Ambiguous Expectations

An American friend who worked in Hollywood for years tells some incredible stories about the perils of celebrity.  Fame and money can play havoc with the human spirit as much as neglect and destitution can.  We all develop behaviours matching what we have learned to believe about ourselves.  In destitution, behaviours relate to excessively low expectations, while in celebrity they relate to excessively high expectations.  Which is not to say that every destitute person has low self esteem, or that every famous or rich person is arrogant.  But that these are risks associated with people who find themselves living an extreme existence.

En route to our English lesson the other day we had an interesting discussion about the criticisms of volunteering with children in third world countries.  The concerns and opinions which I’ve shared on previous blog entries are many, real and valid, but some of them are not clear cut.  For example, to volunteer with orphaned babies in institutions where they are lined up in rows of cots, receiving minimal attention or care.  Devoting a period of time in your life to feed and care for these babies seems a wholesome endeavour, offering human interaction and stimulation which they otherwise do not receive.  Such neglect in infancy can have drastic consequences reverberating throughout a person’s life, explained so well in Dr Bruce Perry’s book The Boy Who Was Raised As A Dog: And Other Stories From A Child Psychiatrist’s Notebook. In his book Dr Perry shares some phenomenal experiences and insights into the behaviour of people who are traumatised at critical times in their childhood and it is a fascinating read.   However volunteering in this way also means you are bonding with a child and then abandoning them, which can likewise contribute to known and predictable psychological disturbances.  Similar arguments can be made about volunteering as an untrained English teacher.  For example, would you want your children being taught by someone without adequate training?  It would seem indisputable at first glance.  But what if your only other option was no English lessons at all?  And what of the high value that is placed in many parts of the non-English-speaking world, of exposure to native English speakers?

These are some of the questions I grapple with during my various Cambodian endeavours.  No single undertaking is without debate around it’s impact.  The contribution Medecins Sans Frontieres makes is a good example.  We enter a country with the intent of making a difference and there is no doubt that significant and positive differences are made.  But there are pitfalls.  For example we adhere to local labour laws, which often exist only on paper and are not implemented either at all, or well, in struggling local systems.  We apply national-standard minimum wages and employment conditions which are often markedly different to those of local government employees.  This establishes a two-tier system which may in turn create a dynamic between, for example, MSF and Ministry Of Health (MOH) staff who work alongside each other.  Staff with identical roles and responsibilities may have quite inequitable conditions.  Then, once our intended goals are completed we implement an exit strategy and depart, usually leaving behind many suddenly-unemployed ex-staff in a struggling economy which cannot sustain it’s workforce.  In my recent experience, once the exit strategy enters the agenda, local staff become anxious and stressed about their imminent future.  The repercussions can be much more far-reaching, affecting patient confidence in the system, service quality as staff leave, and many other related issues.

The other night during a visit with the little boy at Shackville, I asked his mother if I could photograph him.  She agreed and instructed him to put his infected stump up so that it was in the photograph!  Taken aback, I got a great shot of his handsome little face, managing to avoid any unnecessary pictorial evidence of the amputation site.  I showed her the photograph and will give her a copy, so she knows I did not photograph his stump.  Perhaps she believed I wanted a photograph of his injury in order to show others who may be able to help their plight, although I could not be sure.  When I have offered assistance to those in dire need, I have credited it to an overseas friend, often because I have received a donation from generous family and friends wanting to help, but also in order to demonstrate that I have limitations, relying as I do on others to help.  This seems effective in ensuring I am not seen as some sort of “boundless benefactor”.  A logical reaction to this might be attempts to connect through me, to distant and unknown people?

Suffering in Cambodia is conspicuous and beggars are prevalent in comparison to the first world where some level of security is in place for vulnerable people.  Although many beggars are disabled in some way, it is rare here (although not altogether absent, especially in the tourist areas) to see disabilities used brazenly for the purposes of begging.  This is in comparison with other places which I have not visited, where I understand disabilities have a worth attached to them based on the sympathy and donations they can garner from strangers, making the disabled vulnerable to all kinds of shocking abuse.  So while I want to contribute to the life of this little boy, the last thing I want is to influence him or his family to perceive his disability as some sort of cash cow.  Yet if I had not noticed his disability, I would never have approached his mother to ask about him.  So have I already turned his disability into a meal ticket of sorts?

