Integrated Case Study #1 for
Human Services Students
Prepared by Jerry M. Hatfield, LCDP - Department of Human Services
ãJerry M. Hatfield
______________________________________________________________________________
This Integrated Case Study describes the Herring family and each of its members; Jacob (father and husband), Mildred (wife and mother), Jill (first-born daughter), Christine (second-born daughter), Jack (third-born son), Katherine (Mildred's mother), and Sean (Mildred's father). It is intended for use throughout this course. At various times throughout the semester you will be asked questions and given assignments based on topics addressed in class related to this ICS.
The Herrings live in East Ryder,
Many of the minorities live in the town’s public housing project that consists of 4 concrete block buildings, each with 50 apartments. The federal government subsidizes rents. The housing project is 35 years old, and is in general disrepair. Windows are broken, there are no recreational facilities on the premises, there is no public transportation close to the housing project, the grass is rarely cut, and litter is everywhere. Recently, a group of residents formed an Improvement Committee to improve the appearance of the project as well as to focus greater attention on the illegal activities that everyone knows go on there. Drugs are easily available, and occasional gunshots may be heard. One result of the Improvement Committee is that the Police recently opened up a Community Police Station in one of the vacant apartments on the ground floor. The Station is staffed twelve hours a day by resident volunteers, and one Community Police Officer is assigned there during the 3pm to 11pm shift. The Community Police Officer also volunteers on weekends to coach new athletic teams and supervise sports activities. Teams of resident volunteers also patrol the grounds at night in order to discourage the selling and using of drugs in public. In the six months since this experiment started, residents report that the general area is a much safer environment, and that they feel safer walking around the area at night. They have also banded together to pick up the litter surrounding the project. Their next goal is to seek better maintenance of the buildings.
There are two elementary schools, and a combined middle and high school. Most of the teachers have spent their whole careers there. Some of them taught their current students' parents. The district has a difficult time attracting new teachers because of low pay and the isolation of the town. The teachers are complaining that there are so many discipline problems that they cannot teach. The Middle and High School have also started to see some graffiti on its walls, and no one understands it. There have also been two swastikas painted on the front door. The School Department has been cited by the State Department of Education for not employing an adequate number of Special Education teachers, and the two teachers who are there complain that the numbers of special needs students is growing so rapidly they can't keep up with their work. In general, most of the teachers complain that they just don't know what to do with "these kids", and "it's not like it used to be". Students attend school hungry and without coats, they fall asleep in classes, and sometimes smell of alcohol. The bathrooms are smoke-filled, and teachers refuse to enforce the no smoking rule out of fear. Occasionally, the Police are called in to inspect students' lockers, and discover several types of drugs, including marijuana, alcohol, and numerous unidentified pills. In East Ryder, the most important aspect of school is whether or not the football team won the last game. Residents value sports over academics. The drop out rate is approximately 44 percent. Student test scores are substantially below the average. Until recently, adults didn't see the need for an education. The mill didn't require a diploma.
Recently, several mothers joined together to "do something about the schools". They do not want their children to grow up to be unemployed and without marketable skills. After meeting with the superintendent and getting permission to use the high school gym, these mothers began an after school study program for drop outs, middle and high school students. A volunteer teacher helps with the academics, while the mothers monitor the students' behavior and progress. The mothers consistently let parents know how well their children are doing.
Housing prices in East Ryder are rapidly declining. People who want or need to sell their homes are taking a loss. Rumor has it that the mill will eventually close down. Some are afraid that East Ryder will become a ghost town. After the mill laid off so many people, several community leaders got together with the mayor. Together they have been going to the state capitol to lobby for state help. Children have been included in these efforts. Every Sunday after church, children write letters to their legislators and other public officials. This group has also lobbied the town for more money in the school budget, but because of the economy and a declining tax base, the Mayor tells them there is no more money to spend, and in fact, next year will be worse for the school budget. The Mayor has also said that town taxes are likely to increase next year, but he knows how hard that will be on most people.
East Ryder has a high rate of vandalism and burglary. Juvenile arrest rates have increased by 30% in the last five years. Recently there has been a string of arsons. There has also been an increase in the number of reported child abuse cases. The Police Department's budget has been cut back, there is no hope for hiring additional police officers, and the ones on the force are not allowed any overtime payments.
East Ryder is about 35 miles from the nearest urban center. There are no large malls, one small theater, and 15 taverns. Young people hang out at one of the two fast food restaurants or "party" in the woods outside of town. Every house has a television and VCR, and often kids get together at one of the houses to play video games or watch TV.
The church is the mainstay of East Ryder. Bible study, quilting bees, picnics, and family bingo nights provide recreation for many. Since East Ryder fell on hard times, the church is taking leadership in helping families who are in trouble. Volunteers run a soup kitchen, organize family activities, visit the sick and run youth activities. The church also sponsors classes for adults and children where they learn how to cope with being laid off. Children learn how to take on extra responsibility and help their parents. Parents learn how to support one another and not take their frustration out on their children.
Interestingly, the church has also become a popular gathering place for many of the town’s adolescents. The building is open every night until 11:00 p.m., and numerous activities take place. There are outdoor sports, and inside there are movies, music, and space to just hang out. Adults monitor the activities and have received training in communication skills and problem solving. The building is crowded every night. Recently some of the teachers from the school have been recruited to be monitors and supervisors of the various activities. The kids who attend seem to enjoy seeing their teachers in different and more relaxed surroundings. One of the teachers has begun to show movies on violence and racism, and discusses them after the films are over. This has become a regular event, to which some of the kids look forward.
