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Interview with: Brandy Braunig
Interviewed by: Louis Marchiafava
Date: March 10, 1975
Archive Number: OH 013
LM: March, 10, 1975. Perhaps the best way to begin this interview is to—some information about your background, your training, where you’ve worked, your experiences.
BB: Okay. I got my bachelor’s degree at Southwest Texas State University—it was college then—in 1966, then worked 2 years, not in the mental health field. Unfortunately, I had to save enough money to go to graduate school, and the mental health field doesn’t pay well enough that I could afford to. I worked in the petroleum industry. Then I went to University of Houston Graduate School of Social Work. I started in 1968, and that was the pioneer class. It was the first year they had opened up. I got my master’s degree in 1970. Prior to getting my masters, I had had experience with the Dallas County Welfare Department as a volunteer. I lived in Garland, Texas before I moved to Houston. I worked at the Southside Settlement House in San Marcos while I was getting my undergraduate degree. In graduate school they have something like an internship, and the first year I worked at the VA hospital on the medical and surgical wards—oh—and the tuberculosis ward. This was 2 days a week for a whole year. My second year I worked at the Department of Adult—I’m sorry—the Department of Child and Adolescent Psychiatry at UT Medical Branch in Galveston, better known to everyone as John Sealy. And then, after getting my masters, I went to work at the Harris County Mental Health Screening Service, which was a crisis walk-in clinic originally set up to do prescreening for families who were requesting that a family member be evaluated for possible commitment. However, at that time, it was the only place in the county where you did not need an appointment. It was a walk-in place, and it became known as that, so we found that about anywhere from a third to a fourth of the people who walked in did not want commitment or did not want a prescreening for commitment, but were in some kind of a crisis and this was the only place they could be seen that day. I worked there until September of 1973, at which point MHMRA, Mental Health and Mental Retardation Authority, underwent a complete revamping from top to bottom. Many of us had some pretty strong feelings about the heavy-handed way it was handled because we were each given new assignments, much like lathe operators being assigned to new lathes. I went on vacation. Unfortunately, I have a very bad history of things happening to me when I go on vacation. I came back and was called at home that night and was told, indeed, not to go where I had worked for 3½ years, but to go someplace else. So I didn’t like where they put me. I was in the Children’s Services Division of Mental Health and Mental Retardation Authority, which was marvelous, but at that time they had no children’s services. They were only developing services, and they wanted me in an administrative capacity. I had being an administrator and I am a lousy one. I had no experience at it and didn’t want to learn how to do it better because I don’t like it. So we negotiated back and forth and battled for a while. I went to Harris County Juvenile Probation as a consultant for 4 months, trying to weed out the kids in the legal system that had mental health problems and needed to be in some kind of social services system.
LM: 04:16.6 Let me just interrupt you for a moment.
LM: Have you found in your brief experience with juvenile probation that many of the children that get in trouble have some emotional problems?
BB: Absolutely. Absolutely. Now, this is really a problem because the mental health field has no answer for this, so we tend to be very defensive about it instead of just saying, “Look, we have no answer.” I think that there is no doubt that people who commit heinous kinds of crimes are ill. The whole thing with the Heights murders and Speck and Whitman—you know—the whole kind of thing. Of course, the legal definition of insanity is ridiculous. According to the McNaughton Rule you must not be aware of the difference between right and wrong and not be able to understand the nature and consequences of the proceedings against you. That’s the legal definition of insanity. And I have seen some people who were so ill. Crazy is the only word I can think of, no matter how unprofessional it is, hallucinating, delusional. They knew the difference between right and wrong, and so, therefore, we’re declaring them sane. Anyway, the problem is that mental health has not yet found a way to really be able to reach these people. A lot of the people who are not declared mentally ill, or insane per se, are what we call sociopaths. And it kind of means sick in the way they relate to other people. They have no meaningful relationships—kind of con men—very artificial and superficial kinds of things and very intent on number one and this kind of thing. There’s no doubt that that is an illness, but the mental health field has not been very good at treating it.
LM: How effective is—well—I suppose at this point it would be Juvenile Probation—in intercepting these developing cases in children and preventing future crimes?
BB: Not at all. They can’t be. I had a lot of very bad feelings and a very bad image of Juvenile Probation as I went over there, and I came out with tremendous respect for most of the people over there. I expected to find, for example, a very punitive attitude toward kids. “Lock this little bastard up,” or something like that. And I would say 98 percent of the workers, what they call JPOs—Juvenile Probation Officers—care tremendously, but they are handling and processing incredible numbers of kids. And the paper and court work that they are required to do is just phenomenal. It’s just overwhelming. Although, on a limited basis there may be one or two kind of success stories, as a whole, they themselves see themselves and only processors. Once the kid enters the tube of the juvenile system, they just see themselves as the people who grease the tube and get them from one division to the other division and this kind of thing. Now, there are exceptions. There are policies set up whereby children with IQs fewer than 60 cannot, except in special circumstances, be part of the juvenile justice system. In other words, no matter what kinds of things they do, they can’t go to court and be sent to Gatesville or Harris County Youth Village or something like that. But the bad thing about that is, there are no facilities for these kinds of kids, and I have very mixed feelings about it because you can see a very aggressive, unsocialized—and I’m using ‘boy’ because a great percentage of the referrals are boys—a great majority, as opposed to girls—a very aggressive, unsocialized, angry, frustrated, retarded—perhaps minimally retarded or perhaps moderately retarded—boy with an IQ of, say, 58-59. And no matter what he does, he always gets out of it. He gets picked up and put in juvenile probation detention overnight and sent home because his IQ is so low he can’t be a part of that process. The only problem is there’s nothing else to do with him either. So what started out as really a pretty good idea, basically, has just become a mockery because it’s just the revolving door kind of thing. And it creates an attitude in these young people that we’re trying to say, “You’re not different. We want to integrate you into the community. You can be productive. You can do this and that and the other,” and we’re telling them they are different. They can get away with anything.
LM: 09:42.7 Is this unique to Houston?
BB: I don’t know. I really don’t.
LM: I should phrase it this way: Are the resources in Houston equivalent to what one would find in other major cities?
