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Thursday, December 12, 2013

NPR's "This American Life" #317 Considers Attachment Disorder: Unconditional Love

From WBEZ Chicago

With Ira Glass and Alix Spiegel
Originally Broadcast September 15, 2006

Act One, "Love is a Battlefield."

In this act, a family faces a kind of profound question. Can you teach love, even to a child who has all sorts of reasons not to learn love?



Alix Spiegel: Until he was seven years old, Daniel Solomon slept sitting up. This wasn't because upright was a particularly comfortable position, or because some exotic medical condition prevented him from straightening at the waist. It was just because Daniel didn't have another option. For the first seven years of his life he lived in a crib in an orphanage in Romania with another child his age.

Daniel Solomon: His name was Niku and he was more a shy kid. He didn't really talk much. It's kind of weird, but it was fun to have him in there. I don't know what we even did. But we were there for seven and a half years and we got along, I guess.

Harry Harlow: During the day, one set of adults would feed and clean Daniel, Niku, and the other hundred or so orphans who lived in the same room. During the night there was a graveyard crew. But even though Daniel was there for seven and a half years, he can't tell you the name of any of the adults who took care of him. He didn't know any of them well enough to say.

He also can't tell you much about how he passed his time, what he thought about. He didn't go to school. He didn't go outside. He only left his crib to eat and go to the bathroom, so there wasn't a lot of material to draw from.

Daniel Solomon: There was one window where you could see the city. And I don't remember exactly when I started thinking about it, but you kind of started to think about, what is that? I'd see all these car lights and all the lights in the city. I think I started thinking about like, what is that? And why am I here, not there?

Alix Spiegel: One thing Daniel does remember is that he didn't spend a lot of his time yearning for a family, imagining some mother and father would drop from the sky to rescue him.

Daniel Solomon: No. I've seen several kids who had left and I wondered where they were going. But if I knew about it I would have wondered obviously, but you didn't know anything about it. It's like a kid who never eats chocolate doesn't know what chocolate tastes like. I didn't know what family was. I didn't think I really thought about it at all.

Alix Spiegel: In fact, the story of how Daniel came to have a family, whether or not he actually wanted one, begins with a kind of accident.

His mother, or anyway, the woman who would become his mother, Heidi Solomon, got a magazine in the mail from the adoption agency that was in the process of evaluating whether she and her husband were fit to have children.

Heidi Solomon: We were just in the beginning of our home studying when we got a magazine and it had his picture in it. And I don't really know how because there's hundreds of pictures of kids. And I just remember telling my husband, I'm like, I think this is our son. So it was just kind of weird, like for some reason his picture just kind of radiated to me.

Alix Spiegel: Five months later, Heidi and her husband Rick, drove from their home in South Euclid, Ohio, to the Cleveland Airport and took an eight hour flight to Romania to pick up their new son.

Heidi is a special education teacher by profession, and she says that she felt certain ever since she was a kid herself that she wanted to adopt children. Wanted to even though she knew that adoption could be difficult. That the kid might have developmental problems, or emotional problems, or physical problems, or all three.

Heidi believes strongly that people should do what they're capable of, and she says she felt capable of adopting a child. Rick, on the other hand, had started with a more conventional fantasy. That he would have children of his own. But Rick loved his wife, and so even though it hadn't been part of his original plan, he agreed. And he says that when he and Heidi finally walked off the plane in Romania and saw the dark-haired child dancing on the airport ramp, he felt certain that he and his wife had made the right choice.

Rick Solomon: He was just this bouncy, smiling child who was so excited. Appeared to be bright-eyed and happy. And happy to see us. And you know, I think my biggest fear going in was like, he's just going to turn his back on us and we're going to really have to fight to get his love and attention. And you know, it was not like that at all. You know, at least initially.

Alix Spiegel: The family's early weeks back in Ohio were full of firsts. The first time Daniel wore shoes. The first time Daniel slept alone in a bed. They played and danced and worked on English, and even though Daniel had some difficult moments, tantrums, and fits of crying, both Heidi and Rick will tell you that on the whole, the family had a good time. This honeymoon, however, only lasted about six months. And then, Heidi says, came March.