The primary drug of choice among the town’s youth is alcohol. There is an extremely high rate of alcohol abuse and alcoholism among adults. As the unemployment soars, so does alcohol consumption. Many parents tacitly approve of teen drinking, especially for boys. In some way it is seen as a right of passage. They "partied in the woods" and expect their kids to do the same. Parents are becoming concerned, however, about the amount of sexual activity that takes place in the woods. Recently there has been an increase in teen pregnancy.
The town Police Department is also recording an increase in cases of domestic assault, up approximately 42% in the past five years. Most offenders either spend the night in jail if they are also drunk, or the officers instruct the victims to stay with someone else for the night.
East Ryder is a relatively small
town, and as such has limited health services.
There are three general practice physicians, each of whom practices in
his home. There is also a neighborhood
emergency health clinic. This clinic is
open from 9:00 am till 5:00 p.m., and is staffed by a full time nurse who lives
in the town, and a first year medical resident who is affiliated with
There are several “neighborhoods”
in East Ryder. A small neighborhood
known as “
“West Junction” is mostly middle-class and white, and is made up of mostly older people who have been in their homes long enough to have paid for them. Their local Councilman continues to be re-elected by always fighting tax increases. Most residents are on fixed incomes, with no children in school.
“Mill Town” is the area closest to the mill, and is a generally lower-class socio-economic area. Virtually all residents either work at the mill, or did, and are now on public assistance. Ethnically, the area is predominately African-American, Hispanic, and Asian. Most of the residents rent their homes from absentee landlords. The Herrings live in Mill Town.
“The Projects” is the name given the subsidized housing development. It is an ethnically mixed area, and the residents either work at the mill or are unemployed or on public assistance. The property is managed by a company in Rockport City.
A. Jacob Herring, age 50, drives a delivery truck for the clothing mill, and is often on the road several days at a time. He has worked for the company for the last 24 years. Jacob, whose parents are holocaust survivors, was taught at an early age to keep to himself and not to trust anyone, since anyone could betray him. At age 18, Jacob was drafted into the Army and served in Vietnam as an Infantryman. In Vietnam, he was exposed to marijuana, hash and heroin, and used them extensively to ease the alternating periods of boredom and battle. After the war, he was unemployed for approximately three years, and was hospitalized several times during this period, diagnosed with Post Traumatic Stress Disorder, as a result of the war. During his hospitalization he also detoxified from his addiction to heroin. To this day, Jacob continues to smoke marijuana to calm down and ease the symptoms of his PTSD. Jacob took advantage of the GI Bill and enrolled in college, but dropped out his first semester, unable to attend to his school work or keep up with his assignments. After dropping out, he got his current job at the clothing mill. Jacob was raised in the Jewish faith, and although he does not attend temple, is highly disturbed by the swastikas on the school's front door. He also sees many youths with shaved heads, and reacts with a fear he cannot identify at the conscious level. He also reacts in a very negative way to the increasing number of Southeast Asians moving into the community. They remind him of Vietnam, causing agitation and anxiety. Jacob carries with him memories of the war that enter in to his consciousness often. Guilt always follows, for long periods of time.
Jacob's quality of mood and sensitivity are very low, he is easily distracted, and relatively inactive. He prefers to be alone, usually watching TV when he is home. He's often angry and drinks the night away at his favorite bar. On weekends when he is home, he takes his children to whatever athletic games are in season. He particularly enjoys watching high school football. When the games are over, he takes the kids out for snacks at a fast-food restaurant, then they usually go home and participate in some type of sports activity. He looks forward to these “special” days with the kids, but they just seem to “go through the motions”. Mom usually volunteers at church on these days.
Jacob has experienced high blood pressure in the past few years. His doctor has prescribed medication to control it, and also suggested that he lose 25 pounds and quit smoking. Jacob has not gotten his prescription filled allegedly due to the cost, but in reality, he just doesn’t want to take pills. He would like to quit smoking, but each time he tries he “gets too nervous” and starts again. He occasionally gets chest pain, but doesn’t want to tell anyone. His health insurance from the mill does not cover prescriptions and requires large co-pays for doctor’s visits. Jacob also has chronic headaches, for which he takes aspirin - sometimes six to eight tablets a day.
Both of Jacob’s parents died last year, within two months of each other. Jacob’s mother died from pneumonia in a State psychiatric hospital where she had been for many, many years, diagnosed with schizophrenia and severe depression. Jacob’s father always thought his wife just couldn’t cope with the trauma of the Holocaust, and slid into a safer world of her own. She never spoke, didn’t seem to recognize anyone, and was a constant reminder to her husband of the terror they had once survived. After she died, Jacob’s father, who took a bus 125 miles to visit her each week, didn’t want to live anymore. One night, Jacob’s father went home and put a bullet through his head. He was tired of surviving. He survived the Holocaust, survived all those years of his wife’s illness, but finally couldn’t survive this loss. He was discovered several days later by the letter carrier who noticed the mail piling up.
B. Mildred Herring, age 40 is a teacher assistant at the local elementary school. She is of mixed ethnic heritage. Her mother is African-American and her father is Caucasian. She is very light-skinned and most people are not aware of her heritage. She has never felt a part of the African-American community, and has no awareness of any ethnic rituals or traditions. Mildred has many friends and often socializes with a few of them after school. They usually go out for coffee or go to one another's house to talk. She has fairly regular routines, and enjoys new experiences - new movies, books, new recreational activities. She enjoys her job a lot, since it's always different, and the children with whom she works are always interesting and challenging. Her quality of mood is quite pleasant, and her reputation around school is that "she's always smiling".
