Dr Judith Guedalia

'I Am My Brother's Keeper'
This is not our first appointment - he has been here before. We are writing this together, Jeff (*not his real name) and I.  He was referred to me with a possible neuropsychological problem which keeps him from actualizing his full potential.  Some of what has been said about him: "He's a wonderful child"; "He can't get along with authority"; "He's well meaning with a heart of gold"; "He's chutzpadik to his parents and teachers"; "He's self destructive"; "Oppositional Defiant Disorder, but not exactly."
After reviewing his previous assessment and incorporating my clinical evaluation of his behavior, I feel that there is something else going on.  His higher cognitive ability is fine.  This means that he does not have a specific learning disability of a measurable kind.  Though he had been in school, he has not learned in an organized fashion for a long time, practically since 6th grade.  Why, when everything measurable by tests seems to function well, is his life in such a mess?
The purpose of his second appointment was to address what I instinctively felt was the something-else.  The stated purpose however was to teach him the neurology and neuropsychology of Pre-verbal Trauma.  The almost in passing notation in his previous assessment is that he was born with a broken clavicle, a physical trauma not unusual to natural/normal birth.   However, I am saddened to think of this infant being in pain for much of the early bonding time between mother and child and the physically painful connections that would exist between this essential dyad during nursing and being held.  Could this possibly be the basis of Pre-Verbal Trauma that is seen in children, adolescents and adults? * 
After that meeting he decides on his own to come and work on this issue; this "truant/oppositional child" is always on time, always polite and cooperative.  We, him and I, are on a mission to help find, and hopefully begin to allay, the source of his black hole, a sense of unfeelingness that his ever more risky behavior does not seem to fill.
I sit in my office opposite a very handsome and charming 16 year old.  His pleasant disposition and looks belie the fact that he's been out of the organized Haredi school system since fourth grade, bounced to an each-time less demanding religious and academic educational environment until here he is with me, parallel to his being in a rehab center for drug misuse, a hair's-breadth from juvenile detention.
He has spoken about his younger brothers, who idolize him, their oldest brother.  His concern is palpable as he sees them going in his path.
He's sad, dejected and close to hopelessness.  Almost as a pre-programmed robot he relates his next step goals-getting his high school diploma, going to college in the States and then law school.  Even before this mantra of a plan leaves his mouth, he doesn't exhibit a minimum of optimism.  Basically, even before he says it, he feels that it is not realistic or even possible.  I am not sure what is sadder for me to see and hear- his present state or his plan for the future.
What I say and believe is: "I think you have something special to offer your brothers and other people's brothers as well." 
He looks at me askance and is surprised.  He asks me to repeat what I just said. 
"I really do think you have the voice of experience, and since you brought it up, when you mentioned how you fear your brothers will go your way, I think you have something to say.  So much so I would like to work with you and write it up together and see if we can get it printed."
It is post Purim, a holiday which here in Israel takes up the better part of a week, well maybe a month if we start counting at Rosh Hodesh Adar.  Kids of every stripe are mal-educated to believe that ad d'lo yada is an open license for lascivious behavior, be it smoking whatever, drinking or doing whatever.
So we begin to talk about his letter to his brothers:
"Well we are all our brothers' keepers.   My little brother who is eleven-years-old is beginning to hang out with a bad crowd.  He was smoking even before Purim."
"At 11?" I ask. 
"Sure, even before this year, when he was ten-years-old. When do you think I started smoking?  I recall finding a half smoked cigarette, taking matches from home and smoking it with a friend, barfing too!!  That was the beginning.
"I won't talk about drugs because he doesn't know a thing about them yet!  I would say to him:
-Stay in school-Don't start smoking.-Believe in G-d
-You don't have to learn everything the hard way."
Dashed he says: "Nothing I can say that will really make a difference but I'll try. I went to everyone on the face of the earth, every social worker and person like that see what good it did?"
I ask: "What would you say to yourself at 10 or 11 years of age, if you were sitting with the young you?"
"I have no idea, can't look at time like that."
Not giving up on my own pride in this 'wonderful image' I construed, I say: "Well you have siblings, let's look at them like as if in a flash-back." 
"When I was 14 I thought I knew everything, didn't listen to anybody, thought I knew it all.  That was the dumbest thing to think.  When I was 11 I was just opening my eyes."