Heidi Solomon: Until March, I think it was moving in a manageable direction, like there were tantrums, but there was progress. And there was tantrums and progress. And then, his birthday is in March and I remember at the beginning of March he said, they don't have March in Romania because I never had a birthday before. So this whole idea of a birthday was really overwhelming to him.

Daniel Solomon: When March came around, that's when I started thinking like, about the biological things.

Alix Spiegel: You see, until his eighth birthday, Daniel had never confronted the idea that he had been born. And therefore, that he had actual parents. People who could have, had they elected to, provided a birthday party at some point before his eighth year of life. This whole concept deeply disturbed him. And even though Heidi did her best to explain the difference between biological and adoptive families, it seems that Daniel didn't get it because he walked away from that conversation fundamentally confused about his relationship to Heidi and Rick.

Daniel Solomon: I started thinking that they were my biological parents and I was really mad at them that they put me there for seven and a half years and then came and got me, like what happened? Why was I there for that long and what was going on? And that's kind of, I guess, when all hell broke loose.

Alix Spiegel: During this period, Daniel conceived a powerful hatred of his parents. A deep anger that he couldn't shake, even after the difference between biological and adoptive parents had been explained again and again, and his actual relationship to Heidi and Rick became clear. At that point, it just didn't matter. His anger had taken on a logic of its own.

"...his tantrums became tornadoes of rage. Seven, eight hour marathons where he would throw literally, anything he could get his hands on. Rick and Heidi say that he put more than a thousand holes in the walls of his room."

Once he learned about the idea of parents and what has had done to him, he needed to hate someone. And Heidi and Rick were the people closest at hand. And so his tantrums became tornadoes of rage. Seven, eight hour marathons where he would throw literally, anything he could get his hands on. Rick and Heidi say that he put more than a thousand holes in the walls of his room. Until finally, they had to move everything out of his bedroom except a mattress.

They called in professional social workers and specialists, several of whom left bleeding, needing medical attention. Remember, Daniel was eight. But really, Daniel saved the worst of it for Heidi, the person who most wanted to help him. He hated her. Appeared to take actual pleasure in her pain.

Heidi Solomon: Like one time he gave me a black eye when I was trying to help him and he smiled like he was so happy that he gave me a black eye.

Alix Spiegel: And what did you think when you saw your son smiling after?

Heidi Solomon: I thought he really needs serious help. It's very disturbing.

Daniel Solomon: There was a time where I remember my dad had hired this person to come to our house because my mom didn't feel safe with me in the house.

Alix Spiegel: Did you get that? They essentially had to hire a bodyguard. And even so, Heidi found herself calling the police several times a month, until Heidi and Rick turned to the mental health profession. They ferried Daniel from one psychiatrist to another, and religiously followed their advice.

One man told them to put Daniel on medication, pills for ADHD, which greatly improved Daniel's handwriting. But it otherwise didn't do much to help.

Another woman counseled them to buy Daniel a puppy. This also didn't work out so well.

Heidi Solomon: Like, in three days he was strangling the puppy.

Alix Spiegel: Heidi was told by at least two psychiatrists that her son would never love her. That she should give him up to foster care. Worse, the situation with Daniel began to affect Heidi's marriage to Rick.

Heidi Solomon: It was just so hard on him emotionally, dealing with this kid who made no sense at all. And I will tell you, it put our marriage on the line. I mean, there were times when he said, I'm leaving.

Rick Solomon: Looking back now, I didn't want to take that step. But I certainly thought about it, just because I was so unhappy with the whole situation. Yes, I thought about leaving.

Alix Spiegel: But Heidi wouldn't give up on Daniel. Changing her son became a kind of singular focus, an idea that obscured all other considerations.

"One time a case manager sat down and said, this is what I think's going to happen. Daniel is going to hurt you. You're going to be in the hospital. He'll be in juvenile detention and your husband's going to leave you."

Heidi Solomon: One time a case manager sat down and said, this is what I think's going to happen. Daniel is going to hurt you. You're going to be in the hospital. He'll be in juvenile detention and your husband's going to leave you.

Like, I remember that very clearly. And I looked at him, I said, does this mean we hit bottom and we can start moving up now? That was just my response. I'm like, OK, that's your thing. What do we need to do to get better? I understand what the situation is.