Mildred was raised in the Catholic religion and continues to attend church weekly. She is quite involved in her church community, and has many friends from that community. As a child, Mildred was over-protected by her parents. She was not allowed to go out with her friends after school, discouraged from learning how to cook or sew from her mother, and was not allowed to date until she graduated from High School. Her father was the ruler of the family, and never showed any affection. After she enrolled at the local Community College, she began to date, discovering the excitement and elation that came with the boys’ attention. She also experimented with sexually intimate relationships with girls, experiencing satisfaction with them. As a result of her promiscuity, she became pregnant. Without the knowledge of her parents, she had an abortion, after which she was depressed for several months. She continued her promiscuity, looking for the “man of her dreams”. These encounters included fellow students, teachers, and numerous others. She had a brief sexual encounter with Jacob, became pregnant and subsequently married him. Her father refused to go to the wedding or speak to her for years, because she got pregnant and worse yet, married a Jew. Not until their second child was born did he begin speaking to Mildred again.
Sometimes Mildred feels trapped in her marriage, and still wishes she were free to “play the field” again. She loves her children and loves her husband, but continues to look for a more meaningful relationship. This occasionally leads her to extramarital affairs with men in the town. She is afraid Jacob will find out, or that someone she knows in town will see her with someone else. Most of her affairs have been with very controlling men, and some have even bordered on violence. After every affair she vows to herself to stay faithful to Jacob and learn to appreciate him more. As each affair ends, she experiences depression and increases her alcohol consumption. Her alcohol of choice is vodka because she believes that no one can smell it on her breath. Once in a while during these difficult periods, she drinks before school in the morning because it seems to relieve her depression and helps her to be more social.
For the past two or three years, the alcohol consumption has not helped to lighten her mood. She now occasionally calls in sick to work because she cannot force herself to get out of bed in the morning. She would much prefer to sleep or watch TV, often not getting dressed. She cries frequently, has lost her appetite, and has lost 15 pounds in the past 6 months. She spends many sleepless nights just gazing at the TV. Jacob has no hint of these difficulties since he is gone from home so often.
Mildred often takes over-the-counter sleep medications to treat her insomnia. Since she has a difficult time “getting going” in the morning, she has discovered that if she takes Sudafed that she has more energy. She now takes them regularly when she gets up, and sometimes takes them during the day. She has been diagnosed with high blood pressure, but does not take the prescribed medication due to its cost. Mildred is beginning to experience menopause. She is experiencing “hot flashes”, and blames most of her physical ailments on the menopause. She has not been to a physician in about eight years. Sometimes Mildred says that she would “just like to stay in bed for a week” so she could rest up.
C. Jill Herring is Jacob’s and Mildred’s first born, born 6 months after they got married. Mildred’s pregnancy was quite difficult, but she couldn’t talk to her parents about it since they were still critical of her sexual activity. Jacob was not emotionally available, and her only “friends” were those with whom she would go out at night, and they were not interested. Jill was born 1 month premature and was difficult to satisfy. She cried frequently without apparent cause, didn’t eat regularly, and was afraid of new situations. Mildred had a quite difficult time adapting to motherhood, often leaving the baby with a neighbor to go out to taverns with her friends. She relied heavily on neighbors for babysitting, not truly enjoying Jill’s infancy. By the time Jill was two years old, Mildred had accepted her motherhood, and began to pay more attention to Jill and the other maintenance tasks of motherhood.
Jill had a difficult time adjusting to school, beginning in Kindergarten. She cried on and off all day, got sick to her stomach, and wanted to go home all the time. Throughout the first three grades her teachers noted that she didn’t pay attention very well, and as a result, barely passed from grade to grade. Jill continued to be miserable in school, having no friends. When she entered the fourth grade, she was diagnosed with Attention Deficit Hyperactivity Disorder, and given extra help in school. After repeating the fourth grade, her academic performance improved, but she was still unable to make friends, and still found as many excuses as possible to stay home. During the seventh grade she began skipping school to hang around the woods with a few friends. It was there that she was introduced to marijuana. She discovered that while high, she enjoyed her new “friends”, and her troubles seemed to drift away. She has also discovered how good she feels when a new boy pays attention to her. This “special” feeling has led her to become sexually active with several boys in her “group”. She fears pregnancy, using no protection, but is unable to resist the attention, and dreams that one of the boys will fall in love with her and give her the secure life she desires so much.
Jill usually enters a “trance” like state during her sexual activity. This trance-like state allows her to separate her body from her mind, and sex doesn’t bother her as much. She reports that sometimes she imagines being with her father during sex. She has begun a habit of going home after sex and cutting her arms with a razor blade. She always wears long sleeves so that no one notices the cuts and scars. If her sister Christine is home, Jill goes to her room and crawls into bed with her.
Jill is now 16 years old, and in the 10th grade. She is approximately 40 pounds overweight, relying on food to satisfy her when she is troubled. She does not attend to herself, does not eat regularly and her sleeping habits are irregular. She often stays in her room at home with the lights off and just thinks about how miserable she is. Sometimes she ponders how much easier it would be to not be alive at all. She is increasingly dependent on drugs, moving to experiment with anything that is offered to her.
Jill has medium-dark skin and nappy hair, reflecting her mother’s ethnic heritage. She is ashamed of the way she looks, and would rather be “all white”. Some of her classmates call her derogatory names, and Jill often reacts with physical violence.
Jill has been taking Ritalin for ADHD since the 4th grade. But in the last year, she continues to get the prescription, but now sells it to other students. They report that they like it, and she never has any trouble selling her complete supply. Although she has told no one, Jill has serious abdominal pain coincidental with her menstrual cycle. She’s afraid of what it might be because she’s heard about Sexually Transmitted Diseases, but she’s afraid her parents will find out if she goes to see a doctor. In order to lose some weight she has been taking over-the-counter diet pills for the last two months. She has lost some weight, but she feels jittery and sweaty, but it goes away, and she likes losing weight.