BB: No. I would say not. I’m not familiar with other juvenile justice systems in other counties, but based on my overall knowledge of the dearth of facilities in Houston, I would say that probably it’s as poor in these kinds of resources as it is in other ones. And when I was at Juvenile Probation, one-half of the referrals I received were of “retarded” children. Children with IQs under 70, and the other half had been identified by someone as emotionally disturbed. Now, there is also a procedure whereby a severely emotionally disturbed child can be taken out of the juvenile justice system and put into a mental health facility, but I’m talking now about severely disturbed, something that is very obvious to everyone—hallucinating, delusional, think he’s Christ or she’s Mary, the mother of God, or something like this. But kids with vindictive, brutal parents, kids with well-meaning but sick parents, kids with uninformed parents, kids in deplorable social and family situations, kids who never had a chance generally just go through the chute and end up in some kind of juvenile justice facility.
LM: 11:50.1 How does the ratio statistics look at that level—at the juvenile probation level?
BB: I really don’t know.
LM: Are there adequate medical facilities?
BB: No. Within the—?
LM: In the juvenile system?
BB: No. Not at all. They have some things that are really encouraging. For example—I don’t know if it is still true—when I was there, they had the only Boy Scout troop in a juvenile detention home. They actually had a Boy Scout troop in the home and had people come in and take them out to do things. They have the organization PULL(??), and I don’t know what the initials stand for. It’s a recreational activities oriented kind of thing. They take kids out of the detention home periodically for basketball and hockey and this kind of lesson and that kind of lesson. But when I worked at Juvenile Probation, I was surprised, really, at what actually has to go on before a child is either held in detention before he is sent to, for example, Harris County Youth Village—which is out in the NASA area—it’s kind of a pre-delinquency residential facility—before a child is actually sent to Gatesville. I had an image of a kid breaking a store window or ripping off a car and that’s it; they go straight to Gatesville. Actually, there have to be repeated, repeated offenses and repeated attempts at remediation and this kind of thing before they are sent to Gatesville. So that was one preconceived idea of mine that was crushed as soon as I got there. After I was there 4 months—it was on an experimental basis to see if the position was a workable and if there was a need and this kind of thing. I was very pleased that after—I had to do a whole evaluation and wrote pages and pages and pages of the 4 months there—but it is a position that is open there. It is on the MHMRA payroll, so the salary is paid by MHMRA, but they’re actually housed at Juvenile Probation. I did some individual work. In other words, some kids who were going to be on the detention ward for a couple of weeks or so, I went ahead and did therapy and did family counseling and this kind of thing. Probably about a quarter of my caseload was that and the other was just trying to get people in touch with facilities in order to get the kid out of the justice system or in the justice system. And then, the latter part of January, I came here to work at Children’s Mental Health Services Habilitation Division. So I’ve been here over a year. I have also been involved either as a member of the organization or a member of the board or a volunteer in Sheltering Arms, working with the geriatrics population in Meadowbriar— which is a residential facility for pre-delinquent girls—Mental Health Association, Association for Children with Learning Disabilities, National Society for Autistic Children, my professional organization, National Association of Social Workers, and National Council for Exceptional Children.
LM: 16:04.9 Why don’t we talk some about your present duties and the type of problems that you’re dealing with here.
BB: Okay. I’d like to do a little background first on Children’s Mental Health Services because it was one of the things that really impressed me.
BB: It is very important to me in a job what I can give, but it’s also very important to me what I can get in terms of experience and working with very bright people from whom I can learn a lot a be able to sharpen my tools and this kind of thing. Children’s Mental Health Services is a very old organization. If I’m not mistaken, I believe it was started in 1928 or 1929. It was called Child Guidance then. And it was called Child Guidance up until about 1970, at which point they began, after having heard the hue and cry of the ‘60s, to examine what they were doing and to examine their client population. And unfortunately, an examination of the client population indicated to them that they were serving white, Anglo-Saxon, middle-class, usually Protestants—although, I’m sure they let a few Catholics in now and again—generally elementary-aged children with mild-to-moderate parent/child—you know—parent/parent kinds of problems. And they didn’t like what they saw, which is not all that unusual, but then they did something about it, which is unusual. They reorganized in ’71 and renamed the facility Children’s Mental Health Services and divided it into five divisions. Guidance Division is short-term. By short-term I mean, generally, 6-10 sessions. They work with insipient, which is beginning, mild and moderate kinds of problems. I don’t really know how to characterize them. It’s the largest division. They have the largest caseload. But they see perhaps the traditional kinds of family problems and this kind of thing. Therapeutic Nursery is just beginning a birth-three project, which is preventative work with pregnant mothers or mothers of infants who are identified as high risk. Mothers under 16, mothers over 40, drug abusing or alcoholic mothers, or mothers with a history of—I hate the word ‘defective’—but problem children—retarded or handicapped or emotionally disturbed. I think this was pretty exciting because preventative is something we’ve all been hollering about for years, but there’s not that much money to handle it. Therapeutic Nursery will be working on the new birth-three project. Then the other branch of Therapeutic Nursery is working with children ages three to six who have beginning mild-to-moderate problems. Although, they have taken several, in the program, rather severely disturbed children globally delayed. And this is a nursery school approach. They have two classes. One is 8:00-12:00 and one is 8:00-4:00 and work 5 days a week. It’s really exciting to see, with that kind of massive approach and massive intervention—as opposed to the more traditional 50-minutes-a-week interview—the kinds of results they can get. Then there is Crisis Division, which is staffed by Baylor psychiatric residents. If the problem that the family has encountered meets the criteria of a crisis—which really has to be pretty heavy—suicide, homicide, rape, incest, this kind of thing, not just, “Johnny brought home all Fs and he’s never failed before,” they can see the family within 24-48 hours within the initiation of the referral. Then they do short-term counseling, a maximum of six sessions. And will then, if they think it is indicated, refer the people to another agency or another division in this agency. Then there’s Community Division, which is part of the State Department of Public Welfare. We have three, maybe four. One of the problems is each of the divisions here is very autonomous, which is good, but we’re so autonomous we’re almost isolated. So I really don’t know about the other divisions. I came the first day to work at Hab and they handed me my caseload, and I’ve really been involved with Hab Division ever since. Community works exclusively with AFDC recipients, so most of their—all of their clients are poor. Most of them are single-parent households with women rearing children. And then there’s Habilitation Division and that’s mine, my division. It’s the newest and the smallest division. We have two part-time and two full-time people in the division. And, as does everyone in the agency, we work with emotionally disturbed children. But in order to qualify for our division, they must also be physically handicapped and/or mentally retarded. We are funded by the Developmental Disabilities Association, which is federal coming down through state DDA. We are funded from year to year with a maximum of 3 years funding. The first year, DDA paid close to 100 percent. We are now in the second year and they are doing 50 percent. The third year—if we get it—and I don’t know if we will or not because they’re really cutting way, way back. They will pay 25 percent with a community, picking up more and more.