Despite the risks of negative consequences, I firmly believe in engaging with people in need and helping when possible.  Unwanted repercussions can be minimised by being informed and reflecting on our actions and their consequences.  During a recent meeting with the Board of Directors at the orphanage some thought-provoking debates played out between members who feel very strongly about not teaching the children to have high expectations which, once they are living as independent adults, they will not be able to sustain; and other members who feel equally strongly that it is healthy and positive to give the children the confidence and insight to pursue higher dreams.  We were not debating highly unrealistic goals, but rather what prospects should be considered attainable for children from impoverished circumstances, living with a stigmatising chronic disease who are clearly going to face many harsh challenges in life.  I don’t know where I stand on the “Expectations Spectrum”, but it was an absorbing and contemplative debate which I felt privileged to be part of.

Contact between “us” in the wealthy world and “them” in the developing world is no longer a distant and unlikely thing, thanks to the internet.  As the most popular social networking site with almost 100 million users, Facebook is an excellent example.  I follow various Facebook pages, including a number of charities who regularly post messages and photographs to promote the work they do.  This is great publicity for an organisation who rely on donations in order to continue operating.  But it also serves a more important purpose, connecting human beings.  People from far-away places can watch and comment and I regularly read people wanting to reach out and help – asking how to volunteer, how to donate, or sending messages of hope, support and encouragement to individuals whose stories and circumstances touch them.  This is a doorway which, without the internet, would never have been open to so many of us (or to the people who benefit from these organisations).

One of my favourite Facebook pages is Humans of New York (HONY), a photography page started by a young guy called Brandon after he lost his well paid job in Chicago.  He bought a camera and embarked on a tour of America, taking portrait photographs of people he encountered in the street and posting the photographs to a Facebook page.  He asked his friends to like the Facebook page and slowly acquired a small online audience.   When he landed in New York the venture took on a life of it’s own, as to be expected in New York!  He began recording conversations he had with the people he photographed and adding short quotes as a caption to each portrait.  This connected his audience to the subjects of his photographs and the popularity of his page snowballed.  He now has almost 10 million Facebook followers.

Brandon is currently on a United Nations-sponsored “world tour” to ten countries.  With four or five days in each country, he started in Kurdistan about two weeks ago and has since been to other parts of Iraq, as well as Jordan, Democratic Republic of Congo and Kenya, where his most recent photographs were posted from.  He will circumnavigate the globe, touching down to meet and photograph people in various impoverished locations as far apart as Ukraine to Haiti.  The aim of this trip is to promote the United Nations Millenium Development Goals.  There are eight MDGs,  attempting to end poverty and improve life for the world’s most impoverished people.  Read more about them here:

Following the HONY theme, Brandon’s captioned photographs on this global endeavour connects us to people who we would not otherwise encounter.  Brandon’s own words about this project are “Those are the places that have the most extreme headlines coming out… Those are the places most skewed in people’s heads. The work has a very humanizing effect in places that are misunderstood or feared.”  Like thousands of others I enjoy following his journey, “meeting” some of his subjects and learning a little of their lives.  Thanks to Brandon and the UN I’ve met children crowded together on the back of a parked utility truck, waving, hugging and posing excitedly like many scenes I’ve seen in both Central Australia and Cambodia, only these faces are Caucasian instead of Black or Asian; a legless man sitting on the ground in Nairobi describing the impact his disability had on his (non) education; men and women in war torn countries pursuing higher educations in order to contribute to the growth and development of their nations; and so many others who are just people like you and me but born into difficulties that we have never had the misfortune of experiencing.

Perhaps a year ago Brandon posted a picture from Washington Square Park in the affluent Greenwich Village suburb of Manhattan, of a little boy sitting with his mother on a path I recognised as adjacent to an apartment block where Eleanor Roosevelt once resided and surrounded by apartments now inhabited by New York University academics and professors.  A mat was stretched in front of them with “cowboy supplies” displayed for sale.  The little boy wanted to raise money to buy himself a horse and by the end of that day he had earned US$1 towards his goal.  Living in a small city apartment with no extra money meant this was an impossible ambition, but despite this his mother was supporting her son to pursue his dream.  Brandon posted the photograph and caption to Facebook.  An amazing thing then happened – his followers banded together and raised enough money for the boy to go on a horse riding holiday!