D. Christine Herring is the second-born child, now 14 years old, in the 8th grade. Her teachers describe her as a “happy child, always willing to help the others”. Mildred’s second pregnancy was much easier than the first. Delivered at full-term, the delivery was unremarkable. Christine was cooperative as a child, and smiled frequently. She ate and slept regularly, and therefore got all of the positive reinforcement, while Jacob and Mildred continued to ignore or punish Jill. Christine enjoyed new activities and always looked forward to new experiences. Although she was occasionally “punished” by Jill, she continued a course of normal child development. She excelled in school, earning good grades and accolades from her teachers.
Christine experienced a difficult adjustment upon entering the 8th grade. She began to be interested more in boys than her schoolwork, and her grades reflected this new interest. Her mother noticed the radical change and met with Christine’s teachers. They all discussed the problem, worked out a more rigid schedule for homework, and the next quarter Christine’s grades improved significantly.
In the third quarter of the 8th grade, Christine’s behavior began to suddenly change for the worse. She became distant, began treating her friends as if they were objects. She sometimes has conversations meaningless to others. Her friends can’t figure out what is happening, and don’t understand her anymore. She is often in a daze, and without emotion. She no longer has any interest in others, and prefers to be alone. She has almost completely stopped communicating with others, including her family, and refuses to eat at home, suggesting that her father wants to poison her and her sister to get rid of them. She recently has stopped bathing, and most of the time will not open the door to her room. Sometimes her mother hears her say, “Be quiet, be quiet”.
Christine has lost weight lately, and looks gray and drawn. She likes being thin, and is taking the same OTC diet pills as Jill. They use the money that Jill makes selling her medication to buy whatever they want in the drug store. They enjoy their trips to the drug store, and often get their friends to buy things for them so the clerk won’t notice.
Christine has her father’s fair complexion, her father’s straight hair, and easily passes for “white”. Her friends are curious about Jill’s heritage, wondering if they are really sisters.
E. Jack Herring, age 14 was adopted by Jacob and Mildred when he was 4 years old. Jack’s ethnic heritage is mixed; his mother was Vietnamese and his father was Caucasian and in the military. One of Jacob’s conflicts from his war experiences is guilt about his fathering a child while on duty in Vietnam. Jacob also always wanted a son so he could teach him how to play football, go fishing, and other activities they could both enjoy. When Mildred came home from church and told Jacob about the church’s involvement in finding homes for Amerasian children, Jacob could not refuse. After the birth of Christine, Mildred's doctor told her she should have no more children. The only history available regarding Jack was that he was given up for adoption at birth, and was placed in a crowded orphanage in Vietnam. At age 2 he was adopted by a Vietnamese couple who lived in a refugee camp, hoping to travel to America. Six months later, the parents both died of unknown disease. Jack was returned to the orphanage and lived there until Jacob and Mildred adopted him.
When Jack arrived, he did not speak at all. He was not toilet trained, and only walked a few steps at a time. He seemed distant, but Mildred attributed that to an adjustment period. His development continued to be slow through the next three years. By age 6, Jack was speaking well, but his gross and fine motor skills were still delayed. Emotionally he was distant, and seemed not to bond with any member of the family. This was particularly troubling for Jacob, since he had always wanted a son to mentor. Gradually, Jacob drifted away from Jack, leaving his care to Mildred and the girls. Eventually, Jacob seemed to be angry toward Jack, probably resentful of his emotional distance, and even occasionally referred to him using a derogatory ethnic slur.
At age 8, Jack killed the family cat by beating it with a hammer. Devoid of emotion of any kind, Jack left the cat in the back yard in plain sight. His sisters found it after school, and cried hysterically. When they rushed into the house to tell their Mother, Jack simply stated “I did it.” He calmly walked into his room and listened to his radio. After Jacob returned home several days later, he severely punished Jack by beating him, restricting him to his room, and prohibiting TV. Jack remained emotionless. Mildred wanted to take him to a psychologist, but Jacob protested and prohibited it, saying it was too expensive, too far away, and besides that, after the beating, Jack would surely not do anything like that again.
One year later, Jack did it again, only this time it was the neighbor’s dog, again beaten and killed with a hammer. The neighbors complained to the police, and the police questioned Jack, who quickly acknowledged his deed. Since the investigating officer was one of Mildred’s former lovers, the investigation was closed. Once again Jack was severely punished by Jacob, and Jack responded as before. Later that night, Jack walked into Christine’s room and threatened her with a large kitchen knife. She was able to fight him off before he harmed her, but due to the noise, the whole family was awakened, and once again the police were called. This time, the police took Jack into custody, but released him later the next day, with no formal disposition.
Meanwhile, Jack was not doing well in school. His teachers reported that he bullied other students and threatened to beat them up. Jack was well known to the Principal, and spent many afternoons in detention. He began to skip school to hang out in the woods. Soon, he was accused of the rape of a girl three years older than he. She reported that he threatened her with a large rock, and forced her to take her clothes off. As a result of this charge, Jack was sent to the juvenile detention center for 30 days. He got into several fights there, and was accused of attempted rape of another boy there. By this time, Jacob and Mildred did not know what else to do, and eventually they surrendered their parental rights. Under state custody now, Jack was placed in a group home for delinquent boys, but often runs away and peers into the Herring’s windows, running away when he is seen. He often writes letters to the Herrings asking them to take him back into their home. As Jacob and Mildred were discussing it one night, they looked out the window to see their garage in flames. The Fire Department came and extinguished it before it did much damage, and the cause of the fire was never determined. Of course, Jacob and Mildred knew how it happened. After an investigation, Jack was arrested again, charged with arson, and once again placed in juvenile detention.
