Renée Fuller, Ph.D.

Copyright © 2006 by Renée Fuller

     The two women entered my office somberly, followed by a boy of about three. Even a cursory glance at the child indicated that something was very wrong. He showed no interest in the toys strewn around the room, or in the three of us women. Instead the child scratched the furniture, the floor, even the walls with an unabated fury.

     I turned to the two women "He has no language I presume?" Both women nodded. We sat down facing each other while the child continued scratching the diverse surfaces of the office. "What diagnosis, if any, were you given?"

     The older of the two women stiffened. "They said that it was my fault. That I had given Ralph confusing signals and that this is what happened."

     My first reaction was incredulity, "Your fault?!", I asked. Then I remembered that one of the "expert" assumptions, which at that time was still prevalent, was that non-responsive, confusing, ambivalent and punitive mothers can cause schizoid and autistic symptomatology. What those holding to this theory also presumed was that when a child demonstrated such severe disruptive symptoms these in themselves were indicative that the mother must be cold and unpredictable, thereby responsible for the pathology.

     Looking at the obviously brain-damaged child I shook my head and said; "You didn't believe that diagnosis, did you?" Both women indicated "no." But whereas the older woman's "no" expressed resignation, the younger woman's "no" was emphatic and angry.

     I turned to the considerably older woman, assuming she was the mother. "How many children do you have? Is this your youngest?"

     It was the younger woman who answered. "There are nine of us. I'm the oldest and he", pointing to the child who was still furiously scratching, "Is the youngest." As she said this I could feel the closeness, the tenderness between the two women. My impression was that they had come together to our clinic in defense of their family. Questions about the health of the other children were met with a look of pride followed by a look of sorrow as they watched the scratching, out-of-touch three-year old. "The others are all doing well?", I asked.

     For the first time there was a smile on the face of the younger woman. "Yes", she said exuding genuine pleasure. The older woman gave her a look of such affection that I wondered where the eyes of the doctors had been who had made the "It's your fault" diagnosis. I also wondered where their ears had been. Had they bothered to take a history and listen?

     Knowing why they had come to us I said; "Our clinic will run the child through the appropriate brain and blood tests. We'll try to find the physical cause for Ralph's condition and whether there's anything we can do. But you know our science still has a long way to go". The two women nodded. They understood that we might not be able to cure Ralph or even know what had caused the obvious brain damage. But at least we would thoroughly examine the child and listen to them.

     Sadly, despite our listening and extensive lab tests we weren't able to find the cause for Ralph's disorder. But by listening we had at least extended the respect the family deserved and had not done more harm that our lack of understanding might have caused.

     The importance of listening was brought home early in my work as a clinical physiological psychologist. I saw first hand that listening was not only a demonstration of respect to fellow humans but frequently produced essential information. It is not unusual for the information from the parents or patients to verify or alternatively to question treatment protocols and/or test results.

     Rada, a colleague, who had been trained in physiology, had a personal experience reflecting how listening can yield essential information. The essential information was gained on an occasion when she was in her forties after having taken an aspirin for an incipient cold. Shortly after taking the aspirin she experienced a headache on her left side and a blurring of vision including a general feeling of weakness. She suspected that the symptoms might be a mini stroke and that the mini stroke could have been caused by a blood clot somewhere in her brain. To dissolve the possible blood clot she took another aspirin, which would function as a blood thinner. Feeling weak she lay down waiting for the symptoms to get better. They did not, and so in order to make sure that they would improve Rada took another aspirin. The symptoms almost immediately grew worse. At that point Rada suspected that the blood thinner aspirin, rather than being the appropriate treatment, was in all likelihood the culprit.

     She also suspected that by taking a blood thinner she had put herself in danger of a serious hemorrhagic stroke. A hemorrhagic stroke, rather than being caused by a blood clot blocking an artery, is a consequence of a leaking or ruptured artery causing bleeding in the brain. Taking an aspirin, which is a blood thinner, could seriously exacerbate the bleeding. Rada realized that she must inform future doctors about the dangers of giving her Dicumarol should she have a repeat of what in all probability had been a passing mini stroke. Her reasoning was that evidently one of the smaller blood vessels in her brain was fragile and would leak when her blood's normal clotting factor did not prevent bleeding. Having no subsequent symptoms Rada decided that as long as she never took another aspirin she would be all right.