The generosity of his readers continues today, with connections being sought from his audience to his subjects daily.  As one of very many examples, this morning a young Kenyan woman’s portrait caption reads: I’d been studying German for a few years, and I met this woman who gave me the opportunity to go to Germany for a full year. The brochure looked very nice. The program included hikes, volunteer work, singing in church. It was very expensive, but my family thought it would be a great experience for me, so all my relatives chipped in to pay the program fee. I was so excited for months. On the day that I was supposed to leave, I went to the airport, and waited in line to check my baggage. When I got to the front of the line, they told me that my ticket was a forgery. When I tried to call the woman’s phone, it had been disconnected.”  A frenzy of overtures has arrived from HONY.  Offers to buy her a plane ticket, to represent her legally, to host her in Germany and all sorts of other contributions are being hurled at poor Brandon!

He doesn’t acknowledge publicly whether he can follow up on these offers.  I suspect that he cannot because the intention of his work is actually not to alleviate the suffering of random individuals he happens across, but to raise awareness of a global situation.  The enthusiasm shown by his readers wanting to support underprivileged people wherever they are, is an inspiring testimony of the natural tendency humans have towards compassion and philanthropy.  Translating these qualities into acts that actually benefit the most people in the most meaningful way seems to be where the challenge lies, as our need to connect is so firmly entwined with our desire to contribute.

With all of the atrocities that the internet has received notoriety for, it seems to me that social networking also provides us with the possibility of meaningful connections which could literally revolutionise the world?  That’s my hopeful expectation for today’s information superhighway, anyway.


The Boy Who Was Raised As a Dog

The last time I wrote a book review, was probably in the mid 1980s when I had to for school.  So I don’t know how this will go, but it’s worth trying, because the book was great.

Some months ago, when I was still fostering, I was talking to a social worker about things, and she recommended I read Dr Bruce Perry’s work.  A few weeks later I came home from work and a pile of books had been left at my front door.  I’ve just finished The Boy Who Was Raised As A Dog, a series of case studies about different traumatised children Dr Perry has dealt with over the years.

Dr Perry is an American psychiatrist who has undertaken a lot of research in neuroscience specific to childhood trauma.  He founded (I believe) the Child Trauma Academy in Texas, a not-for-profit organisation involved in clinical care of traumatised children, as well as research and health professional education on the issue.

The Boy Who Was Raised As A Dog reveals the stories of a small number of the children Dr Perry has helped.  He outlines their traumatic experiences, how these experiences impacted on the childrens’ neurological development, from a physiological perspective and how this abnormal physiology can explain the behaviours displayed by each child, and then how and why he and his colleagues implemented treatment which helped (or in some cases, didn’t help) the children.

Throughout the book he discusses the development of the human brain, and how traumatic experiences can interrupt normal development leading to delayed, unusual and / or disordered behaviours.

For years I’ve argued with people that many children and young adults misbehave due, at least in part, to disadvantaged upbringings.  But it’s not really disadvantage, which was an unsophisticated way of describing it.  It’s exposure to traumatic experiences which affects our neuro-physiology, which in turn affects our psychology.  Anyone living in socio-economic disadvantage has an increased risk of traumatic experiences by the very nature of such an existence.  Poverty, overcrowding, exposure to mental illness and substance abuse, exposure to stressful situations such as financial hardship and hunger, domestic violence, and lack of stability, are all things which increase any child’s risk of exposure to traumatic experiences, and simultaneousy reduces their chances at access to decent support systems to compensate.

Dr Perry takes it a step further though, explaining that it depends when you are exposed, to what type of trauma or neglect, how often you are exposed and at which stages of your brain development throughout childhood, as to how a child may or may not be affected.  For example, a newborn who is severely neglected from his first days of life will have very different brain development processes, than a toddler who had some time for healthy processes to occur prior to being neglected.  He discusses two such cases – one young man who is severely dysfunctional (and has committed a double murder) after experiencing severe neglect throughout his infant years, and one young man who displays unusual but endearing behaviours after experiencing a healthy first year or so of life before being left for long periods of time during his older infant years.