While in juvenile detention, Jack was given a battery of psychological tests, and was diagnosed with Obsessive Compulsive Disorder and Depression, in addition to Oppositional Personality Disorder. He was administered medication for the OCD and depression, with good results. When he was released from detention, Jacob and Mildred took him back into their home on a temporary basis. Jack continued to take his medication, and currently is causing no trouble. He remains, however, devoid of emotion and communicates very little with the family. Most of his time is spent in his room, listening to the radio. He expresses deep resentment toward his parents for all that has happened, and frequently tells them he hates them and hopes they die.
Jack enjoys smoking marijuana, and uses it almost daily now. He also takes some of Jill’s ADHD medication when he feels like “being with it”. He has friends who can buy beer for him and his friends, and if he needs money, he steals it from his mother’s purse. His mother gives him aspirin for his chronic headaches. He reports that “my head pounds so much I can’t take it.” Jack has also been diagnosed with ulcerative colitis, but is not currently under any treatment for it. He has frequent stomach pain, but does not tell anyone.
F. Katherine Connors, age 56, is Mildred’s mother. She very active in the local Catholic Church, and has been plagued by chronic depression. As a result, she has been hospitalized several times throughout her life, each time being released with medication which she takes for a couple of months, and then discontinues. She has been treated with Electro Convulsive Therapy several times, with good results. She and her husband live in the same town as the Herrings, and since the family’s reconciliation have been supportive of Mildred’s family. Katherine has often babysat for the children, often takes them to church when Mildred is ill, and often cooks for the family. Although she is afraid of Jack, she expresses support and empathy toward Mildred for all that she had done and tolerated.
From the time Mildred entered school as a child, Katherine worked in the mill, trying to put money aside for her retirement, but always “loaning” it to Mildred when money was short. Six months ago, she was among those who were laid off, and now is unemployed, with little savings and no retirement. She suffers from emphysema and blames it on the mill and the dust from the cloth she worked with. She now volunteers two days a week at the church, and keeps busy the rest of the time helping out with Mildred’s family. Her applications for disability are consistently denied, based on the fact that her husband smoked all his life, and that her affliction is caused by second-hand smoke, not the mill.
Katherine is of African-American heritage. Her parents both worked in the mill all their lives and expected Katherine to do the same. She dropped out of school at age 16 to follow her parents to the mill. Her school experiences had not been very good. She had a difficult time learning, and her teachers ignored her, as they did most African-American students. She gradually withdrew from all social contact. People always told her that she was so pretty she didn’t have to be smart. Soon after she got her job at the mill, her white, middle-aged supervisor began to touch, feel, and molest her. He threatened her with her job if she told anyone. When she met Sean at the mill, she saw an opportunity for protection. They soon married, but the unwanted molestation continued for several more years. Unfortunately she became known as the girl who was “easy”. Instead of the protection she had hoped for from Sean, she got rejection and disgust.
G. Sean Connors, age 70, is Mildred’s father. He emigrated from Ireland at age 12, and has lived in the town ever since. He, too, has worked at the mill all his life since age 14. He met Katherine at the mill, and they were married when he was 30 and she 16 years old. He has heart disease, and cannot do much. Most of his days are spent at home in the living room watching TV. Katherine prepares his meals, washes and irons his clothes, keeps the house clean, and tolerates his verbal abuse.
Soon after they were married, Katherine discovered that Sean still had several girlfriends with whom he spent time at the local bars. Although he frequently came home at 2 or 3 am, he always told her that he had been at the tavern. Katherine knew, however, he had been with the other women. Katherine was very young, and had never even dated another man before Sean. If she complained too much, he would insult her until she felt guilty for complaining. At some point, Sean either quit his infidelity or Katherine quit caring. Either way, the result was the same – the marriage had died. By this time, neither had any practical reason to divorce, an act that the church would not allow anyway. Indeed, they had many practical reasons to maintain the marriage. They needed two incomes to pay the mortgage on their small cottage, and they still had a daughter to watch over.
When Jill and Christine were young, Sean looked forward to babysitting for them. He especially looked forward to the times Katherine would go out shopping and he had the kids all to himself.
Sean’s parents were both killed by gunfire in Northern Ireland when he was 5 years old. He was raised by his rigid and controlling aunt who had no children of her own. No bond ever developed between the two, and his aunt took him out of school in the 5th grade in order to clean the house and help with the laundry she did for the neighbors. By age 12 the relationship was so strained that she sent him to America to stay with another of Sean’s aunts.
Katherine complains now that Sean is getting more and more forgetful, and seems distant most of the time. He sometimes cannot remember anyone, leaves the house and gets lost, and Katherine knows that this is the beginning of the end. He continues to be verbally abusive, and now has become physically abusive, leaving Katherine with multiple bruises and contusions. Katherine tries to keep these problems hidden from her friends and from Mildred, but everyone knows. When he is lucid, he tells Katherine that she must take care of him and threatens her if she even thinks about a nursing home for him.
During Sean’s lucid times he looks back over his life and regrets most of it. He is proud of his strong work ethic but feels a failure as a husband and a father. He feels estranged from everyone, fears death, but loathes life.
III. The Family Asks For Help
One warm summer evening, Mildred decided to go out for a while. Although she hadn’t really decided where to go, her normal path would have taken her to one of the local taverns. It had been quite some time since she had gone there, having been pretty occupied with her kids and their troubles. On her way to the watering hole of her choice she passed by the Church and noticed the lights on. Because it was unusual, she thought about it. Oh yes, it was open for confessions, she knew that. Somewhere in her brain was a place for that information - the same place as remembering the Holy Days, the Rosary, and the Seven Deadly Sins. Only this night, the light invited her up the stairs to the Church instead of to the tavern. Upon entering, it was clear she was the only soul she could see in the building. How foolish, she remembered. Of course Father is here. He’s in the confessional. The door was not all that easy to open - maybe it hadn’t been open lately. After all, this wasn’t the kind of town that usually asked for forgiveness.