Alix Spiegel: Would you have sacrificed your marriage?

Heidi Solomon: I didn't want to.

Alix Spiegel: The portrait that you're painting is you had to take everything out of his room. At a certain point, you kind of hired a bodyguard. It put a strain on your marriage. You called the police regularly.

Heidi Solomon: When you're saying it and I said-- I mean, I feel like, OK, like I'm crazy when you say everything in that list. It's not like I was with the bodyguard and I'm thinking, like, wow, last week. I wasn't like always putting everything together in a list like that. This is the way our life was. So I just did it. I'm like a really stubborn person.

Alix Spiegel: Then one day after school when Heidi was busy making a snack for Daniel in the kitchen, he grabbed a knife from the counter and held it to Heidi's throat.

No one in the family likes to talk about this episode. It clearly frightened both of them. The only thing Heidi's comfortable saying about it now is that the experience convinced her to reconsider the way she went about Daniel's education.

Heidi Solomon: I stopped doing any kind of tutoring with him at all for a long time. Because I said, I don't want him to learn how to read. Because this is around the time when Columbine happened and I was like, it's really good that he can't get any information on his own.

Alix Spiegel: Did you feel like Daniel was homicidal at any point?

Heidi Solomon: Well, I was told he was homicidal.

Alix Spiegel: How do you love somebody who is homicidal?

Heidi Solomon: Well, because he was my son. I mean, you have to love him or else there's no way out of it. It's like, if you're lost, you want to keep moving forward to get to the end place. I don't think I ever questioned my love.

Alix Spiegel: Heidi says the only time she did question whether or not she should keep Daniel was when she thought about the possibility of Daniel hurting someone else, a fear that became more pronounced in the wake of an outside incident that happened around Daniel's 10th birthday. By that point, Daniel had been given the diagnosis, attachment disorder. Meaning his primary problem was that he was unable to feel connected to other people.

Heidi knew another kid who had been diagnosed with attachment disorder. She'd met him through her work, and had been so impressed with him that she actually asked the kid who was slightly older than Daniel, to be his big brother.

Heidi Solomon: I thought he was doing really well, Like he'd been featured in the newspaper, he delivered Meals on Wheels. And then it was President's weekend of 2000, he committed murder. Like, I mean, he came home and just sat down on his parents' couch that night after cold-blooded murder without any emotion at all. I think I'd seen him the day before.

It was horrifying in many levels, like I'd worked with this kid. It was on that whole professional level. But it was horrifying to me personally because I was like, oh my God, here was a kid with attachment disorder that I thought was doing better and this is how sick he really is. I was like, I will never be comfortable with Daniel.

Alix Spiegel: Heidi was coming to believe something that frightened her. She was coming to believe that because kids with attachment disorder couldn't connect to other people, they couldn't feel empathy. And without empathy, they didn't possess a really important human quality.

Heidi Solomon: The bottom line is these people, like people who attachment disorder, they don't develop a conscience and they have the ability to hurt other people without feeling guilty. That's really dangerous.

Alix Spiegel: Heidi wanted her son to have a conscience. She didn't want him to be dangerous. And so she began to call around to find out more about aggressive treatments for the problem.

.....................................................................

The treatment of attachment disorder has a long and controversial history. Such a controversial history that many of the people who practice versions of the therapy declined to use its name. It was started in the mid '70s by a psychiatrist named Foster Cline, who felt that children who acted out because of an inability to connect to their parents should be forcibly regressed. Made to feel helpless and hopeless, so they'd return to a baby-like dependence.

Early versions of the therapy involved berating children, poking them, and physically subduing them by holding them down. Therapists would sometimes direct profanity at a child and also have the child direct profanity at them. Cline, himself, acknowledged that this was so harsh it was often difficult even for professionals to watch. But when outsiders criticized the treatment as sadistic, Cline responded that, quote, "These children need the kind of love that forces them to love others."

After the '70s though, the therapy changed substantially. Particularly after a couple of children died from being smothered in blankets. And by the time Heidi started hunting for something to help Daniel, most of the extreme methods of attachment therapy had been abandoned. So when Heidi heard about the doctor in Virginia who appeared to have had some success with a highly intensive program related to attachment therapy, she leapt at the opportunity.

