A Mind in Disarray

We were outside, waiting for the buses, on a cool spring afternoon. I noticed Dave standing nearby. His coat was unbuttoned despite the sharp breeze, and his shoes were on the wrong feet.

“How ya doin’ today, Dave?” I asked.

“Awright.”

“Say, you might want to button your coat. It’s pretty chilly out here.”

“Yeah.” Usually he needed help with zippers, but buttons he could get by himself. When he finished, I asked him if he had worked hard that day.

“Yeah.”

“What kind of work did you do?”

For a moment he seemed to be considering the question. Then, surprised, he looked toward the driveway. “Van laaate,” he said.

“The van? Well, I’m sure it’ll be here pretty soon.”

There was a short silence before he said, “Eyes are sore.”

“They’re sore, huh?”

“Yeah. Back, too,” he said, pointing to his back. He had lordosis (excessive forward curvature of the spine), which made him look like a kid whose belly sticks out even though he isn’t fat.

Throughout our conversation Dave was looking about, so he noticed when Ruthie—short, curly-haired, and dazed—walked by. He wrapped his arm around her neck and pulled her over.

“Hi, Ruthie,” he said. Then to me: “I lllll-like ’er!” He wasn’t stammering; sometimes he just elongated a word as a way of emphasizing it.

“I can see that. So, do you remember what work you did today?”

He dropped his hold on Ruthie and she wandered off. For a few seconds he thought about the question, but it drifted away before an answer came to mind. “Van laaate,” he repeated.

“Yeah, it is a little late.”

I figured we had about exhausted the work question, so I decided to try another. “Tell me who your supervisor is, Dave.” I knew that since I had last worked with him, in the Toy Department, he had stayed almost exclusively in the prevocational area.

“Ummmm, Cynthia.”

“Well, yeah, Cynthia is your case manager. But who works in your room with you?”

Dave saw Cynthia standing a few feet away. He went over and tapped her on the shoulder. He didn’t say anything, though, so I told her Dave was trying to tell me who his supervisor was.

“Who’s your boss, Dave?” she asked.

“Ummmm, ’Arbra.”

“Well,” she said, “Barbara used to be your boss, that’s right, but who gives you your jobs now?”

He looked puzzled, as though he were trying to recall something from the distant past.

“Do you remember?” Cynthia asked. “Her name begins with a Ray sound.”

“Raaaay,” Dave said.

Finally she whispered, “Rachel.”

“Rachel,” he repeated.

A minute later I asked him what he was going to do that evening.

“Go home,” he said.

“Uh-huh. What’re you gonna do when you get home?”

There was a pause as he looked toward the driveway.

“Van laaate,” he said finally.

Dave was like a little kid. He had a curious, wide-eyed look; his hair was always mussed; and he had an endearing grin, highlighted by a big hole where one of his upper front teeth was missing. He had the rumpled, haphazard appearance of a child whose parents let him run wild: shirts were just barely tucked in; buttons and zippers were frequently overlooked; and the chances were only fifty-fifty that his shoes were on the right feet. He was about 5’2” and 120 pounds. Dave was born in 1951, his intellectual disability coming from a postnatal cerebral infection. He was in Boulder from ages eight to twenty-five. After that he lived in a succession of Great Falls group homes.

Dave was moderately energetic, yet he barely lifted his feet when he walked. Essentially he slid them, like a cross-country skier. His walk was functional enough—it did get him from one place to another—but it seemed not fully developed, as if he was still learning how to take a step. Occasionally someone would suggest that he pick his feet up more. Dave would respond by lifting each foot way up, as though, having encountered deep powder, he had exchanged his skis for snowshoes. But within seconds the idea would evaporate and he’d go back to sliding.

I spent my first six months at the Center in the Toy Department, where our main product was wooden rocking horses. The clients in the shop cut the pieces for each horse; the Toy Department then sanded the pieces, assembled them, and painted the finished animal.

Every morning before the clients arrived, I set up the work tables, putting at each client’s place whatever I wanted them to work with: for one client, perhaps a sander and the neck of a rocking horse; for another, a practice board for hammering nails; for a third, a partially assembled horse plus all the tools and materials the client would need to finish the assembly. When the clients entered the work area, I kept an eye out for Dave, because if left alone for even a few seconds, he could create chaos out of order. Like a restless toddler, he’d push things here and there, leaving nothing in its original spot. The notion of an orderly arrangement—the idea that things might belong in one place but not in another—was alien to him.