“Father, forgive me, for I have sinned.” And sinned, and sinned, and sinned. Where do I start? What should I say? What shouldn’t I say? He knows who I am. What’ll he think…after all these years? I’m a good person, dammit, and maybe that’s all he needs to know. Maybe I need to know more. Oh well, I’m here, and I’m guilty as sin. Dammit.
An hour later, she escapes, having bared her soul, released herself from the bonds of sin, and really didn’t feel one bit better. But she had to do what Father told her. Oh, God. Why now? After all these years? What will happen? I can’t make the call. I’ve never been able to do what I had to do. But I was good at doing what I knew I shouldn’t do.
As the family poured into the small office, each examined the room before taking a seat. Jacob sat straight as a ramrod. Mildred sat next to him, hoping. Jill’s face told everyone they needed to watch out. Christine’s body said “Leave me alone.” Jack sat.
“Let’s start by just talking about what brought you all here”.
I wondered how it would start, but even more I wondered how it would end.
After a few swollen moments, Jacob spoke.
“Well, isn’t this cozy? You want to know why we’re here? We’re losers. We’ve been losers since I can remember. I used to try. I used to think it was mostly my fault. I was never around, always on the road, never had much time for anyone else but me. But then I guess I just sort of quit. Quit. I don’t even remember when. Just quit.”
Mildred couldn’t believe her ears. Never had she heard him say anything like that. Was he drunk again? No, he was stone sober. Stone sober and he opened his mouth, and what came out couldn’t have been Jacob. After all these years of stone silence. What’s going on? Did he just open the door?
Jill cried. Jill cried? What kind of conspiracy is this? Jill doesn’t cry. In her first three years she cried enough for her whole life, and must have run out of tears, because she hasn’t cried since. But Jill cried. And cried, and cried. Didn’t say anything, just cried.
Christine looked like she was inflating like the balloons at the state fair. What happened next no one could have predicted. In five minutes that stretched into at least 10 years, she emptied more toxic trash from her gut than the town could have produced in a decade. Jacob got it, Mildred got it, Jill got it, and Jack got it.
The Counselor asked each member to describe their family. Jacob spoke first, surprising everyone. He said he always felt like he didn’t fit in the family. Jill had Christine, Jill and Christine always seemed to have their Mom, and Jacob said he was never “in the loop”. Sometimes he saw the family as the “girls against the guys”. Jacob described his family as a “mess”, everyone doing whatever they wanted, never knowing when or if dinner would be…sometimes the trash piled up in the kitchen, sometimes there is no food in the house, it’s “just a mess.”
Sometimes Jacob would have to discipline the kids when he got home from a long trip, but he was the only one who ever did, and he always felt like the “bad guy”.
Mildred was next. She, too, said she didn’t think they were much of a family. She and the girls felt close, but no one felt close to Jacob or Jack. The word “love” was never spoken in the house. “If a visitor came to the house, they’d never know we were related to each other.” Mildred says she misses her mother and thinks about her all the time. She feels like she never took good enough care of her mom, and wishes she were “home” again so she could do better.
Jack. Jack sat. And sat, and sat. Motionless. Tearless. Lifeless. Oh, Jack.
Several months later, most of the family was trying to stay on the right track. Jacob took a job in Shipping and Receiving. Fewer hours, but home every night. Mildred sat and thought a lot, remembering the good times, but still trying to remember the last time she smiled at home. Jill didn’t go out much. Mostly she stayed home now, wondering what to do. Christine worked the hardest. She got a part-time job, and gave some of the money to Jacob, who couldn’t take it at first, but then he realized she needed to give it.
A few weeks later, the Herring family met with their family therapist, who recommended that they would all benefit from entering into individual treatment. The Herrings had felt some satisfaction from their family therapy, and somewhat reluctantly agreed to individual treatment. The family therapist provided them with a list of names of people whom he recommended, and the family scheduled appointments.
Jacob met with his counselor a couple of weeks later. The counselor’s notes from his first interview reflected that Jacob was participative, but his voice was a little hard to understand. Jacob seemed to speak very softly, and sometimes the counselor could not understand what he was saying. Jacob seemed to be somewhere else, never looking at the counselor, but rather looking at the floor. He was slow to answer questions, and although cooperative, seemed to be angry. Jacob’s description of his history was slow, but detailed and easy to understand. He seemed firmly in touch with reality, although his reality was a harsh one. Although he sometimes couldn’t remember all the details, his story made sense to the counselor. The counselor noted that while Jacob reported his story, he didn’t seem to connect it to his present life.
After a few weeks with the counselor, Jacob started talking about his experiences in Vietnam. Just a few random thoughts at first, but after a while, most of the story came out. Jacob was one of thousands of men on the battlefields, just one more guy with a rifle. One night after they had been on patrol for weeks with very little sleep, they were ordered to occupy a small village suspected to hiding a large group of enemies. It was well after midnight that they approached the village. At first there was no activity in sight. Then they saw the shadow of a figure moving from hut to hut with what looked like a rifle. The first barrage of gunfire erupted, and after that, he didn’t remember many details, except that the sky lit up with artillery shells, they all took cover, and the explosions didn’t stop for what seemed to be hours. Eventually the gunfire stopped, and everyone sat quietly and waited for the dawn. As the sun rose, Jacob was ordered to go into the village to assess the damage. He saw bodies everywhere…women, children, old folks, young folks…no uniforms…no weapons. “Oh my God…what did we do?” Soon, the rest of Jacob’s company of soldiers swarmed the village looking for the bodies of the enemy. Not one was found.