LM: 22:05.0 So it is a matching funds type of funding?
BB: Yes. Developmental Disabilities Association is concerned with children who are mentally retarded, who have epilepsy, or who have cerebral palsy. So that makes up—oh, I would say—four-fifths of our caseload. Unfortunately, that does not include all the multiple handicapped children who need services, so we see other children as well, once we fulfill our numbers to DDA. They require certain numbers. We see a lot of other children, too. For example, psychotic blind, psychotic deaf, psychotic blind and deaf, post gunshot wound—so there’s considerable brain damage—all kinds of post trauma, post surgical trauma, automobile accidents, hyperkinetic—we have one boy who is hyperkinetic and has hemophilia, which is—
LM: A terrible combination.
BB: It is. It’s unbelievable. When he first came in, I really thought that I was going to bite my fist all the way through because he was everywhere, all over, up the walls, up and down, here and there, and, of course, you’re always terrified that he’ll start to bleed. Let’s see. We see a number of children with multiple congenital anomalies and/or retardation superimposed over that and that kind of thing. The nature of our caseload is that it is generally long-term, chronic. We have a joke that Hab Division never closes a case. Statistically we do because it’s required of us. But what we like to think is that we help the family resolve a certain crisis, because, let’s face it, I can’t make the kid get out of the wheelchair and walk. I can’t give him arms where he doesn’t have any. I can’t add 40 points to her IQ. So we try to help them develop their own resources to be able to cope with whatever kinds of problems they’re having now, put them back together, let them know this is a place they can come, and then put them on inactive for a while. Because the chances are that these families will have more trouble than “normal” families with the regular everyday crises, such as when a child hits adolescence. That’s traumatic for everybody; any mother or father of a teenager will tell you they know what that’s like. And when a sib leaves home to go to college, to get married, to go into the service, the handicapped or developmentally disabled child suddenly finds that his chief confidant and friend is gone. All of the normal kinds of crises that families go through, our families need more help with it. We have people who we see— I have a woman who laughingly refers to her 12,000-mile checkup because she comes in once a year. I saw her at another agency for a year and a half in individual therapy, and when I moved, fortunately or unfortunately, one of her children qualified under this program, even though he needed no assistance. It was she who did. And this is something else we do. Very often the “handicapped child” is not the one who needs therapy. Either the retardation is so severe that there’s no way to be able to reach him. I don’t believe that no one with an IQ below 80 can benefit from therapy. A lot of people will tell you that. It’s a copout because it’s—we haven’t been real good at finding out therapeutic ways of reaching someone who’s intellectually limited, and so you will find a lot of places that will—there will be an adolescent girl, say, who is acting out sexually and having a lot of trouble at home and she has an IQ of 82, which makes her dull, normal, this kind of thing. The therapist or the psychiatrist or whoever will send a report that says that she does not have the intellectual capability to be able to benefit from psychotherapy, and that’s a bunch of bunk. We have to learn how to take our beautiful, lofty words and get them down on a level that someone who is more limited than we can understand. Maybe that’s threatening to people. Maybe they like hiding behind some of the pretty words. But anyway, very often we do not deal with a child who has been identified as handicapped at all. There is a youngster who is 6 who is rather severely and multiply handicapped whom I have never seen, but I see his mother and both his sisters and his brother in individual therapy because they are really severely-to-moderately emotionally disturbed. The kid is doing beautifully and is in a great program and this kind of thing. So we don’t have to see the identified patient. Also, in this division, we don’t have an age limit, and every other division in the agency does. We work with adults who are handicapped, retarded, and this kind of thing.
LM: 28:14.8 Can we follow one patient in—let’s say—when you first process them, how do you work with them? What do you do?
BB: I just closed a case yesterday. Of course, I’m not going to tell you about one of my failures. I have to tell you one of my—no, I’ll tell you one of my failures later if you want, because there are a lot. But let me give you one of my successes first. This is a 16-year-old black girl who is minimally retarded and has seizures. I’m trying to—okay. Her mother called in to the agency August 27th of last year, and wanted to know what we could do. We mailed her an application form, which is standard. We have an intake form where the people—you have some idea of the problem. We get some basic demographic data and this kind of thing, and then we mail an application form. We received the application form September 5th. We had two intake appointments, September 11th and September 18th, and that was with me and one of the psychiatrists who works one day a week. She and I do intakes on Thursday. After the two interviews—and we do anywhere from one to five intake interviews depending on how long it takes us to try to get a handle on what’s going on. Some of these multiproblem families who are so involved in the pathology—it’s like an explosion in a spaghetti factory. You just can’t weed it all out in more than four or five times, but this only took two. She is adopted, one of 18. There is some indication that her natural mother is retarded and also syphilitic, so most of the sibs have significant problems in some area or another. The adoption is the informal adoption where the mother, after having the baby, gave it to various and sundry people—gave away all of her children to relatives and friends. None of them have ever been in an institution. It was in a rather rural area, and this is a practice that’s rather widely accepted. This girl was later formally adopted by a woman and her husband. The husband is now disabled and cannot work, and also in the home is a maternal grandmother. This 16-year-old girl was fighting in school, scratching, biting, kicking, and fighting in school and on the bus, was asking repeated, redundant, ridiculous questions, such as she’d point to a green chair and say, “Is that a green chair?” And this is a kid who has some intellectual limitations, but probably is capable of getting the equivalent of an 8th to a 10th grade education. She’s not severely retarded. She’s mildly retarded. There were a lot of behavior problems at home with the mother and with the grandmother, and the biggest concern I had upon seeing her—although, this was not a concern of the mother’s—was her incredibly immature behavior. In the evaluation, if I would have closed my eyes I would have gotten the feeling that I was talking to a very cute, very seductive 5-year-old, and this was not because of her intellectual limitations. This is because of a pattern that had been set up and reinforced at the home. Very, very immature, very babyish, very wide-eyed and talking like a little baby, and acting like a child. Of course, part of the problem was that this was not a concern that the mother had, which is what happens to us a lot. They’ll come in and say, “Johnny is failing at school, and he’s so much trouble. We don’t know what to do.” And we say, “Well, come on in and bring all the children.” To us, Johnny’s the healthiest one in the family and all the other kids are just crazy. But they fit the family pattern so much better than Johnny who is acting out and rebelling against all the craziness in the house. So I started seeing this girl. Call her Mary, or have I already called her something?