     That, as it turned out, appears to have been the correct conclusion. Rada, now in her sixties (more than 20 years later) has not had further symptoms indicating a mini stroke. She has also never taken another aspirin. Having moved to a new location she thought a local medical doctor would be useful, just in case she ever needed one. Which was the reason she made an appointment with Dr. Esterbrook.

     The doctor's waiting room was filled with the usual sniveling, coughing, and obese patients. After waiting a good hour Rada's turn came. She explained to Dr. Esterbrook that there was nothing wrong she just wanted to have a local doctor. Dr. Esterbrook didn't seem to hear her; instead he proceeded with an extensive physical examination, including chest x-rays, blood workups and urine analyses. When it came time to talk to his new patient he indicated there was no time. Rada, however, thought it was important to tell him why she had checked that she was allergic to aspirin on the form she had been given. "'It's not that I'm allergic to aspirin, rather I'm apparently sensitive to its blood thinning aspects."

     The importance of this information did not seem to register on Dr. Esterbrook. So Rada explained that should she ever have a stroke it would be imperative that she not be given Dicumarol as a matter of course. When the doctor did not appear to have heard what she had said, or make a note of it, she repeated herself. It was no use. The doctor wasn't hearing her. He wasn't listening.

     Rada understood. She realized that finding a doctor who would listen and record important information could be a matter of life or death. After considerable searching she found herself a physician who listened and recognized the importance of the information he had been given.

     A short time ago Rada called me. It was shortly after Israel's Premier Sharon's stroke. "They made that inexcusable mistake. They administered Dicumarol when his mini stroke must have been caused by a leaking artery that stabilized itself. What with Sharon's speedy recovery from the mini stroke, the doctors had time to wait for the test results to see if they should administer Dicumerol. Instead they gave the blood thinner immediately as a matter of course thereby inducing a major hemorrhagic stroke. And that major hemorrhagic stroke, as we heard on the news, required surgical intervention in a frantic attempt to stop the bleeding." Rada was sure that Sharon's doctors had not paid attention, in other words, listened to the researchers and statisticians who have warned that there are a number of strokes that must not be treated with a blood thinner. As Rada phrased it, "Their lack of listening, of paying attention to that possibility may well have changed the course of history."

     And then there have been my own experiences. The most recent was when I sought treatment for an eye inflammation. The ophthalmologist's waiting room was large with impressive picture windows overlooking the parking lot and the mountains beyond. I counted at least three bookkeeper-receptionists manning an equal number of computers. Although my appointment was for 8:30 A.M it was not before an hour later that one of the numerous technical assistants called my name and ushered me into a small cubicle where she proceeded to give me several eye tests. After another 45 minutes wait in the cubicle the DOCTOR arrived.

     Ironically the inflammation had resulted years before after the removal of an eye splinter by another ophthalmologist. The latest ophthalmologist, like the previous ones, made clear that he did not have the time to listen to the history of an eye inflammation, which he explained was a result of my being fair skinned with pink cheeks. My response was: "All the women in my family have had very white skin and pink cheeks. But they didn't have eye inflammations." Did he hear me?

     I don't think so, because he immediately went into a spiel about cataract surgery, which he proceeded to diagram with gusto. Did he hear my response of "I know how the surgery is done?" Since he continued his pitch as though there had been no interruption I added "Eye surgery when there is an eye inflammation doesn't sound like a good idea." He didn't seem to hear that either.

     Was this economically successful ophthalmologist unusual in not hearing his patient? Does being an "expert" mean that you don't have to listen because you already know the answer, have all the information? My experience with a dentist was similar to that with the ophthalmologist. I was told that I grind my teeth at night. Whereupon I pointed out that that would be impossible since I can't sleep with my mouth closed because of the large caps on my front teeth. Like the ophthalmologist the dentist didn't appear to hear me. Instead he said I needed crowns on those back teeth, which he suspected would require root canal work to be done by a colleague.