"Okay," I say. "What did you see?"     
"At that age you are not a baby anymore and just beginning to realize stuff.  Kids have minds; they understand stuff."
"Yes, you are correct," I answer.  "They understand enough which is why your brothers could and would learn from you." 
He thinks a moment and says: "I wouldn't bother; trying to help kids is well, setting yourself up for failure.  Truthfully, I think you can only bribe them."
"What will happen to them the next time, bribery sounds like it is a one time solution of sorts, not an educational moment," I ask.
"What about the next time, it's really the friends that they meet.  Kids today are stubborn and awful."
Boy, you sound like a dejected and rejected parent!!  You know, I don't agree with what you said, I don't believe kids are bad.
"I don't think kids are bad either, really.  Stuff that you do can be bad. Stuff they do can define them."
Boy that's what Dumbeldore said to Harry Potter.  Maybe we can even understand the saying: Zeh lo hakankan ela ma she betowcho-It's not the kettle but what is inside.  Wait a minute-in the story of Cain and Abel, Hashem understood what Abel's kavana was - his intention, not specifically the sacrifice itself.  This is something Cain did not understand at all.
"To me," he says, "maybe it is like when you open your eyes and see something new, a new store in the mall.  It seems interesting and better than all the other boring stores.  You are always going to find something new.  I discovered this hanging-out in Jerusalem, smoking and hanging out with friends.   When I was 11, I was smoking cigarettes, but I never thought I'd be doing drugs."
What happened? 
"I found a cigarette one of the Arab workers had left behind, I made a 20 shekel bet that I would smoke it; took a package of Listerine and deodorant spray out of the house and I smoked two puffs and sprayed myself.
"And that was the beginning There is nothing that protects kids from when they see something new that isn't good."
I look at him as the fountain of youthful information, the mayim should and could have been Torah, but instead something happened along the way and today he has the wizened words of an old man, not a sixteen year old who is bright and should have the whole world in the palm of his hand.  I ask this zaken, this wise old man:
"What's the difference between the kids who did see it - did see the new and didn't get sucked in, versus the ones who couldn't keep from falling into the trap?" 
"I have a friend who did all the bad stuff and he went one way and I went another.   I also thought he'd end up like me.  He's a really good kid now; we are still friends.  He experienced a personal tragedy before high school. I was sure he would be my buddy on this trip, thought he was coming with me, but he changed paths, he took a fork in the road and ended up a good kid, and I..." his voice trails on. 
Thinking of his floundering away, a fish out of water, hanging with a bad crowd I feel he IS his own tragedy.  
"Maybe you need a personal tragedy too", I say. 
But his demeanor and answer showed me this was too flip and too fast.
"I know kids who took their tragedies in a totally opposite reaction too." Meaning they REALLY went down a terrible path.
 I couldn't check my next remark, it just popped out: "I don't believe that".
"Yeah, I don't believe, Tupac is dead"-huh?
"You know the first Rapper."
"He's hiding out with Michael Jackson, and the Lubavitcher Rebbe," feeling this would really get a rise out of me.
"Now if you said Elvis, I'd have a hard time arguing with you ." I'm just joking, I say,
"Yeah, I know that" and left unsaid, was that I wished he was too.                              
We make an appointment for next week.
            Eight weeks have passed quickly.  We did some EMDR but mainly we spoke, he taught me many things.  At our last meeting before his case goes to court to decide what happens next, he wrote me a Rap Song.  He asked that I not share it with you, so I won't.  But he is calmer, more resigned to be helped in Rehab, and hopefully gleaned a sense of purpose to be his brothers' keeper.


* Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy; Journal Child and Adolescent Social Work Springer Netherlands' ISBN:0738-0151 (Print) 1573-2797 (Online);Volume 23, Number 2 / 4/2006;D10.1007/s10560-005-0039-0; Pg.147-171; also Dr. Bruce Perry's work: www.ChildTrauma.org) 
Dr. Guedalia is Director, Neuropsychology Unit; Senior Medical Psychologist; Shaare Zedek Medical Center; Licensed Psychologist; Supervisor and Specialist in Medical, Rehabilitation, and Developmental Psychology; EMDR Level II, Co-Chair Nefesh Israel. She can be reached through her website: www.drjudithguedalia.com