LM: 33:01.6 No, I don’t believe so.
BB: Good. We’ll call her Mary. I started seeing this girl and her mother. The father could not come in, so I made a couple of home visits to kind of try to get his help. It became pretty obvious pretty quick—the mother works—that the grandmother just adores babies and children. She’s just this marvelous old lady who adores babies and doesn’t particularly like adolescents. Although it was unconscious, she was very much trying to keep Mary a baby. So I worked with the grandmother, and I got her involved in this program at Jeff Davis where they have foster grandparents. So she now goes 3 days a week and takes care of babies. And I worked with the school. I really did not work with Mary very much. I worked with the mother a great deal. Mary had been tested several places and nobody had ever told the mother the results. Nobody had ever—now sometimes families are told this and just resist it, just don’t want to hear it. But nobody had honestly ever told this mother, “Your child is retarded. She cannot be a nuclear physicist. She cannot go to college. There are certain things she’s not going to be able to remember. She is going to have trouble with certain other kinds of things.” And the mother is a marvelous person, but is illiterate and neither reads nor writes. So the fact that her child could read and write meant that she was a genius. She had very unrealistic expectations. So we set up a behavior mod program in the home whereby Mary, if she went one whole day without asking a ridiculous question, got X number of pennies. If she went one whole day without getting into a fight with her grandmother, got X number of pennies. If she cleaned up her room and did her homework and did not fight on the bus, got X number of pennies. Because prior to that, she had gotten allowance from the father, but it was just kind of every Saturday he’d hand her five bucks for nothing. This kind of thing enabled her to make up to five bucks, but considerably less if she didn’t fulfill the obligations. I went out and made a final home visit last week and a school visit, and she’s doing very well in school. Not academically because she can’t. She’s not fighting in school. She’s not fighting on the bus. She’s getting along much better with the mother. The mother is a lot more relaxed about it. And she’s scheduled to be referred to vocational rehab as soon as she becomes eligible, as soon as she turns 16, which she will very shortly. The only thing I could not get the mother to do is begin thinking about birth control for Mary. I think I at least got her to start thinking about it, but this is something the mother is very opposed to because she likes babies. I kept saying, “Mrs. Whatever, just because you and your mother like babies is no reason to think that Mary can be a mother.” And so right after I had seen them about 3 or 4o times, Mary was raped at school.
LM: 36:38.0 What school was this?
BB: Not HISD, but I can’t recall. Just a minute. I can look it up. Woodson Junior High School. It’s part of HISD. So that did upset the mother. That did get her to Herman Hospital. I contacted the social worker and the doctor there asking them to at least explain to the mother the various kinds of birth control that were available. I really was a terrible thing to happen, and I’m not pleased that it happened, but it’s difficult for parents to hear from me, “You need to start thinking about putting your daughter on birth control.” I think it’s interesting that we don’t say ‘put your son on birth control,’ but we don’t. The parents interpret that, very often, “She’s saying my daughter is going to be a slut.” And the mothers will tell me, “Well, no. I expect her to be able to control herself.” In light of the new morality and children being more sexually active these days and also in light of the retarded child having limited intellectual capabilities, this is not realistic. So sometimes we’re devious, and sometimes what we say is, “Well, of course you will bring her up in all of the upstanding Christian values.” Whatever it is that will get them to listen to us. “But you have to think about her safety these days with all the kinds of things that are going on and about her being forced or about her being raped or about her being involved in a situation over which she has no control.” And they can accept that better. They can accept it a lot better. We do very long-term planning with our families. We evaluated a 6-year-old girl a couple of weeks ago now who is moderately retarded and who has seizures and who is hyperactive and who has cerebral palsy. We started talking to the parents in terms of wills, lawyers, some kind of trust fund. You say to the parents, “What is your child going to do if you’re both killed in an automobile accident tomorrow?” Family members may be willing to take on normal kids, but nobody’s going to want to take on this child. We talked to them in terms of long-term educational planning. “Forget the high school diploma. Forget the GED. Yes, your child can stay in school until he or she is 20 and can get a sheet of paper, but then it means nothing. What do they do? Get them into some kind of vocational program as soon as possible. Start thinking about birth control as soon as possible.” We kind of try to help them look at the long-term, which is difficult because so many of these families are enmeshed in the incredible day-to-day, hour-to-hour, minute-to-minute problems that they can’t even bear to look to next Tuesday, let alone to 15 years from now.
LM: 40:03.1 While we’re talking about the reaction of parents, maybe we can carry that forward a bit more. What is the general reaction of parents to retarded children, to handicapped children—physically handicapped children—and to the other types of problem children that you deal with? Their reaction to you and their reaction to the child.
BB: Yeah. Of course, everybody’s different and there are all different kinds of reactions all along the continuum, but a lot of research has been done in this area and a lot of it by (Dr. Howell??), incidentally. She’s written two papers thus far on it. And I can give you kind of a typical reaction that we probably see more than any other.
LM: That’s what I’d like to have.
