Private Eyes

Strange, considering the dedication she’d shown in arranging the referral, but everything related to this case smacked of strange, and I’d gotten used to it.

Remembering what Eileen had told me about Melissa’s fulminating school phobia, I asked Melissa the name of her school, looked up the number, and called it. Presenting myself as her doctor and not clarifying when the clerk assumed pediatrician, I asked to speak with Melissa’s teacher- a Mrs. Vera Adler, who confirmed that Melissa had missed a good deal of school early in the semester but since then her attendance had been perfect and her “social life” seemed better.

“Was she having social problems, Mrs. Adler?”

“I wouldn’t say that, no. I mean, she was never a problem of any sort, Doctor. But she wasn’t the most outgoing child- kind of shy. Off in her own world. Now she mixes more. Was she ill before, Doctor?”

“Just the usual stuff,” I said. “Just following up.”

“Well, she’s doing fine. We were starting to worry, she was absent so much, but she’s fine now. A very nice, extremely bright little girl- she tests out on the Iowa at the ninety-ninth percentile. We’re so glad she’s gotten adjusted…”

I thanked her and hung up, heartened. Said to hell with the grown-ups and continued to do my job.

By the fourth month of treatment, Melissa was treating the office as if it were a second home. Sauntering in smiling, making a beeline for the drawing table. She knew every cranny, could tell when a book had been moved from its usual place, was quick to put it back. Restoring. Showing an unusual eye for detail that jibed with the perceptual sensitivity Dutchy had described.

A child whose senses ran on full throttle. For her, life would never be boring. Could it ever be tranquil?

As the fifth month began she announced she was ready to talk again. Informing me that she wanted to be a team- just like I’d said at the beginning.

“Sure. What would you like to work on?”

“The dark.”

I rolled up my sleeves, ready to muster every kernel of wisdom I’d gathered since grad school. First I taught her to recognize the physical warning signs of anxiety- how she felt when the fear came on. Then I trained her in deep relaxation that evolved into full-blown hypnosis because of her ease at drifting into imagery. She learned self-hypnosis in a single session, could sink into trance within seconds. I supplied her with finger signals she could use to communicate while under, and finally began the desensitization process.

Seating her in a chair, I told her to close her eyes and imagine herself sitting in the dark. A dark room. Watching as her body grew taut and her index finger popped up, I warded off the tension with suggestions of deep calm and well-being. When she’d relaxed once more, I had her return to the dark room. On/off, over and over again, until she could tolerate the image. After a week or so, she’d mastered the imaginary darkness and was ready to tackle the real enemy.

I drew the outer office drapes and manipulated the light-switch rheostat, getting her accustomed to gradually increasing dimness. Stretching the time that she sat in partial darkness and reacting to evidence of tension with instructions for deeper and deeper relaxation.

Eleven sessions into the treatment, I was able to pull the blackout drapes closed, plunging both of us into total darkness. Counting the seconds out loud and homing in on the sound of her breathing. Ready to move in at the merest catch or quickening, determined she’d never experience prolonged anxiety.

Rewarding each success with high praise and low art- cheap plastic toys that I bought in bulk at the five-and- dime. They thrilled her.

By the end of the month, she could sit in blackness- which sometimes made me lose my balance- for an entire session, free of tension, chatting about school.

Soon, she was as nocturnal as a bat. I suggested it might be a good time to work on her sleep. She smiled and agreed.

I was especially eager, because this was my bailiwick. During my internship I’d been presented with several cases of children with chronic night terrors and had been impressed with the level of disruption the episodes caused in kids and their families. But none of the psychologists or psychiatrists at the hospital knew how to treat the disorder. Officially, there was no treatment other than tranquilizers and sedatives whose effects were unpredictable in children.

I went to the hospital library, chased down references, found plenty of theory but nothing about treatment. Frustrated, I sat for a long time thinking and decided to try something outlandish: operant conditioning. Bald behavior therapy. Reward the children for not having terrors and see what happened.

Simple-minded- almost crude. Theoretically, it made no sense. As the senior staff was quick to inform me over their fuming pipes. How could unconscious behavior- arousal from profoundly deep sleep- be consciously manipulated? What could voluntary conditioning accomplish in the face of hard-wired deviance?

But research had emerged recently that suggested greater voluntary control over body function than had ever been imagined: patients learning how to raise and lower skin temperature and blood pressure, even mask severe pain. At Psychiatric Case Conference, I asked for permission to try to decondition night terrors, arguing that there was nothing to lose. A lot of head-shaking and words of discouragement, but consent was granted.

It worked. All my patients got better and stayed better. The senior staff started implementing my plan with their patients and achieved similar results. The chief psychologist told me to write it up for a scientific journal, listing him as co-author. I sent the article in, overcame skeptical reviewers with columns of numbers and statistical tests, and got published. Within a year other therapists had begun to replicate my findings. I received requests for reprints and phone calls from all over the world, was asked to give lectures.

Had been doing just that the day Eileen Wagner had approached. It was the lecture that had led me to Melissa.

And now Melissa was ready to be treated by the expert. But there was a problem: The technique- my technique- depended upon family cooperation. Someone needed to monitor the patient’s sleep pattern precisely.

I buttonholed Dutchy on a Friday afternoon, before he had a chance to dash away. He gave a resigned look and said, “What is it, Doctor?”

I handed him a pad of graph paper and two sharpened pencils and, adopting the demeanor of a full professor, gave him his orders: Before bedtime, Melissa was to practice relaxation. He wasn’t to badger or remind her; it would be her responsibility. His job was to record the occurrence and frequency of night terrors. Nights without terrors were to be rewarded the following morning with one of the trinkets she seemed to love so much. Nights following terrors were not to be commented on.

“But, Doctor,” he said, “she’s not having them.”

“Not having what?”

“The terrors. Her sleep’s been perfectly calm for weeks. The bed-wetting’s also ceased.”

I looked over at Melissa. She’d stepped behind him. Half a small face peeked out. Enough for me to see the smile.

Pure joy. Reveling in her secret, as if it were confection.

That made sense. The way she’d been brought up, secrets were the coin of the realm.

“The change has really been quite… remarkable,” Dutchy was saying. “That’s why I didn’t feel it was necessary to-”

I said, “I’m really proud of you, Melissa.”

“I’m proud of you, Dr. Delaware,” she said, starting to giggle. “We’re an excellent team.”

***

She continued to get better more rapidly than science could explain. Leapfrogging over my clinical games plans.

Healing herself.

Magic, one of my wiser supervisors had once said. Sometimes they’ll get better and you won’t know why. Before you’ve even started doing what you think is so goddam clever and hotshot