     And in my own field of psychology? How many times have I heard the all but desperate cry from parents? "The child is real smart at home." This is followed by descriptions of the many things the child can accomplish. "The school psychologists examined him at school and said that "He/she is learning disabled, dyslexic, has Asperger's syndrome, etc."

     The "I refuse to hear you" experience also happened to the Brooks, parents of Allan, a second grader. They were astonished when they received a letter from the school informing them that Allan would not be promoted to third grade because he had not acquired the reading and grammar skills that are required for entrance into third grade. Mrs. Brooks, certain that there had been a mistake, called the school office and laughingly spoke to the principal about the "mistake."

     As Mrs. Brooks told me later, the voice at the other end of the phone responded rather coldly telling her that. "There was no mistake. Allan's test results have shown that he has a total lack of phonemic awareness and ignorance of basic grammar. There is no way he'll be able to meet the requirements for entrance into third grade. Hopefully by repeating second grade he'll learn these basic reading skills."

     According to Mrs. Brooks what happened next was that in her anger at the attitude of the principal she lost her cool and exploded on the phone. The explosion boiled down to, "For goodness sake, the child just finished reading TREASURE ISLAND and told us all about it at dinner; why it was such a good book. Allan is way beyond the third grade level of your lousy, incompetent school."

     The response of the principal was that Mrs. Brooks was deluding herself. "The test results show what's really going on. They don't have an ax to grind. They can face the truth."

     Needless to say Mrs. Brooks continued to be livid; and she still hadn't cooled down when we met several days later. "That woman didn't just not believe me, she didn't even bother to listen. I don't think she heard me when I said she could find out for herself that Allan is a fluent reader - way beyond the third grade level. She just wasn't listening. She's willing to listen to some damn test but she won't listen to me or listen to the child read! When I told her about our local child-librarian who's been advising Allan on the books he'd like; that she could talk to her - she wasn't listening to that either. My husband says we should take this problem school and the principal to our lawyer and make a court case out it. But it bothers me that meanwhile Allan would have to put up with being humiliated. I was thinking maybe we should just find an alternative school."

     It was the local librarian who suggested the alternative school that turned out to be a great success. Being so close to the children and the community the librarian knew what children had had happy school experiences, and which schools produced the happy positive learning results.

     When Mrs. Brooks went with Allan for an interview with the principal and the third grade teacher of the alternative school she informed them of the test results of the previous school. She also told them of Allan's reading ability. The response of the principal was to take TOM SAWYER off the shelf: opening the book to the first chapter, she asked Allan to read to them. This the boy did with gusto. Smiling, the principal asked Allan whether he liked the beginning of this book and what kind of story he thought it would turn out to be. The resulting conversation, lasting about an hour, was a joy for everyone, including Allan and especially his Mom. Needless to say there was no talk of Allan having to repeat second grade.

     Amused, the principal, shaking her head, said to both the mother and the third grade teacher, "Just goes to show that neither phonemic awareness nor theoretical grammar are necessary skills in order to be able to read. There was an interesting research study in the l970tees that showed just that. But nowadays it makes a lot of money for the testing companies to test for phonemic awareness and grammar." Then, turning to the third grade teacher the principal grinned and said "Allan might like our advanced reading class. It's a mixed age group with youngsters who have already learned to enjoy books."

     Allen's response to the advanced reading class was one of pure joy. Mrs. Brooks's description of her son's reaction to the new school went something like this: "When he comes home Allan talks about nothing else. He just loves talking about the books they're reading. And he can't wait to go to school the next day. He used to be all hangdog waiting for the school bus. Now he jumps up and down all excited, waiting for the school bus to hurry up and come."

     About a year later Mrs. Brooks called me, her voice triumphant. "After finishing third grade Allan has been skipped to fifth grade. The principal told us that 'Since Allan's three best buddies from the advanced reading course are going into fifth grade he'll feel right at home in a class with them. We're sure that what with his reading and writing ability he can handle the work.'" Then Mrs. Brooks added "And this was the child who was supposed to be left back in second grade!".

     The Brooks family found the new alternative school so rewarding that they became involved in the funding for the new school building. Mrs. Brooks told me how grateful she was that they had escaped from having their son recklessly humiliated - something she felt might have affected him the rest of his life. "It's made all the difference that the principal and the teachers of our school know how to listen."

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