As Jacob finished his story, he was shaking, perspiring, and his voice was that of a frightened child. “I’ve never told anyone that story before, Doc. I’ve been too afraid that I might just completely fall apart when I told it. I dream it almost every night. I can smell the gunpowder, the bodies, the blood, I can feel the horror, and I wake up with tears flooding my face. I just can’t believe I did that. It will never go away. I relive it almost every night. Then I wake up, and I start adjusting to life back home all over again. It’s almost like I just came home every day. I can’t get rid of it.” He continues… "They should never have been there in that village. Didn't they know we'd be coming? They should have known. They knew it was 'hot' area. They were fools. They deserved what they got."
During subsequent sessions, the counselor encouraged Jacob to connect his PTSD to his current life, to begin to understand how his historical experiences impact his current behavior. Jacob acknowledged that he is afraid of his wife, his kids, and most others. For this reason, he likes his new job driving a truck for the mill. He gets to be alone most of the time. What he fears most is getting close to his family, because he might have to tell them all that he has lived through, and as a result, they'll think he's "crazy". His extreme guilt also prohibits him from sharing the experiences.
As treatment for Jacob continues, the counselor gets more concerned about Jacob's health. He recognizes that Jacob's self-care is poor, and that good self-care will be integral to his successful treatment. The counselor recommends that Jacob have a complete physical, to which Jacob agrees. During the next appointment, Jacob looked worse than he ever had before. The counselor made this observation and asked Jacob about his physical exam. Jacob didn't respond for quite a while. He just sat there, crying. Jacob finally composed himself, and reported to his counselor that he just found out that morning that he is HIV+. "Just what I need. I guess I deserve it after all. But I never touched another woman, honest, and I sure as hell don't go for guys. I guess it's just God's way of treating me the way I've treated others".
Jacob's doctor also told him that there were many new drugs available for HIV treatment, and that he should start as soon as possible. Unfortunately, the mill did not pay for Jacob's health insurance, since they are in serious financial condition. So he's kind of left high and dry. The doctor says that the drugs alone will cost at least $5,000 a month! Jacob is thinking, just like the rest of my life…there's no hope. I can't tell Mildred or the kids. They'd be even more ashamed of me than they are now. Maybe I should end it now instead of later. I still have some life insurance, and I still have my pistol."
Mildred couldn't see any point in all of it. They had been to family counseling, and everyone now understood what they had to do. At last, the family had seen the light…Jacob, Jill, Christine, and even Jack. "Now", she thought, "maybe I will have a more peaceful life, things will change." What Mildred couldn't see was that she had very skillfully avoided talking about herself during treatment, and successfully portrayed herself as the "victim" in the family. Individual treatment scared her; she couldn't imagine being alone with the counselor.
She reported that her health was "probably poor", but she could not be specific. She complained of headaches, lower back pain, and an often-upset stomach. All she knew now was that she needed to escape from this small room! She was getting sweaty, afraid of what she might say. This is not the first time for these symptoms. If only she could have a drink to calm her down, but that's not going to happen here. She should have had one before she came.
As she began, she spoke so rapidly that the counselor could hardly understand her. Then she would slow down and whisper. Her speech was clear enough, but the counselor suspected something significant was going on. She smiled, she was pleasant, and yet she spoke of her troubles and hardships. Her voice said one thing, thought the counselor, but her words say another. Which is believable, if either? The counselor noted that her thought process was clear and undisturbed, content was normal, but what was wrong?
When counseling began, her strategy was clear. She would seduce the counselor. She would do the one thing she was good at. It always worked before. And, of course, it would keep her safe and in control. That's what she wanted; safe and in control. That's what's good about being an adult…she can finally be safe and in control. Her strategy was the same as it had been before. She would smile, tell him what he wanted to hear…be the "perfect" client. And then she'd move in for the final seduction. But it didn't work this time. The counselor knew what she was doing, and confronted her about exactly 'who' she was trying to seduce! Damn! She resisted and resisted, but finally gave up and started to share some of her history, and eventually she started to see herself more clearly. Even more clearly than she wanted. After all this time, all those men, all the alcohol, all the troubles, she began to see it clearly; she was really angry with her father and wanted to be in control. It was, of course, very difficult for her to talk about it. She didn't want to remember the way he was, nor all that he had done. She always knew her mother was real sick, and she tried to help out any way she could, and she believed her father when he told her how she had to be the "mom" in the family. But now she hated him for it. She lost her youth, she lost her innocence, and now she didn't even know who she was, and she was afraid of losing the only thing she had left; her family. Now, what should she do? She kept asking her counselor, "What do I do now? Who am I now?"
Of course there were no easy answers, but she kept looking. And still, in the back of her mind, she wondered how long it would be until she was finally able to seduce him.
Jill thought she had been through enough already. She poured out her gut to the family counselor, but that didn't seem to improve her day-to-day life. She started getting sweaty just waiting for the counselor to speak. She gazed around the room…it seemed to take hours just to look at the books on the shelves. She thought they might fall in on her, they were so full. But then she saw the magazines, and picked one up. The pictures were so flashy she could spend the whole night looking through them. She never noticed before how complicated some of the magazine pictures were…there were so many parts to one picture…man, this is too much, I really can't take this. Close the magazine. Whew…what a relief. Oh no, here comes the counselor. Jeez, I'm thirsty. I wonder if he has any soda. Maybe something to eat, too.
After his gentle greeting, he asked her a question, but by the time he got to the end of it, Jill forgot the beginning. She tried to fake an answer, but the counselor looked puzzled and she knew she hadn't done it very well. She asked him to ask the question again, so he did, and she used all her powers of concentration to pay attention. The question had something to do about her relationship with her father. She starts thinking "Man, that's like some universal philosophical question, how could anyone answer it? You'd have to know God first. He really doesn't get it." Then she realized it had been a very long time since he asked the question, knew that he'd figure her out pretty soon, so she just had to leave. She got out of her chair, said "I'm really not feeling very well" and left the office.