.....................................................................

According to the doctor, Ronald Federici, mother and child needed to spend several months side by side, literally no farther than three feet apart.

Heidi Solomon: The goal of his plan is to try to recreate the bond that never occurred because I wasn't with him when he was born. But it'd be very natural for a newborn baby to spend an extensive amount of time just next to the mom, and so you're trying to recreate that attachment. So Daniel and I were like three feet apart for about eight weeks.

Daniel Solomon: I didn't go to school. She stopped her job. When she would go to the bathroom I would be right outside a door. When I went to the bathroom, she'd be right outside a door. The only time she was not next to me is when I was sleeping. And like literally, that was it.

Alix Spiegel: But it wasn't just being side by side, there were other elements to the program, like eye contact. Federici felt that because mothers and their babies spend a large amount of time just staring into each other's eyes, it was important for Heidi and Daniel to do the same. Daniel was required to look into Heidi's eyes during every interaction they had. And neither of them were allowed to move onto the next activity until Daniel did it correctly.

Heidi Solomon: Like if I was talking to him, I would keep repeating what I was saying until he made correct eye contact. I remember one time we spent like 20 minutes, him handing me a notebook. And part of it also is he is not allowed to ask for anything. He couldn't ask because babies don't ask for anything. They learn that they're going to have their needs provided for. So it's not that he couldn't have a treat or he couldn't have every-- he just couldn't ask. Like we went to the store, could not ask for anything. Because he had to learn that I was going to provide for him what he needed.

Alix Spiegel: Predictably, Daniel resisted the program.

Daniel Solomon: I hated it. I totally, absolutely hated it. I did every single thing not to do it.

Alix Spiegel: The problem was, every time Daniel resisted treatment, he was subjected to yet another program dictated activity. Time ins, the alternative universe version of time outs. The idea is that since kids with attachment disorder prefer to be alone, every time they do something bad, the response should be to make them spend even more time even closer together.

Heidi Solomon: Like we would sit on the coach and I would hug him. That was his punishment.

Alix Spiegel: Like he said, at first Daniel hated the treatment. And at least initially, his behavior actually deteriorated. But then something happened.

Daniel Solomon: I think it was around the third week that I actually-- like I was with her more. I think I realized that she's not as bad as I thought she was. This is kind of when it kind of changed. I didn't have as much time to hate her, I guess. And so I kind of liked her a little more. Like before she would tell me not to do this, so then for 45 minutes I would hate her because she told me not to do this. Well, there wasn't a time where I could just like go somewhere else and hate her. I was next to her. I had to live with her whether I liked her or not. Just something changed.

Alix Spiegel: Daniel says he actually came to understand, maybe for the first time, that his mother loved him. The realization just dawned on him in a different way.

Both Heidi and Daniel will say that after eight weeks Daniel was cured of his violent behavior. It was gone. Done. No more tantrums, no more throwing, no more threats. But there were still problems. Instead of acting out against his parents, Daniel started stealing. At first, just small items from the local store. But it got worse.

After one particularly bad episode where Daniel nearly ended up in juvie, Heidi decided it was time to go back to therapy. There was a center near their home called the Attachment and Bonding Center, run by a guy named Greg Keck. Keck proposed a program that was in some ways similar to the three feet plan. In addition to regular counseling, Daniel, who was now 13 and larger than his mother, would participate in holding therapy. That is, every night for a year, 20 minutes a night, Daniel, Heidi, and Rick were supposed to hold onto each other and talk. Rick and Heidi cradling Daniel like a newborn child, which is exactly what they did.


Heidi Solomon: Even though he was really big, I would try to cradle him on my lap. Or it was really both Rick and I because he would take up both of our laps. And I would look into his eyes the same way you would with a baby and you make eye contact. And we would feed him with a spoon-- ice cream. That's what we'd have to do to get him-- because he liked ice cream.

Daniel Solomon: It definitely feels really weird. Like, what is this?

Alix Spiegel: How did that change the way you felt about them?