BB: Okay. A typical reaction is first that we are either the first facility to see the child, or we are the first facility to level with the parents and to say, “Look, your child is not emotionally disturbed. Your child is retarded.” Generally, in the typical pattern, you see a very over involved, very over protective mother. We call it “smothering mothering.” And you see an absent, distant father who has immersed himself in his work. He’s chronically angry at the child, but of course can’t admit that to himself. How can you be mad at a handicapped child? That’s unforgivable. Of course you can be mad at a handicapped child like you can be mad at anybody else. But in the families, they don’t see this. The father is not getting the kind of support—the kind of emotional support—that he needs from his wife. The mother is not getting the kind that she needs from the husband. So there’s quite a schism that develops in the marital relationship. I’m thinking of a woman, of a family we saw, I guess it was last year now. The parents had not slept together since the birth of the handicapped child which was 11 years. (Laughs)
LM: 02:25.0 Yeah. I imagine things could get very difficult.
BB: And I said to the father—the child was not in this interview—it was the parents. I said to the father, “You can’t tell me that doesn’t piss you off. You can’t tell me that doesn’t make you furious.” And he said, “No. I can understand that. She needs to devote all her time to little Billy.” And I said, “Bunk. You can’t tell me that doesn’t make you furious.” And finally, for the first time in 11 years, he was able to say to his wife, “Yes. I’m angry about it.” But the patterns develop and they just encapsulate themselves. So you have the smothering mothering and you have the child delayed or handicapped even more than he need be because the mother has never given him the opportunity to develop what he or she might be able to—no autonomy whatsoever. So the kid has a very, very poor image of him or herself because he can’t do anything. And the way it comes across from the parents is, “You’re too stupid or you’re too dumb to be able to do anything, even decide what you’re going to wear.” You would not believe how many mothers we see are still dressing their adolescents. Now, I’m not talking about severely handicapped kids who cannot, indeed, dress themselves, but mothers who are dressing their adolescents. Mothers who are bathing their adolescents—adolescent girls and boys, which gets into a whole different—you’ll forgive the Freudian reference “can of worms.” And then the siblings—the brothers and sisters—if they are “normal”—are just pushed out, lost somewhere. If there’s an older, normal daughter, she finds herself being stuck with being the mother surrogate, and so a lot of the adolescent sisters of retarded children—16, 17, 18—have no friends, have never dated, have never been to a dance because they either willingly or unwillingly find themselves to be the caretakers. The reaction probably of a family first is anger, anger at me. They can’t be mad at the retarded child, and they can’t be mad at the retardation. How do you get angry at retardation? You can’t. And you find this very often in all kinds of fields. People become angry at the bad news and angry at the bearer of the bad news. I know a friend of mine, who is a surgeon and works at MD Anderson—specializes in cancer surgery—has told me that in his career, he has been slugged several times because he goes to a family and says, “Your relative—mother, father, daughter, sister—has terminal cancer,” and they just become furious. It’s a very typical reaction. So they get very angry at me. They tell me I don’t know what I’m doing; I didn’t spend enough time with the child, etc. It’s very important at this time to not let my own feelings get in the way and not get my feelings hurt. The next step generally is denial on the part of the parents with a lot of the anger still involved. “She didn’t know what she was talking about. It was a rotten place. I don’t like the way she parts her hair anyway.” A lot of fathers tell me I’m just a woman so I can’t do it right. People used to tell me I was too young. They don’t tell me that so much anymore.
LM: 06:26.9 And that hurts your feelings
BB: (Laughs) Yes. It used to be something that used to aggravate me when they’d tell me, “You’re too young to be able to know what you're doing.” And now I kind of miss having people tell me that. But anyway, we try to encourage people at this time to let them know that it’s okay to be angry at us. We can take it, and they can come back. Usually they do, rather contritely, having been very embarrassed for what they see as having made fools of themselves, having lost their temper. And part of my job is to help them understand that this is a very normal, typical reaction that they have to go through, and indeed it’s part of the therapy. In a way, that’s helpful to them because—you know—I tell them that’s something you had to do. And indeed, if you hadn’t gotten angry, I would have tried to push you to get angry. It’s what I wanted you to do, so they can accept it better. We try to encourage people to get other opinions if they want. Very often professionals are kind of funny about this. It’s like, if you want to go and get another opinion it’s because you think I’m a hack or something. They either get their feelings hurt or get very huffy or this or that or whatever. We try to encourage people to do that. We can recommend people in this agency who can give them another opinion. We can make several recommendations of other agencies or private facilities. Sometimes the family gets a little suspicious and they want to do a totally different opinion—you know—someone who we don’t even know. But we try to encourage them to do this. The next step in the typical family is doctor shopping, wild, weird hopes, faith healers, acupuncture, megavitamin therapy, doctor after doctor after doctor. I’ve had a lot of people tell me, “Well, you’re not a psychiatrist. A psychiatrist will be able to help my kid. A psychiatrist won’t tell me that he’s retarded.” So they go to a psychiatrist, and the psychiatrist says, “He’s retarded.” After that—and each of these steps is a necessary step. It’s something they have to go through. Unfortunately, a lot of people get stymied. You see some people who may have been able to afford it literally invest everything in flying their kid here and there to this place and that place for different opinions. The fourth step generally is grief, real grief. With parents that have handicapped children, there is such a body image thing. “This child is an extension of me. It is an extension of me. It is part of me, and he or she will be able to do all the things I wanted to and couldn’t and will have all the things I wanted to and couldn’t and will give my life more meaning and more worth by his or her accomplishments and achievements.” And then you get a defective child, so it’s grief not only for the child, but also for oneself. And that’s not being selfish; that’s where it is. That’s what they have to go through, and it’s very realistic. Very often you find the mother involved in more grief and guilt. “I should have taken better care of myself when I was pregnant. I shouldn’t have gone horseback riding in the fourth month.”There are all kinds of primitive kinds of things that neighbors and in-laws will tell you. “I told you, you shouldn’t have gone to see that movie about the retarded kid while you were pregnant. I told you, you shouldn’t have gone to the zoo and seen the elephant. That’s why your kid doesn’t have a nose.” Weird kind of stuff like that. But particularly if it’s the result of a birth trauma, the mother will be very, very enmeshed in grief and guilt. If it’s the result of an accident, it can really be bad. “I should have been watching him. I shouldn’t have let him go out in the street. I shouldn’t have let him get the gun.” I’m very honest with them. Yeah, truth be told, they shouldn’t have, but life is full of shouldn’ts, and everybody does it. It’s a shame. Everybody’s human, and everybody makes mistakes. You can stay locked into the grief and guilt forever, or you can kind of try to get things back together and move on.