The counselor put a note in her chart that she seemed a little paranoid, her thought process and content were at least mildly disturbed, and that she needs a psychiatric screening. Call her next week to re-schedule, suggest she see a doctor.
Christine failed to keep three appointments before finally going to the counselor, and only then because her mother almost dragged her out of the house. When Christine spoke to the counselor, her words were a little slurred, she kind of starred around the room, and every once in a while spoke to someone who was not there. The counselor couldn't make any sense out of what she said. She expressed no emotion, and most of the time just sat and looked at the floor, as if there were no one else in the room. In a very low whisper, she kept repeating "I want to die, I want to die." The counselor called the hospital in Rockville and made arrangements to commit Christine for a period of ten days for screening and treatment. The hospital came to the counselor's office to transport her, and after she left, the counselor called Mildred to tell her what he had done.
Six weeks later he saw Christine again, and this time she was conversant and could speak to him, but still in a monotone. Her speech was slow and barely a whisper, but he could understand her now. Unfortunately, her appearance and hygiene had not improved. Her clothes were wrinkled and soiled, she apparently had not bathed in a while, and her hair was tangled and uncombed. He spoke to her about her hospitalization. "It was awful…they put me on this ward with a lot of loud, crazy people. I swear I didn't belong there. And they made me take these pills. I hate these pills. My mouth gets dry all the time, and I feel like I'm not really here…or there…or, where am I anyway? The voices are still calling me…they’re so loud, I tell them to ‘shut up’ but they don’t listen. I just want to get away from them. Can you make them go away?” The counselor spoke to her about the importance of continuing to take her medication, because it would be good for her. And that's about as far as he got. She just seemed unable to understand any more than that. He scheduled another session with her in another week. Maybe then they could converse. Or maybe not.
The counselor entered more notes to her chart. “Scheduled follow-up appointment in six weeks. Consult with psychiatrist regarding medication and prognosis. Help other family members understand the disorder so they can be supportive.”
Jack’s first appointment had been postponed several times, telling Mildred he’s sick and can’t go out anywhere. Since he came back home, he’s been much easier to manage, and even seems pleasant at times. Mildred is starting to like him again sometimes. He still has outbursts of anger, and tells Mildred and Jacob he hates them, but the outbursts are less frequent than they used to be. Jack continues to spend time in his room, and misses school at least two or three out of five days a week. The school principal has told Mildred that he will probably not pass this year, but Jack does not seem to care.
When Jack first enters the counselor’s office, he doesn’t sit down. He stands, and moves around a lot. The counselor allows him to stand if he wishes, and then asks Jack if he wants to take a walk to the local convenience store. They leave the office, and walk to the store to get a snack. On the way to the store, the counselor asks Jack how he’s been doing lately… “Anything bothering you?”
“I just get so pissed off sometimes, at nothing. All my Mom has to do is look at me the wrong way, and sometimes I go off on her like she’s the worst person on earth. But she’s really a good Mom and I really do love her, but I’m afraid she’s going to throw me out again because sometimes I’m such a jerk. My dad, he’s a different story. I really don’t like him. I don’t think he was very nice to my sisters. I’d really like it if he would just disappear. We’d all be a lot better off if he would. He’s nuts, you know. I hear him yelling in his sleep at night, I don’t know how my Mom puts up with him. No wonder she goes out so much. I don’t blame her. I think I really want to stay home now, but after all the shit I’ve pulled, I must be on really thin ice. I can’t go back to one of those group homes, they’re really scary. I’m afraid of them.”
“Tell me what else you’re afraid of, Jack,” said the counselor.
After a very long pause, Jack says, “I think I’m afraid of everything and everyone. It’s getting so that every time I leave my room I get nervous. I just want to stay in my room. I’d like to eat there, too, if my Mom would let me. Every time I leave the house, my stomach gets all upset and nervous, and all I want to do is go back home. That’s what it’s like at school, too. I’m always nervous, I just want to run outside and run home. I feel like a little kid when I feel that way, and I always want to cry, but I hold it back because I don’t want anyone else to see me. Most of the kids think I’m bad, and I want them to keep on thinking that. That way they stay away from me. I don’t like to hang around people…they make me nervous, so I just get high and it all goes away. I couldn’t live without getting high. It’s what keeps me from going nuts.”
The counselor continued to see the Herring family for several months, but then the insurance ran out. The counselor kept them for about a month after the insurance ran out in order to prepare them all for termination of treatment. It was a very difficult period for all. The counselor had grown quite fond of each of them, and was quite gratified looking back on the family’s period of treatment. So gratified that he hesitated to discharge them, but he had made his decision. They must be discharged. He attempted to find a treatment agency that would provide some treatment without charge, but couldn’t find an agency that was within easy traveling distance.
So the Herrings ended their treatment. Family treatment was over, individual treatment was over, a lot of things had changed; some things had remained the same, and some things had actually gotten worse. They were still all together, but still had a lot to learn, and a lot to discover about each other. In some ways, they had just begun, after climbing what seemed to be a mountain of change. Just a few weeks before treatment was terminated, Katherine Connors (Mildred’s mother) died of a heart attack after a long illness complicated by her emphysema. Sean Connors (Mildred’s father) now has advanced Alzheimer’s disease and is in a nursing home fifty miles away from East Ryder. Even when Mildred goes to visit, he no longer knows her. The Mill has reduced its workforce by half, but Jacob still has a job. Mildred’s job is less secure now, since the school department has laid off three other Teacher Assistants, and she’s next in line.
But the Herrings move on, just as they always have.