start with angry. Marcus grabs a walrus and sets him in the center of the sand.
“What is the walrus angry about?” Sarah asks.
“His mom and dad are gone,” he says. “They went to the zoo without him.”
“Because he was bad,” Marcus says. He was “hitting people” because he was angry.
“Let me do happy,” he says.
He picks up a yellow rubber duck and places it in the sand.
“Why is Ducky so happy?” Sarah asks.
“ ’Cause his mom is with him,” Marcus says. Then he reaches into a bin, grasps a rubber snake, and slowly grinds him into a hole.
“How come he’s going in that hole?” she asks.
“He’s sad,” Marcus says. “ ’Cause his mom and dad ain’t comin’.”
Sarah and Marcus look down at the snake, its head crammed beneath the sand. Even after one session she senses the boy’s troubled depths, wondering if, over the months ahead, she can rescue what he has buried.
Day two of four
Educating children with emotional disturbances is a national problem. | A7
@ Go to Kansas City.com to find where to go for help in your area.
DAY 2 GRAPHIC.
Kids and Mental Illness by the Numbers:
1 – Percent of children in public schools receiving special classes (about 8,000 in Missouri, 4,000 in Kansas ) because they are severely emotionally disturbed.
20 to 50 – Percent of depressed children and adolescents with a family history of depression.
25 to 50 – Percent of anti-social children who become anti-social adults.
50 – Percent of children with a mental illness that drop out of high school.
70 – Percent of children in the juvenile justice system with a diagnosable mental illness.
Sources include: President’s New Freedom Commission Report on Mental Health 2003, American Academy of Child & Adolescent Psychiatry, Missouri Department of Mental Health, Kansas Department of Health and Environment, Substance Abuse & Mental Health Services Administration, National Mental Health Association, National Alliance for Mental Illness, U.S. Surgeon General, Centers for Disease Control and Prevention .