LM: Where do most of your referrals originate from?
BB: Oh, everywhere. We get an awful lot of referrals from the Bluebird Clinic in their neurology department. We don’t require that the referrals be from an agency or from a professional. We get them from doctors, ministers, friends, neighbors, walk-ins, self referrals, nursery schools, clinics, everyplace.
LM: Do your clients reflect a typical economic level, or do they come from all areas?
BB: Not at all. Children’s Mental Health Services charges on a sliding fee anywhere from $40 per patient hour—which is the maximum—all the way down to nothing. I think our minimum fee is a quarter for a therapy hour, and a maximum is $40. And some people pay nothing. Anyone who has Medicaid, for example, does not pay anything. Medicaid reimburses us, which is marvelous because it allows people to choose their own facilities. So if one has a very limited income, you don’t always have to go to Ben Taub for everything. If you have Medicaid, you can choose your own health or treatment facility, and that facility will be reimbursed. So generally, our clientele—no, I can’t even say that. We have—I don’t think I have any millionaires on my case load, but I have everything from what I would call upper class, with close to $100,000 a year income, down to one of the most scandalous things I’ve ever seen; a very physically ill woman with three very chronically physically ill children who is living on $35-a-week child support. That’s all her husband will pay, and that makes her ineligible for any other kind of financial assistance except food stamps. So she is supporting four people on 35 bucks a week. And she pays a dime—a dime a week. A dime a week or a quarter a week might sound pretty silly, but this changes people from customers, purchasers of service—it changes them from recipients of charity to purchasers of service.
LM: 14:44.7 It’s like—(speaking at same time).
BB: Yes it is. It is. And you take seriously what you pay for. I mean, I’m sorry, but this is—I don’t know if it’s the whole world’s mentality, but it is at least the American mentality. We tend to judge people and their worth by how much they make. What was the survey about the three greatest living Americans? The three choices were Bob Hope, Billy Graham, and Richard Nixon. This was prior to resignation. I think they confused notoriety and visibility with greatness. But we tend to take more seriously that which costs us something. And so you have people doling out their dimes. They get receipts for it and the whole thing. We have a really flexible attitude about fees. We have a business manager who does not have a flexible attitude, but we need her. We need her to be the balance. If it was up to us, we’d probably only charge everybody a dime, and then the place would have to close down. But if, on the sliding-fee scale, a family still thinks that this is too much to pay—and these days, let’s face it—I once looked up what I, on my income with no dependents, would have to pay here, and I couldn’t afford it. These days, I think everybody is in a pinch. And if the family feels that this is too much, first they discuss it with the receptionist. And if they can’t come to an amicable agreement, then they discuss with a bookkeeper. And if they can’t come to an amicable agreement, then they discuss it with a therapist, and I can do whatever I want. I have a woman who should be paying $16 per session based on her earnings, because they take gross annual income based on dependents. But particularly with our families, so many of them have multiple medical expenses, besides which she has two kids in college whom she is sending through. They’re working, but her husband is dead and she’s sending them through. And on paper it looks as if she ought to be paying $14 or $16 dollars a session. I forget which. But there’s no way. There’s no way. And she and the business manager couldn’t agree, so the first time she brought it to my attention, I just said, “What do you think you can pay?” And she said, “Two dollars.” And I said, “Fine.” So that’s what she’s paying.
LM: What is the quality—let’s begin this way first—are there many other resources, such as your own agency here?
BB: No. No. We are unique in Harris County. In fact, it is rather a unique approach to be concerned about the mental health of developmentally disabled, handicapped, mentally retarded, whatever, children. There has been—well, in fact, I went to a Developmental Disabilities Association conference last year and this year, and we are the only agency statewide—and there are a number of agencies funded by DDA—working with the mental health—the emotional aspect—of these children. Now, of course, any time you get a caring person involved, there are an awful lot of paraprofessionals and case aides and occupational therapists who are listening ears to mothers or to children and this kind of thing and they do a fantastic service. I’m not at all denigrating that. It’s just that we are the only facility—as far as I know—statewide—that is concerned with the emotional and mental health of these children. There are facilities that will teach them how to walk, how to talk, how to eat, try to train them in some kind of vocational rehab aspect and this kind of thing, but this is unique in Texas.
LM: 19:00.8 Do you get many referrals from the Department of Public Welfare?
BB: No. You mean State Department?
LM: Yes, State Department.
BB: The State Department of Public Welfare? One, as far as I know. I don’t know why that is. I would suspect part of it is that it is so big over there. That’s the problem with so many resources. They just don’t know we’re here.
LM: That’s why I asked the question. I would have thought that you would have received a great many referrals.
BB: Uh-hunh (negative). Actually, we got two, but one never came in. The worker told us about two and brought one over, and the other one refused to come. Now we get some from Harris County Child Welfare. Part of the reason may very well be that because of this agreement with SCPW that our community division has—they may be doing that—some of that. But I would suspect that it’s like Juvenile Probation and everything else. I have had numerous, numerous conferences with all kinds of people at Juvenile Probation because I was over there for 4 months and I know how many of their kids are retarded. I know how many of their kids need our services. And still, about once a week, I’ll be talking to some juvenile probation officer and—you know—they still call me about facilities and this kind of thing. And I’ll say, “Well, send the kid here. That’s exactly the kind of child we need.” And they’ll say, “Well, I didn’t know you did that.” It’s a problem of getting the word down to the bottom ranks. Memos that you send, my fantasy is that the memos float from supervisor to supervisor and then are thrown in the waste can. I don’t know if that’s true or not.
LM: Are there any other significant agencies which would deal with these types of problems?
