Miracle and Wonder

Peter Cohen headshot

Dr. Peter Cohen

One look at the news might convince you that the primary way we Americans bolster our self-esteem is by viralizing others’ failures. Through breaking news reports, texts, tweets, emails, and videos, we report, complain about, accuse, embarrass, and/or castigate others for their faults, mishaps, FUBAR’s and SNAFU’s. The main message: Everyone’s an idiot, heaven help the USA.

Yet, in everyday 21st century America, there are myriad acts of charity, breakthrough discoveries, teachable moments, and reliable, top rate human services–all life-enhancing. As Paul Simon sang, “These are the days of miracle and wonder.”

These events can even occur in a therapeutic high school full of “wild and woolly” teenagers, the ones no longer deemed appropriate for mainstream schooling, who are given “one more try” to get their acts together or be ejected. And miracle and wonder happen despite the fact that many youngsters have no reason to trust that adults in power are on their side. Something like the spirit of Tupac must inspire them: “It’s crazy, it seems it’ll never let up, but please, you got to keep your head up.” And many of these kids do brave the storm and keep their heads up.

I wish I could tell you some of their stories, but the rules of confidentiality won’t allow it. So I will create one, a compilation of students I’ve known. We’ll start with the facts, the case report. This first case will be about a boy. In the future, I will highlight a girl. In future blogs, I’ll also share my impressions of how school interventions can go right or wrong, and how I think we professionals either enable or disable the process of a troubled and troubling teen growing into a healthy adult.

As you read along, consider what direct and indirect role substance use plays in the development of the teenager.

Note from the Editor:
This post is part of a series by adolescent psychiatrist Peter Cohen called “High School Confidential: In the Trenches with Substance-Using Teens.” Please click here to read previous posts.

 

Case Study: R.J.

R.J. is a sixteen year old 10th grader. He was admitted to a therapeutic high school after multiple absences, failing grades, fights with peers, refusal to do work in class, and unpredictable disappearances at his previous high school. After being adjudicated for first-time marijuana possession and shoplifting electronic accessories from a big box store, he now has a probation officer.

What are R.J.’s gifts? Drawing cartoon heroes engaging in interstellar adventures and battles, but delaying any romance until the last page. Composing rap lyrics on the fly with inventive word play, stories about himself as a glorified loner and desperado drug user. Playing basketball with a raw talent that includes remarkable spring and a good outside shot. Despite this latter gift, he gives only lip service to trying out with his home school’s team.

What are his goals for this year? To catch up so that he can graduate on time in two years, then find a job that pays minimum wage.

What are his life goals? To be a culinary chef and create fusion Old South-Mexican-East Indian fare.

What is his background? He identifies as African-American, although he knows little about his family’s history. For the past four years, he and his younger sister have lived with the same foster mother. His father has been in and out of prison for drug possession and assault and battery. His mother keeps relapsing because of heroin addiction. He rarely talks to either parent, but will fight anyone who besmirches them. Other than his sister, he has little contact with other family members, and less since his maternal grandfather died last year from complications of diabetes resulting in a heart attack. He attends church every Sunday, cannot be located halfway through the reverend’s sermon, but (after unplugging from the music on his smartphone) can “B.S.” his way through the topic on the drive back home.

Who are his friends? Two other boys, one of whom attends the same school. Before and after school, this trio text and snap-chat as their default social modes, usually trading observations about video games or songs.

And his love life? He recently fell hard for a girl he met through a chat site, but after two months, she dumped him because of his jealousy. Despite being blessed with handsome features (and using them to his advantage), he admits in private his fear of getting hurt and hides it from girls by horsing around or play wrestling. He used to have a running love-hate relationship with one girl in the school, until he insulted her about her weight. He claims that he “was only playing with her.”

R.J.’s foster mother wants him put on a medication, citing his impulsiveness, stealing money, refusing to do chores, and breaking curfew.

Stresses and traumas? He was sexually abused at age six by a neighborhood teenager (the perpetrator was adjudicated and sentenced to a juvenile facility and now no longer lives in the area). He was then referred to therapy, but reports about the results of this treatment are not available. He also witnessed his maternal grandfather’s death from the heart attack.

Past medication treatment? From 2nd grade through 8th grade, he took a long-acting stimulant for ADHD. Since entering foster care, he resists any meds. “They slow me down and rob me of my character.”

Drug of choice? Marijuana. Over the last year, he has used it daily after school and on weekends, when available. It calms him down and makes him oblivious to the stress around him. He bums it off his friends and, if desperate, will steal enough money from his foster mother to pay for a dime bag.

Mental and emotional status? He is of moderate height but muscular, with prominent high cheekbones and braided hair, and clear medium brown colored skin. His speech is clear, then begins to slur when he’s tired, but it is unclear if this is drug-related. He frequently can’t sit still in class and leaves the room to hang out in the hallway at least five times per day. In the classroom, he complains of being bored, restless, and hating the amount of noise in the room. While he refuses to cooperate with any formal cognitive or memory tasks, he is clearly well oriented to time, place and person. He shows no signs of psychosis or major mood swings, although he looks sad when he briefly lets his guard down. He refuses to talk about his mother, stating only that she is a loser. He says he likes his father, but speaks with no affect. When asked about his deceased grandfather, his face tightens up, then he snaps at the examiner, saying “I don’t want to f…g talk about it.” He denies suicidal and homicidal ideation and shows good reality testing.

What does his past testing say? He scores below average in verbal and written testing, on the borderline of having math and reading learning disabilities, with challenges in understanding verbal instructions. He learns best by doing and worst by listening to a lecture. Projective testing has never been done.

Developmental history? One brief sentence in his psychological testing from an unknown source reports that his milestones were within normal limits.

Why is he referred to me? R.J.’s foster mother wants him put on a medication, citing his impulsiveness, stealing money, refusing to do chores, and breaking curfew. Furthermore, for reasons unknown, he has refused to do schoolwork, has been roaming the halls with his impulsive friend, and recently–after losing his temper at being told to go to class–kicked the fire alarm mechanism free from the wall.

Peter R. Cohen is a board certified child and adolescent psychiatrist with additional certification in addiction medicine. For the past 34 years, he has worked in hospitals, residential programs, and outpatient clinics. For almost twenty years, he served as the medical director at the county and state level, focusing on policy and quality assurance for behavioral health programs. Now semi-retired, Dr. Cohen works part-time at a therapeutic high school in suburban Maryland.