“My husband left
home last month, partly because of our youngest son, Steven, aged 7, who is
severely learning disabled. Steven’s head-banging has got worse to the extent
of knocking himself out and there seems to be nowhere for him to go except in
and out of hospital with people saying I should expect this because of his
handicap. I can’t manage on my own but don’t want to have to send him away.”
Mrs
Y.W.
Children often
experience a marriage break- up as something they have caused by their own bad
thoughts and behaviour. They cannot understand that their parents are separate
beings involved in their own problems. Children with a learning disability can
feel even more to blame when a parent leaves. Their fear that they have caused
the difficulty is compounded because the rest of the family often agree and,
like Mrs Y.W., see it as an external reality. An untreated reservoir of guilt
in both child and parents about the existence of learning disability can play a
corrosive part here pointing to the need for support at the earliest stages.
Problems of extreme
self-injury are painful to witness and difficult and dangerous to manage. Few
places wish to deal with this, especially when there is staff shortage and lack
of staff support. Head-banging, eye-poking, self-mutilating may initially
appear alien and frightening. However, the problem is a familiar one. Daniel,
aged 16, an intellectually gifted adolescent, failed all his GCSE’s when his
father left home. His attacks to his head were silent yet they knocked him out
educationally as powerfully as Steven’s blows knock him out physically. Marie,
aged 25, had 3 broken engagements and a new partner almost every week. Her
attacks on her capacity to be part of a couple knocked out her partners and
herself emotionally. However, when the method of self-attack takes a different
form we hear, as Mrs Y.W. does “It’s because of the learning disability”.
Sarah, aged 20,
a profoundly learning disabled young woman, blinded herself in one eye after
her mother had died. She was in a hostel where her workers did not think she
understood the concept of death. They never discussed with her why her mother
had stopped coming. It took support for the staff before they could realise
that Sarah’s action had meaning and was not because of her learning disability.
Such views strip all meaning from behaviour as well as being wrong. Disability
can wear away emotional resources leaving the individual vulnerable to
emotional disturbance but it does not cause the behaviour; nor does lack of
cognitive intelligence take away from an individual’s capacity to emotionally
understand what is happening around them.
Mrs Y.W. has
understood there is meaning in the timing of Steven’s behaviour and perhaps she
can discuss this with him, but she rightly points to an appalling lack of
national provision and she needs help now. Bethlem Royal Hospital researchers
Murphy, Oliver & Corbett found that out of 596 self-injuring children and
adults in one region only 12 were receiving any kind of psychological treatment
yet pioneering services are facing cuts.
How can Mrs Y.W.
manage? Professor Kolvin comments, “there is no possibility that children with
such multiple and acute problems can be assessed and managed appropriately
without such a training and research resource as Hilda Lewis House and there are
few places in the UK that can deal with such serious problems in the short term
whilst arranging plans and care in the long-term”.
The Hilda Lewis
House considers that families like the Y.W.’s need the broad-based service that
combines weekday residential treatment (in order to keep the family contact at
weekends), support for parents and community links. They add that “Head banging
is common in normal small children and rarely persists but it can be more
persistent in severely learning disabled children. It matters a great deal to
find the meaning of the behaviour. Sometimes there is an untreated underlying
depression”.
However, despite
the scarcity of provision, there has been inspiring co-operation between the
few psychoanalytical and behavioural psychotherapists specialising in this
work, which bodes well for the future. However, until there is adequate funding
on a national level for this work, Mrs Y.W. and Steven will receive patchy
support.