There is, as you might expect, a story about a boy who is raised for around 5 years with an elderly man who worked as a dog breeder. When the elderly man inherited the care of this baby via some convoluted family connections, he kept the baby in a dog cage, with very little human interaction, through a lack of understanding rather than any desire to cause harm to the baby, who he wasn’t able to care for properly.  There is also a chapter on the child survivors of the Waco Massacre, and how and why they were treated together in the first few weeks after their release from captivity by Dr Perry and his colleagues.

The eleven chapters each tell a different story, each very different and informative in varied, but inter-connected ways.  Anyone who works with or has any kind of contact with children who have, or are at risk of having, traumatic experiences, would find the stories and explanations in this book as invaluable as I have.

At the same time as reading this book I undertook an online Psychology course and learned about the human brain, another informative experience.  The way that the spinal column leads up to the brain stem, our most primitive brain area which we share with reptiles.  This area of the brain is responsible for very basic processes such as maintaining temperature and blood pressure, breathing, digestion, etc.

With evolution, our brain developed further, with the limbic system which is involved in formation of memories and emotions.  Then the “neocortex” developed, and is involved with more sophisticated things such as language, perception, awareness of others’ feelings, etc.

The way that these different areas develop through childhood means that the brain of a child is highly – far more than I ever imagined – sensitive to, and affected by, the experiences that occur during childhood. When in childhood the traumatic experience occurs, and how the child presents to the clinician, determines the treatment significantly. Dr Perry uses what he calls “neurosequential treatment”, whereby the child’s brain is literally “mapped”, and the areas of the brain which are underdeveloped (due to neglect) or shut-down (due to exposure to trauma) are identified, and then given appropriate attention to promote healing. This may be as simple as rocking an older child back and forth repeatedly in a loving way, as an infant experiences regularly with their mother in normal experience, if the child is found to have missed out on such nurturing during infancy. Or it could be teaching a teenager who is self harming – which I learned is a very effective way for some, to block out bad memories of abuse – ways to “zone out” which don’t involve self-harm.

It has evoked memories for me, of a boy I nursed almost fifteen years ago who when he was admitted to hospital at around age 6, was found to have been living in a pen with pigs.  He was removed from the family and came to hospital whilst alternative care was arranged, which in the time I was involved, didn’t happen and he remained hospitalised for a prolonged period of time.  He could not speak, did not know how to shower or dress himself, and had many very odd behaviours.  But in the couple of months that I knew him, he improved significantly simply by having contact with familiar people.  He learned to follow basic commands, and bonded with a number of the nurses caring for him.  He would be close to 20 years old now, and I often wonder what became of him.

Since that time I’ve had a lot to do with many traumatised children, and I wish that years ago, I knew the few basic concepts that I have learned from my reading and studies in recent times.  It was interesting to hear Dr Perry describe how little was understood in the 1990s, and how much research has occurred since then.  Child psychology and psychiatry has advanced in leaps and bounds since then, and despite having so much more to learn, advances in the field have had a major impact on what help is now available for those children who are lucky enough to engage with professionals  in the system.  Unfortunately many children in need of such help never encounter it because they don’t access or remain engaged with the systems in which psychologists, psychiatrists and social workers work.  The children with highest need also don’t tend to remain well engaged in schools, where teachers may have the appropriate training to make a difference.

Those of us lucky enough to lead stable, happy childhoods are far less likely to end up with psychological problems, than those exposed to misery, deprivation, fear, violence, etc. Dr Perry also talks about the role that genetics and other influences have, and is very clear about the fact that every individual is different. But the brain development processes that occur in each of us during childhood, are a dominant consideration. It makes complete sense intuitively, yet learning about the processes that occur during childhood trauma, and stories of children whose brain development has been disrupted, and then learning that there are often effective ways to treat the resulting symptoms for many children, was really enthralling and I recommend the book to anyone interested in childhood and / or social psychology.

Boy Who Was Raised as a Dog