Dad, Mom, Cira Doe and Jane Doe.

                  Anashku, aged about 41 years had called Cullinan – the psychologist by 3:30 P.M on a Saturday seeking an appointment. They knew each other for 8 years and this was the first time, Anashku asked Cullinan for a help. It was later understood that it was for Anashku’s son Jane Doe.

                  Anashku was working as a waiter in one of the oldest hotels in Democratic Republic of Bingle while his wife was working in a garment’s factory as a tailor. They were earning a decent income by struggling hard day in and day out. This couple had a couple of children. Cira Doe, aged about 17 years, doing her under graduation in one of the recognized colleges in Democratic Republic of Bingle while Master Jane Doe was studying his 10^th grade.

                  Mr. and Ms. Anashku got Jane Doe to the hospital to talk to Cullinan. Cullinan investigated and assessed the patient and advised Anashku “Jane Doe needs intense, frequent and long-term therapy to be as functional.” The father was devastated to listen to the treatment plan and questioned Cullinan “What is the reason behind my son’s present condition? Can it be cured? Will my son be fine? I love Jane Doe. I want him to be normal – like other guys of his age.” 

Ms. Anashku asked if there are any medicines for Jane Doe instead of therapy. She added to it that she was ready to give him medicines secretly without the knowledge of the patient. They were educated about the pros and cons of drugs on the client’s body and mind.

Story of Jane Doe

Pre-Birth – the mother’s psychological health

During this phase, as the mother was fed with healthy and nutritious food but the environment was emotionally contaminated because of her father’s alcoholism and frequent fights between her parents. This had an impact on the emotional state of Mrs. Anashku. She had been in this environment during the 6^th, 7^th, 8^th and 9^th month of pregnancy.

“I was scared almost all day – every day and I have spent many sleepless nights because of my parents. It was almost every day, my parents used to fight.” Said the patient’s mother.

On the day of delivery

“My parents threatened me saying that they would kill the baby if the baby is a girl again. I was into labor pain and these people talked to me this way.”
She also reported that her mother was in the labor room during the procedure. 

“No woman would have faced this kind of situation in their life. I was so near to death.” She added.

Mrs. Anashku passed out because of excessive bleeding and intolerable pain. After she became conscious, she understood that she had given birth to a male child.

Jane Doe’s infancy and early childhood

Jane Doe had been with his mother in her parents’ house as Mr. Anashku had no parents to take care of infant Jane Doe. It was also understood that Mr. Anashku was working two shifts to make money. During this period, Cira Doe was put in a day care.

“Fights were still going on and things started worsening.” Reported Mrs. Anashku. She also added to it that Jane Doe had a delay in achieving developmental milestones. She specified that Jane Doe started speaking when he was 2 years and 6 months old.

On probing, it was understood that Jane Doe had limited linguistic abilities. Also, Jane Doe was finding it difficult to maintain eye to eye contact with others. “He never spent time with anybody except his grandfather.” Said the mother. Mother was going to work in the garments during this time.

She explained that she left her parents with Jane Doe when he was around 3 years old.

Jane Doe’s schooling

Jane Doe started his schooling and was observed to be comfortable staying in school from the very first day. Jane Doe was spending time with Cira Doe was, by this time, a passive aggressive child with issues with mother, father and younger brother. Sibling rivalry and bullying started at a very young age for Jane Doe. Cira Doe used to make Jane Doe starve till the late evening. As a result of which Jane Doe was underweight or into malnutrition. It was evident because, it was understood that his academic achievements were below average and was having frequent physiological illness during his 10 – 12 years of age. The patient’s mother also reported that he had been cared by his grandmother when he was hospitalized. Parents also reported that they have never spent quality time with the Jane Doe. Jane Doe started bullying others after he came to 7^th grade. It was understood that the teachers had been calling the parents with a list of complaints  about Jane Doe’s problematic behavior, attendance shortage, vulgarity and physical fights.

“We four are staying together since about 2 years now. I am shocked to see my son behaving this way. He doesn’t respect elders, he doesn’t listen to anything we say, he doesn’t talk to us. All he does is – hanging out with friends, smoke, drink, pick up fights with neighboring area people and play games on mobile phone till late night. No seriousness at all.”

When probed about the negative history of Jane Doe, his mother remembered an incident which she thought was not important to present in front of the therapist. “I don’t know if it is important for you to know about this or not, but, he had galloped from the house and was away from us for a week. We lodged a missing complaint. He came back after a week. He said that he was in his friend’s house during this period. We were so scared during this time. His behavior completely changed after this incident.”

Recent history – Even during lockdown, Jane Doe was not wearing masks while going out, was going out to buy and sell pigeons, dogs and cats, was not maintaining social distance. It was also understood that Jane Doe and his friends were into cannabis use every day during the lockdown period (60 days). Mr. Anashku reported that he had been finding it difficult to arrange money for essentials as Jane Doe was robbing money from home for his cigarettes and cannabis. This resulted in a fight between the father and son which ended after Jane Doe slapped Mr. Anashku for questioning him about money. This made Mr. Anashku call Cullinan for an appointment.

Problematic behavior of Jane Doe that leads to a classic diagnosis are as mentioned below:

·       Drug abuse (explained below).

·       Steeling money.

·       Physical and verbal aggression (initiating fights)

·       Serious violation of rules and getting into arguments with others.

·       Gambling.

·       Limited prosocial emotions (Callous).

·       Selective mutism associated with passive aggression.

·       Excessive lying for materialistic gain like cannabis, cigarettes and alcohol or money to buy these.

·       Truancy.

·       Lack of guilt for his behaviors, decisions and outcomes.

·       Attention and concentration distortion associated with partial impairment in immediate memory which is not explained by any other conditions.

A part of verbatim when Cullinan was with Jane Doe and his parents:

Father: I don’t know if I have been expressing love or not expressing love to my son. I love my son from the bottom of my heart.

Mother: Yes sir, I too love my son. I wish I spent time with him, sharing some stories and incidents. I never observed how my son grew up. I am feeling guilty now. I wish we could go back in time and make things right.

Jane Doe: Sir, I don’t want them (pointing at the parents). They don’t deserve to be parents. (walked out of the room).

Mr. and Mrs. Anashku were devastated after listening to Jane Doe’s words before he left the hospital. 

Jane Doe had his own vehicle in which he went to meet his friends while his parents were sobbing in front of Cullinan.

Diagnosis: Conduct Disorder with Childhood-Onset type Associated with Limited Pro-social Emotions.

Co-Existing - Substance Use Disorder because of Child Neglect and Upbringing Away from Parents.

Line of treatment:

1.          Lack of insight – with problematic external locus of control.

2.          Mutism during therapy with minimum/ no eye to eye contact and communication.

3.          Denial to take personal therapy.

4.          Apathic state of emotion and affect.

5.          Addiction to cannabis, alcohol and cigarettes.

·       Jane Doe is advised to be under surveillance of medical experts for further investigation.

·       Jane Doe’s father was also referred to a rehabilitation centre for his Substance Use Disorder.

·       Family therapy and Psychoeducation to family members to make them understand how to minimize Jane Doe’s problem behavior.

·       Individual therapy for both the parents as they were observed to be neurotic.

A gentle note to readers:

Dear all, the money you save and the property are your assets you own for your children’s secured future. Make sure that you are not too busy to ignore or neglect your children’s present. If they don’t have parents in their house, they find parents outside.