BB: Oh, yeah. Absolutely. There’s the Cerebral Palsy Treatment Center, The United Cerebral Palsy Center of Houston, Galveston, and the Gulf Coast, Harris County Center for the Retarded, MHMRA—the mental retardation aspect—The Bluebird clinic, The Easter Seals Society, there are a number of agencies. We refer back and forth and this kind of thing. In our approach, we work not only with the person who is identified as the patient or the client, but also their families, their schools. I try to make a school visit on every kid, every semester. That’s my goal. I’ve never made it yet, but that’s what I try to do. That generates a lot of referrals. It also lets the school know, “Look. Here I am, Here’s my face. I’m not just a name. I really am a real person. I’m not up in the clouds. I won’t instantly psychoanalyze you.” I don’t even know how to psychoanalyze, but I can’t tell you how many times at parties, as soon as people find out what I do, they kind of walk away. And, “I’m here, and I’m working with the child. Let’s keep in touch because there are things that happen at school that I need to know about. There are things that happen here that you need to know about. This is something that I have found that works pretty well in trying to handle the child.” This kind of thing. We also work with agencies who work with the children. In other words, there is a Good Samaritan Faith Lutheran Home in Cypress, and it is a church-supported home for retarded adolescents and adults. And we are about to negotiate a contract with them where we will not only see some of their more disturbed people for therapy, but we will actually, on a consultation basis, work with their staff members. In our funding—what do you call it? The thing you write to get the fund? Program project, whatever, proposal. One of the things which we have said that we will do, and we are doing—and I really enjoy it—is to work on a consultation basis with whom we call the caretakers of the disabled because their mental health is important, too. I think people forget that too often. One of the things—God love her—that my boss insists upon is—and it sounds kind of hard, and we don’t mean it to. But you can’t be a bleeding heart and be here in the mental health field. People always ask me, “Don’t you take your cases home with you?” It would kill me if I took them home with me. I’ve got to have myself and my time, too. And I’m really pretty possessive of my private time. I just tell people, “I gave at the office,” because you reach a point where you give so much of yourself away that you’re no good to anybody. But anyway, I’m digressing all over the place. And now I can’t remember where I was.
LM: 24:16.4 I think you were at—
BB: Oh, the mental health—the mental health of the staff. It sounds hard, and we don’t mean it to be hard, but Dr. (Howell??) insists on spreading the winners around, because I could not work all day every day with a deformed, spastic, retarded child in a wheelchair. I just couldn’t. So periodically, we get a case and we evaluate it and we see a family. And there are lots of resources and they’re motivated and they’re verbal and they’re ready to go. You just know, like 8-10 sessions, and it’s really going to work out. Sometimes I don’t get that family even though I’d very much like to work with them because maybe Elaine is just full of people who aren’t getting anywhere and very much needs a boost.
LM: 25:03.9 How well do the public schools perform as a screen for discovering children that have these problems that can be helped? It would seem that they—
BB: Public schools are a scandal, and HISD is no less scandalous than any of the others. They are in such a crisis. HISD is probably no worse than most, but certainly no better. There’s a whole scandal now about records and labeling and this kind of thing and the kinds of things that untrained—of course, they’re trained to be teachers—but that untrained people make observations on things like homosexual tendencies and all kinds of things. They’re not a good screen. They’re really not.
LM: That’s too bad. They would seem that they would be a very convenient place to discover these children and get help to them.
BB: They have hyperactive kids with severe CNS dysfunction, minimal central nervous central dysfunction—it’s just another name for hyperactive—in classes for educable mentally retarded or trainable mentally retarded. It’s not because they don’t care. It’s not because they’re ogres. They’re absolutely overwhelmed. And now this whole Plan A thing.
LM: What’s the Plan A thing?
BB: Oh, it just gives me a giant pain. Well, like a lot of things, it started out as a good idea. The problem is, when you operationalize it, it turns to shit. Plan A is let’s not label these different children as being different. Let’s not subject them to ridicule. Let’s not separate them. We want to integrate them into the community and into the schools. Let’s not separate them in special classes and this kind of thing. So they’re trying to integrate the child back into regular classes. Now sometimes this works beautifully. Sometimes, the problem you have is, here’s this poor kid who loved his special ed class, who was doing very well, who could keep up with the work, who was in the middle of the top of his class. They put him in a regular class and suddenly he’s bringing home F, F, F, F. Everybody calls him cripple, drunk, retard, sped—that’s a big thing now with kids. It’s short for special ed—call them sped. And it’s not working. It was a great idea, integrating the kids back into the classroom. Sometimes it works pretty well. Like, they’ll have a child who’s pretty good in English, so he may be in a basic or a regular English class and then the rest special ed. But often it’s a disaster. And then of course, you have to understand the standard problem of mental health professionals. I guess a lot of other fields, too. If I am not careful, I begin to think there’s not a normal person in the world because I don’t have, for example, any contact with normal children. Probably there are hundreds and hundreds of kids for whom Plan A is working beautifully, but if it is and they are not a problem at school and they are not a problem in the home and they are not a problem in the community, I don’t see them. So it’s like everything else, I think it’s very hard for me not to become biased.
LM: It’s one of the risks of the profession.
BB: 28:34.0 Yes, it is. It really is. And I know a lot of my friends kid me because whenever I go over to anyone’s house and they have children, I’m so desperate to get a baseline. I’m running them through all the growth and fine motor coordination tests and doing many IQs on them and this kind of thing, trying to get a baseline because after you work with retarded children for so long, when a dull/normal child comes through he looks super bright to you. You have to keep kind of reevaluating your focus.
LM: I think we’ve covered the area fairly well, but if there are any areas that I have overlooked, feel free now to address yourself to them.
BB: Thank you. There is one, and that is the—I don’t know of a word strong enough—shameful, criminal—lack of children’s residential and children’s inpatient facilities in Harris County. Harris County is a very medically rich community. I mean, let’s face it; look at the medical center. People are being flown in from all over the world for this kind of thing. And yet, for an extremely disturbed child who requires inpatient treatment, there is a small unit at Texas Children’s Hospital, and they have all kinds of diagnostic categories that exclude children. We have to ship these kids to Austin State Hospital. Our relationship with Austin State Hospital is very tenuous at this point because they have a point when they say, “Goddammit. Quit sending us your kids. Get off you duffs and do something about the facilities you need.” All kinds of research projects have been done on the benefit of inpatient hospitalization for a child or an adult if he is more than a hundred miles from his home. And it doesn’t do any good. You can’t get the family involved in treatment. You don’t know enough about the community resources to be able to plug the child or the adult back into what he needs. And it’s really—I don’t know what it’s going to take to get Houston or Harris County to do something about it. I suspect it’s going to take a crisis because we are so crisis oriented. The whole ship channel is going to have to burn down before we do anything about that. Look at what had to happen at the Heights before something got started about that.