Sanding was the only work I’d dare let him do unless I was standing right next to him. He got tired of this job, so eventually I made him a deal: if he’d do some sanding each morning, then right before lunch I’d let him put the two rockers on a horse. He enjoyed this task enough that he was willing to put up with the sanding. Every few minutes he’d turn his sander off and say, “Hey buddy, rrrrrr-rocker?”

“Not yet, Dave. Not till about twelve o’clock.”

“Okay.”

Whenever Dave did this job, I’d hover over him anxiously the whole time. The Center depended upon the income we received from our products and services, and this could be maintained only by keeping the quality of our work high. As a result, supervisors spent much of their time monitoring the clients’ work, inspecting products, and touching them up. I was especially watchful of Dave: any tool he grabbed, I’d put a hand on also, hoping I could keep him from damaging the horse.

Each rocker was three feet long and several inches wide; its top edge was straight, its bottom edge curved. The first step was to take a plastic template of the same size and shape, and lay it on the rocker so the edges were even. By poking a pencil through some holes in the template, the client marked where nails would later be driven into the rocker. Dave, however, had almost no intuitive sense of shape; he would sometimes put the template on upside down, with the straight edge of the template on the curved edge of the rocker, and see nothing amiss.

“We need to turn the template around, Dave.”

“Turn around?”

“Yeah, we need to turn it around so the edges match.”

“Okay.”

Next, using a ruler, we’d draw a line on the side of the horse, marking where the rocker should go. Dave would begin with his pencil against the ruler, but as soon as he started drawing the line, the pencil would veer off to the side, as though the ruler weren’t even there. Many times I tried to show him what the ruler was for and how to use it, but I never got through to him. The only way to get the line marked right was for me to wrap my hand around his while he drew it.

After we placed the rocker on the line, Dave would start the four nails, then whale away at them—and, if we were lucky, not dent the wood too badly. The nails had to be countersunk, so I’d get my courage up, then hold the punch while Dave hammered. (If Dave held it, it would slip off the head of the nail after he struck the first blow. Still, he’d continue hammering, slowly driving the punch through the wood as if it were a thick spike.) After the nails were countersunk, he’d cover the holes with monstrous globs of wood putty, unless I got a hand on the tube and restrained his zeal. Then we’d turn the horse over and put the second rocker on the same way. One set a day was enough for me.

Together Dave and I put a lot of rockers on, and the last set was no easier than the first. Although he let me guide his hands, he never saw the difference between the way he did a particular step and the way I did it. The reasons for doing things one way rather than another eluded him; he didn’t think in terms of how and why. He had only a tenuous grasp of the conceptual frameworks that most of us take for granted and that help us navigate through life—things like cause and effect, ends and means, tools and techniques. Dave’s thinking was less structured than this, and more haphazard. His attention was fleeting, his thoughts evanescent, his actions impulsive. His mind operated in jerks and starts—and his emotions followed suit.

Most of the time Dave was a likable guy.

One night, after the client-staff basketball game, he came up to me in the gym. “’Lenn?” he said.

“Yeah, Dave.”

“Buddy, can I talk to you pleazh?”

“Sure. What’s on your mind?”

He looked around the gym, then at me, and noticed my wet forehead. “You cold, buddy?”

“No, I’m hot.”

“You hot?”

“Yeah. Hot and tired.”

He touched my forehead, then my neck. “Neck’s red,” he said.

“I believe it.”

“You sweating?”

“Yup, I sure am.”

He looked out through the open door. “It’s cooold outside,” he said, his face intense.

“Yeah, we may get some snow tonight.”

He held out the ends of his jacket. “Buddy, zip ’ish pleazh for me.”

At lunch Dave enjoyed talking with the other clients. He’d look on with genuine concern when they were angry or upset, and even though he usually didn’t understand what they were agitated about, he’d respond with sympathetic words.

He was particularly attached to two clients. To Jody and Ruthie he was invariably affectionate—sometimes oppressively so. Jody was cute and plump, and often walked around with her mouth dropped open. She didn’t really need Dave’s attentions, but was passive enough to submit to them. When he first saw her in the morning, he’d gently take her hands in his, or rest his hands on her shoulders. Some days she made a feeble attempt to wriggle away, but most days she stood still, and for a long time they stared at each other in complete silence.

Ruthie, tiny and giggly, needed more looking after than Jody, and Dave was quick to volunteer. One afternoon he was in the cloakroom when she came in. “Ruthie,” he said, “your shoe’s untied. I’ll get it.” I watched with some interest as Dave approached her, since he, like Ruthie, couldn’t tie his own shoes. But the mystery was short-lived.

“Say, buddy. ’Mere pleazh.” I walked over while Dave lifted her foot high in the air. “Tie it pleazh,” he said.

