For some time before and since my retirement from private practice as a psychoanalyst in 1993, I have been visiting innercity public schools to volunteer my services as a consultant. My training and experience as an analyst informs everything I do in that role. In particular it helps me to recognize negative transferences and ambivalence, and to help school staff work through these feelings. It helps me see the problems of school staff from their point of view.
It would be arrogant to suggest that being an analyst is a requirement for such work — I have seen other gifted people without such education making remarkable contributions. But as an analyst I have a language for describing the processes. It also helps me in the seminars with the residents in psychiatry who are consultants in the program. I encourage them to explore their emotional reactions, biases, prejudices, and transferences, both positive and negative, as these experiences develop. Toward this end, having an analytic perspective is extremely important.
The volunteer consultation program I now chair was developed by Bruce Sklarew and me when we were cochairs of a mental health subcommittee of the “Goals for Healthy 2000” Committee. We thought we might be able to help the most by working with school principals, counselors, and teachers. We hoped to increase their understanding of psychological processes and child development through case discussion and an educational program given by speakers on selected topics. Our original idea was that in assisting and influencing principals and counselors to deal with disturbed and disturbing children we might help more children than by attempting to treat them directly. We thought consultation with the staff might influence the climate in the classroom.
These thoughts are too grand, but we may be having an impact. The staff of the schools want help but are not clear about what help a psychiatric consultant can offer. I think it will take a few more years for them to learn. Also, the staff are insecure about their jobs and pensions. They may look at a consultant as an additional burden to a crowded schedule. They are guarded in their approach to the psychiatrist, sensitive about their position in relation to the consultants who are often better educated, and mostly white, and often do not trust that a volunteer will make a continuing commitment. One counselor said to me, “You guys have the keys” — meaning the keys to lock up an institution, suggesting an element of fear. There is a more suspicious attitude toward psychiatrists than psychologists or social workers on part of school personnel. Clearly, they are sensitive and defensive about the slightest suggestion of condescension or dogmatism. Also, they present the most difficult cases for consultation — because they are desperate, but also as if to say “fix it.” I do not believe these are conscious thoughts, but they are indications of ambivalence and mistrust.
In the elementary schools discipline can be maintained at least until the fifth or sixth grade. Poor inner-city children, who have a high incidence of neglect, abandonment, and abuse, or parents on drugs or other family problems, are damaged in a number of ways. Impaired in psychological development and object relatedness, they are incapable of holding attention or learning to read. They are restless and disorderly. They are often depressed or defending themselves from depression. Many must defend themselves against aggression from others. Many of these children suffer from witnessing violence or the loss of a relative or friend. There may be unresolved grief over loss. In one elementary school, many children receive medication for hyperactive and attention deficit disorders.
One first grade teacher keeps coats and shoes in her closet to distribute to some of her children in need, and most of the children in that school are eligible to receive free breakfast and lunch. In a couple of middle schools I have visited, 80 percent of the children are functioning two grades below level. By the time they arrive in middle school, there are a large number of provocative, aggressive, defiant children who have no respect for authority of any kind and who are disruptive in the classroom. One only has to listen to rap music, which is popular in middle schools, to hear the extent of rage.
Teaching in classes with these children is a very difficult job. Sometimes keeping order becomes a primary task. It only takes one noisy, defiant child to disrupt a class. The natural tendency of the teacher is to have the disturber expelled from the class and send him to the principal. But the principal does not have many options. He can send the child to the counselor for talks; have the counselor contact parents for discussion (although many of the parents are not available to participate or control these children); isolate the child in the outer office; or suspend him. Quiet children who are depressed, anxious, and inattentive may sometimes be overlooked. Some schools have help from part-time social workers or psychologists paid through principals' funds or special grants. I have talked with a few principals about alternatives to suspension. This topic is getting more consideration, because efforts are being made to isolate the child within the school instead of sending him home to an empty house to watch television or out on the street where he can get into further trouble. I use the male pronoun because this description applies more often, but not exclusively, to boys. Girls present with other problems in addition to these. For example, they are vulnerable to physical abuse, rape (often by family members), and teenage pregnancy.
I have been impressed by the strength and character of some principals who are well-organized and have tremendous capacity for leadership and control over their environment. In spite of what I have described and what you read in the newspapers, principals continue to do their jobs. They maintain commitment to the education and development of their charges. They support auxiliary programs to help the children. They solicit and administer outside assistance from painting of buildings by volunteer students. They invite mentoring projects sponsored by private and government institutions, and promote special programs in art, dance, music, athletics, foreign languages, karate, and drama. All of these examples take place outside of the regular educational program, and are often served by volunteers or financed by special grants.
Principals want outside consultants to see individual children, to treat or to make diagnosis, to refer them for treatment to outside agencies, of which there are very few, or to do
something for them in the school. Our consultants have felt compelled to see kids, but we are hesitant to do this too much because it would limit the consultant's contribution. We are not offering a therapy program. In addition to myself, we have one senior psychologist, one social worker, and five senior psychiatric residents from St. Elizabeth's Hospital consulting in eight different schools a half-day a week. The residents meet with me once a week in a supervisory seminar.
Each school has its own climate and each resident has his or her own skills, thus our consultants deploy our resources in a variety of ways. One consultant is working with a group of teachers meeting weekly in an elementary school. In another, a resident is assisting in resolving a problem about a disturbed child who is aggressive to girls after school and his mother, who denies this and threatens to sue the school. In another, a resident has gotten histories from a dozen children who presented problems and, by sharing some of this information with the counselors and principal, has helped the situation. I think he is demonstrating the importance of history-taking before judging or punishing. For example, one five-year-old kindergarten student was referred because she cries incessantly. She had an eight-year-old sister who cared for her and brought her to school. There was no mother in the home. The child could not accept separation from her sister. Permitting her to visit in her sister's class, and vice versa, relieved the problem. One young woman resident is working with a group of six adolescent girls in a middle school, talking about their sexual identity and other problems. A male resident is meeting with a group of boys and girls in a middle school, and discussing with the principal and counselor establishing a timeout room.
The residents have observed the developing acceptance of their consultation efforts in the schools, and how gratifying it is to have children come up to them and say, “You are a psychiatrist!” One resident said, “I feel great doing something that may be preventive.” One said to me that just being there is important; another told us she sees that she is now a positive presence in the school because her commitment and constancy is recognized and appreciated. A principal told me that the presence of a consultant was helpful in the school. The principal said that the consultant's calm manner and respectful way he talked to every one was a model. Even though he interviewed a few students only once or twice, she felt that he made a difference. That neutral, noncritical, observing, “being there” attitude is a contribution in itself. It is not the same as compassion or empathy, it is a field in which other processes and relationships may develop.
We do not have enough to offer in relation to the seriousness and quantity of problems these children face, or the difficulties the school personnel have in educating them. We do not have instruments to measure systematically the effectiveness of the encounters we have with children and school personnel. We are trying to reach out to them. I believe we have made an impact in a few schools.
I do think that the experience of consultation for the residents in psychiatry has been a useful contribution to their education. Perhaps we should direct our efforts to help less disturbed children who have more potential to “make it.” I think early intervention in first grade to help parents who are willing and able to help their children is useful. If we obtain some funds and staff to develop more structure, I see ways to improve the program and make assessments. Sometimes I think we offer only a drop of hope in a sea of hopelessness. On the other hand, the life force and energy of the children, the dedication of the teachers, counselors, and principals, and the concerned parents who do work in the schools are truly inspiring.