LM: Has something gotten started?
BB: 31:11.2 Yes. They have several Heights facilities now. There’s also Operation Peace of Mind, which is a call in for runaways which is Texas based and was started exclusively as a result of all the torture/homosexual/slaying/murder things. And there are several recreational facilities and this kind of thing that have been started. I’m afraid it’s going to take a crisis to get us off our duffs about this, too. Then you have another problem, which is the philosophy of our division is that we treat the children no one else will treat, because you take a physically handicapped, mentally retarded, and emotionally disturbed kid. You take them to the emotionally disturbed facility and they say, “Heavens, he’s physically handicapped. We can’t deal with him. He needs to go to the physically handicapped facility.” And they say, “Well, good Lord. We can’t deal with him. He’s retarded. He needs to go to the retardation facility.” And of course, what would you expect? The retardation facility says, “My Lord. He’s psychotic. We can’t handle him.” And it becomes additionally difficult when you get, for example, a psychotic, retarded child, because Richmond State School says, “He’s psychotic. We can’t handle him. Put him in Austin State Hospital.” And Austin State Hospital says, “He’s retarded. We shouldn’t have to handle him. Put him in Richmond State School.” And Richmond State School has a 3-year waiting list. It’s really something. And MHMRA is trying to get a couple of things started. They have Cambio House, which is a residential treatment facility, not a hospital.
LM: What is the abbreviation stand for?
BB: Cambio is Spanish for change. So they got that when I was working with MHMRA. That’s part of what I did was survey the needs, which I thought was ridiculous. Everybody knew what the needs were, but that’s how statisticians and project designers—first you have to survey the needs. I’m sure there’s some value in it. I just come from a different slant or a different bias. But they do have Cambio House. Hope Center for Youth, which is partially funded and run by MHMRA, is doing some townhouse facilities and adventure trails and wilderness camps, so some things are getting started. The way the economy is now, I don’t know how much longer they’ll be able to stay above water because things are really getting slashed and probably not done being slashed.
LM: Where does the initiative for establishing these new programs seem to come from? Is it from officials—state and county officials, city officials—or does it come from private agencies or from researchers?
BB: Probably comes from public agencies, such as MHMRA, such as Children’s Mental Health Services. Sometimes from officials. Some officials are very involved.
LM: Any you particularly have in mind?
BB: Yeah. Ex-county judge Bill Elliot, about whom there was much controversy, about whom I have many mixed feelings, as I’m sure many other people do. He had a commitment to mental health that was phenomenal and was very instrumental in getting the new detox and treatment units set up on my floor. Now of course, it’s going to be closed down because the commissioners have voted not to refund it as they originally said they would. So we have one giant step forward and three backward. Anyway, another one is probably Barbara Jordan, who is very involved in foster parents care and child abuse in mental health facilities in the black community. Another one is Judge Chris Cole, of course, who is just into all kinds of things all the time and was quite instrumental in helping get Hope Center started, the way I understand it. There are probably others about whom I’m just not aware. State Senator Jim Wallace is another one who’s been quite involved in this in a number of different areas. But probably mostly public agencies, which may or may not begin it as a result of feeling pressure from the community. But the residential facilities for these children, who are not quietly crazy, withdrawn, and this kind of thing, are very, very, very small. Facilities, for example, for the mildly retarded or the borderline retarded child who is acting out, which is a nice way of saying who is a terror, who may be acting out sexually, who may be acting out aggressively—you know—this is the kid who beats up all the other kids in the neighborhood with lead pipes. One we had through here not too long ago constantly tries to set his brothers and sisters on fire by pouring gasoline on them. This kind of thing, Richmond State School said, “Oh, my goodness. He’s psychotic. We can’t handle him.” He’s not psychotic. Austin State Hospital said, “He’s retarded. We can’t handle him.” Harris County Child Welfare could not pick him up, even though his mother had deserted them and there were six kids living at home unsupervised. The oldest brother, who was 14, was panhandling and sweeping out a couple of bars at night to get enough money to feed them. Harris County Child Welfare wouldn’t pick them up because they had no place to put this one extremely disturbed, acting-out child. And you can kind of see their point. You get Harris County Child Welfare worker in her—and I say her because most of them are women—in her Volkswagen—and I say Volkswagen because a lot of them drive Volkswagens—to go pick up all the kids; what is she going to do with this big, retarded kid who loves to set fires to people? Is she going to keep him in her Volkswagen? There was no place to put him, so they wouldn’t—couldn’t—pick up any of them. And we finally got Austin State Hospital to take him, but they weren’t very pleased about it. They said, “This is not our responsibility. This is not our obligation.” And of course, way up, as Austin State Hospital was designed, it is their responsibility to take—but they have a good point. They shouldn’t have to. It’s antitherapeutic. It does no good. So all we did was just ship this kid out of sight, out of mind to protect the community for X number of weeks. But sooner or later, Austin State Hospital is going to say, “Okay, his behavior is good now and he’s in much better shape. We’re going to send him back home.” We’re going to send him back home to the same situation, and he’s going to be running around with his Cricket lighter again. And finally, he’s going to end up in the—probably in the penitentiary and going to cost us a fortune to support him for the rest of his life in jail. It would be a lot cheaper to do something about it now or to have done something about it a long time ago. I’m afraid for John it’s a little late for preventative care.
LM: Well, it seems that we’ve brought up some critical problems. I don’t think we’ve come up with any answers, but we have at least defined some of the problems in the area that we were discussing.
BB: I don’t have the answers. At this point, I’m not sure anybody does. I’m not asking for the answers. I don’t think any of us are. I think we are asking for a commitment to a study of the problem, a commitment in time and in energy and in money.
LM: Anything else?
BB: Not that I can think of.
LM: On behalf of the Houston Metropolitan Archives and Research Center, I want to thank you for your participation in the project. It’s been a very important interview, and I thank you for your time.
BB: You’re very welcome. I enjoyed it.
(End of dictation)