He was not always so considerate. We had more violent incidents with Dave than with any other client except Grant. Rarely did these become Code 9s, however, because Dave could usually be quickly subdued by one or two staff. He was dangerous, though, because his first strike often came without warning: there was no threat beforehand, no hesitation, as there was with Grant. Once, when he was working for Tina, he picked up a chair and, for no apparent reason, shoved one of the legs in her face, cutting her eyelid; a fraction of an inch lower and he could have damaged her eye. A few weeks later she was complimenting him on his work when he threw a can at her, striking the top of her head. Both times she was taken to the emergency room for stitches. After the second incident, Dave wasn’t allowed to work for Tina any more. “I lllll-like ’er!” he used to tell me.

Earlier that year Dave had attacked the woman who drove his van. Afterwards he was assigned to another van driver. Before the incident, it had become clear that Dave had a crush on her. Like Tina, she was young and attractive. Dave’s mental age was two and a half but he had the body of a man, and some of his violence may have come from sexual frustration.

In the five months between the attack on the van driver and the attacks on Tina, Dave was involved in one violent incident after another. Most of these were directed at staff, especially female staff, and most occurred at his group home—thirty-nine incidents in one month alone. The attacks on Tina finally led to Dave’s being put on Navane, an antipsychotic medication that is sometimes used to reduce aggressive behavior. For the next year he had relatively few outbursts, but when they began escalating again, the Navane was increased.

Often the incidents seemed to come out of nowhere, with no clear explanation; other times they were less of a mystery. At the Center, if he suddenly shoved his work across the table, it meant he was tired of his job and was about to start throwing things.

Grant was a brawler, Dave was a thrower. Sometimes young children are throwers also: a person who is weaker than those around him may discover that a small, hard object can make him instantly formidable. Dave was cat-quick, and if you supervised him for very long you inevitably were going to look up one day and see a missile coming at you—a hammer or a power sander, a chair or a lunch box, a book or a shoe. Usually he was overpowered within seconds, but soon after he was released he might throw something else or overturn the nearest table. Sometimes there were several outbursts in a row. It could get much worse at his group home: the pattern of fighting and restraining, fighting and restraining, could go on for hours. When it got to the point where the staff was exhausted and the residents were in tears, the police would come and take Dave to the hospital.

Once set in motion, anger is the most tyrannical of emotions. It develops its own momentum, and in its determination to express itself suppresses all other feelings and ignores all consequences. Afterwards, though, when the events that triggered it have passed and the emotion has dissipated, that expression of anger can engender profound regret.

So it was with Dave. After his anger had spent itself, he’d be anxious for reconciliation. Sitting in a chair, he’d be breathing hard, his body would be shaking, and his face would be drenched with tears. “I’m sorry, I’m sorry,” he’d sob, and he’d want to hold hands with the people he had just attacked. The first time I saw this it seemed sad, but it became less so with repetition. Yet the guilt he displayed was real. Dave wanted to be friends with the world, and was genuinely upset that he had attacked other people and aroused the animosity of staff.

Together, Grant and Dave caused most of the disturbances at the Center, but they viewed people very differently. Grant enjoyed having fun with people but only on his terms; he had no regard for their wishes. Dave, on the other hand, tried to respond to the needs of others and sympathized with them in their distress. Grant would do somebody a favor if he thought it would bring him a hug or a pat on the back, but Dave would do it because he wanted to help. That didn’t stop him from attacking and even injuring people, but it did cause him to feel genuine remorse afterwards—something that Grant never experienced.

Dave’s encounters with the law had one curious effect upon him: he had sheriffs on the brain. Sometimes he came up to me, grinning, and said, “Hey, buddy?”

“Yeah, Dave.”

“Buddy, I’m gon’ call the sheriff on you!”

“You are?”

“Hey, buddy?”

“Yeah?”

Still smiling, he’d point his index finger at me. “Pow!”

Our speech therapist once interviewed Dave to see how well he understood his own anger. Especially, did he know what caused it, and did he see how his feelings of anger gave birth to his actions? She showed him pictures of different faces, and though he could pick out the angry face when it was opposed to the happy face, he could not distinguish it from the sad or scared ones.

She asked him what he was supposed to do when he got mad, and he answered, “Walk away.” This was what the Center and his group home had been trying to teach him: that instead of throwing something, he should walk away from the situation until he was calm.

But then she asked, “What makes you mad?” and again he replied, “Walk away.”

“Do people make you mad?”

“Walk away.”

Her last question was whether or not he liked being mad. After looking around the room, he focused on the slowly revolving tape that was recording his words.

“Ooooh, noisy!” he said finally.