Daniel Solomon: Well, it was like, they were feeding my ice cream, so I was like, OK, fine. But it was like that's when I actually first started to be able to talk about what I was feeling.

Alix Spiegel: For the first time, Daniel really talked about his experience in the orphanage, opened himself up. And maybe it was the holding and maybe it was the fact that the Attachment and Bonding Center gave Daniel a therapist he says he actually trusted who led him through the process. But for one reason or another, Daniel began to transform. There wasn't a specific moment anyone can point to. If Daniel had gone bad in one month, the going good was a lot more gradual. Without anyone quite noticing, he began to help around the house. They were able to move furniture back into his room. He started to make friends his own age.

Then four months ago, the rabbi of their synagogue called Heidi to tell her that Daniel had won something called the [? Brickner ?] Award. The [? Brickner ?] is given to the valedictorian of the confirmation class, and it's a huge honor for anyone. But in the case of Daniel, it had particular weight.

Heidi had taken Daniel to synagogue initially because she thought that it would help them to develop morals. But the training didn't take. Daniel spent several years being removed from the temple in police cars. At one point, he was actually banned from going to services. So as far as everyone, including Daniel was concerned, the fact that he got the honor constituted a minor miracle.

One element of the award is that the winner gets to make a speech in front of the entire congregation. And Daniel told Heidi and Rick that he wanted them to think of his speech as a gift. And so when Daniel took the stage, the whole family was there.

Daniel Solomon: I spent my first half of my childhood in an orphanage in Romania. So for those years, I had no family, no love, no fun, no music, and no toys.

Alix Spiegel: Daniel talked about his early life and all the trouble he'd gone through since. And during most of the talk he was smooth and composed. But then he got to the end. And even from the audience, it was clear that Daniel was shaking, struggling to keep his voice under control.

Daniel Solomon: Before I finish, I'd like to thank two people, my mom and dad. The reason that I'm here today and the kind of person I am today is because of you. Mom, I can never thank you enough for all the places you have taken me to, even when I absolutely refused to go to somehow have fun when I got there.

Dad, you're one heck of a guy to put up with a crazy family like this. And you guys are both amazing. I love you very much.

Alix Spiegel: It was Heidi says, without doubt, the most spectacular moment of her life.

The question of whether or not it's possible to teach love is not an academic one. There are plenty of people who will face this issue.

Adoption these days is on the rise. Most of these children will be fine, but some of them won't. And at least on its face, the story of Heidi and Rick and Daniel seems to offer an encouraging example. Heidi and Rick were able to take a seven year old with no direct experience of adult affection, and with a certain amount of pain and suffering, turn him into a loving son. The only problem is that the actual participants in this story see things differently.

Alix Spiegel: Do you feel like you can teach love?

Heidi Solomon: No.

Alix Spiegel: See, Heidi actually has a very humble view of what is and is not possible. What should and should not be expected as far as love is concerned. In fact, she tells me that in her own mind what she wanted from Daniel all along was very, very modest.

Heidi Solomon: I don't think the goal was ever love. The goal was attachment.

Alix Spiegel: Do you feel like you can teach attachment?

Heidi Solomon: I mean I think you can work really hard to create an environment where you can form attachment. You want to create these situations where it's more advantageous for them to attach than to keep doing things their own way and being in their own world. Isolated.

Alix Spiegel: Heidi seems utterly practical about the whole thing, even about whether or not her son now loves her.

Alix Spiegel: Do you feel loved by Daniel?

Heidi Solomon: Yeah, I feel loved by Daniel.

Alix Spiegel: Like in a way that you--

Heidi Solomon: I don't think he wants to hurt me. I don't worry about that at all.

Alix Spiegel: "I don't think he wants to hurt me. I don't worry about that at all."

It's a very unsentimental view of her relationship with her child. But that is probably exactly what had made Heidi so successful. That is, Heidi is an unusually pragmatic person. She's not a flowering earth mother with a wealth of love to give. She is fundamentally realistic, tough-minded. And these are precisely the characteristics that are needed in this situation.

If you're the kind of person who actually needs love, really needs love, chances are you're not the kind of person who's going to have the wherewithal to create it. Creating love is not for the soft and sentimental among us. Love is a tough business.

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