A Shocking Silence

Billy was thirty five years old when we met, he lived in a residential care home with two other men who had severe learning disabilities. I was told, ‘Billy doesn’t talk, he hasn’t said anything for years’. When I questioned further, they believed that he understood what was said to him.

Tragically, when Billy was sixteen years old, a terrible thing had happened which shook his family to its core. His elder sister, Mary, was attacked and murdered when walking home after a night out with friends. The effect on Billy and his parents was catastrophic. Emotionally traumatised, he withdrew into himself. His grief stricken parents were  unable to console him and offer the comfort he desperately needed. Medication had no effect on Billy’s mental state and a psychiatrist recommended ECT, electroconvulsive therapy. Billy’s parents told me that Billy had been afraid and had not wanted this option but swayed by medical opinion, they had gone against their better judgement and had allowed the treatment to go ahead. The consequences for Billy were devastating.

The series of electric shocks rendered Billy helpless and unable to function. He became immobile, totally passive, unable to feed or dress himself, emotionally and physically dependent and unable to communicate. Debilitated by their own grief, his parents were unable to cope with the extra burden of looking after him.  Devastated by the loss of not only their daughter but also their son, they reluctantly placed him in a community home for adults with learning disabilities. Billy’s parents made regular weekend visits with the family dog and took Billy out in the car but although he recovered his mobility he remained silent, passive and dependent. Emotionally starved, he developed strange addictive behaviours in connection with food and raided the kitchen cupboards,  devouring  anything available in a packet including washing powder.  He became obese through constant bingeing in an attempt to assuage his emotional need and fill the bottomless pit within.  The programme of electric shocks had emotionally and mentally disconnected him from painful reality.

Residential care staff were at a loss to know what to do and had tried many ways to encourage Billy to speak. In an attempt to persuade him to use their names or to choose activities or food, they would coax and cajole him….all to no avail. Billy’s sister, Mary, was never mentioned for fear of rekindling painful memories from the past.

Having visited Billy on several occasions to observe the nature of interactions taking place, I felt it was important not to put any pressure on him to communicate and time was spent talking to those involved with his day to day care.  Billy’s favourite activities were colouring with crayons, painting with large brushes and enjoying coffee and cake in local cafes.  Care staff  were asked to encourage these activities as much as possible because they gave Billy an opportunity to relax .  Care staff  were requested to contact Billy’s parents to ask what music their daughter listened to prior to her death.  I hoped that hearing his sister’s favourite music again, would provide Billy with an opportunity to release some of the painful emotions he was suppressing.

old-radioSpontaneous crying is a release and heals painful emotion. It is our own discomfort that makes us try and stop someone from crying and healing in this way. Musical memories from the past would  hopefully reconnect Billy to a happier time in his life before he lost his sister so suddenly and tragically.

Therapeutic Intervention

I suggested a programme of sessions, where there would be no expectations or judgements and no initiated interaction if Billy chose to sit with me in silence.   My approach must have seemed very strange and unorthodox to staff in his residential home. It is to their credit that they accepted that taking the pressure off Billy to communicate might bring positive results and they agreed to support me in my endeavours.

We agreed that Billy would visit me for an hour’s duration on a weekly basis. During these sessions, I offered him the choice of a hot or cold drink but did not initiate any other communication and we sat together in companionable silence. Individual members of staff  accompanied Billy on a rota basis and waited in reception until the session was over. There was no pressure to attend if Billy showed reluctance.  During the session the door remained  slightly ajar and if Billy prematurely got up and walked to the door, the session would be over .

Billy came to see me every Monday morning at 11.00am for twelve months.  Appointments were only cancelled for illness or holidays. During this twelve month period, I met with his care staff on a monthly basis to explain my approach, review progress, offer in-service training and  share and resolve any concerns or difficulties experienced in the home.

 During our sessions, ‘coffee’ was the only word Billy used in response to the drink choice offered. Occasionally Billy would look at me and hold my gaze as he drank his coffee, at other times he would look around the room or out of the window. He remained for the full hour and at the end of that time, he got up from his chair and left the room to meet the member of staff waiting for him in reception.

After two months, Billy, by now familiar with the route and the routine, initiated walking the quarter of a mile to the clinic alone. At first a staff member followed at a distance until he/she was sure that Billy was confident in making the journey alone. By the end of our session, a member of staff would be waiting to accompany him home.

During this period, his sister’s favourite songs from the 1980s were gradually introduced into Billy’s residential home. Initially they were played in the communal sitting room. I was told that Billy went into the room when he heard the familiar music and that he sat and cried quietly as he listened. He was eventually asked if he wanted to play these songs in his own bedroom and he nodded. He chose to play them each evening and again sat and cried quietly as he listened. Billy’s carers needed constant reassurance that crying would begin to heal Billy’s pain not add to it.

Outcome

Although Billy always sat with me in silence and didn’t initiate any interaction for twelve months, his communication in the home slowly began to improve. At first, to his support worker’s delight, he began to use her name spontaneously and to use the names of other members of staff without any prompting. Billy then  initiated one word requests for food or activities, progressing to familiar phrases and longer sentences . He was introduced to a local Art class where he enjoyed filling the canvas with bright rainbow colours.

Rainbow-paintsA crystal was hung in his bedroom window so that when the sun shone, the refracted light  filled his room with rainbows. Staff noticed that gradually Billy stopped gorging himself on inedible items from the store cupboard.

As his communication improved, his parents made a decision to come and see me and for the first time began to express some of their pain, as they talked about the trauma they had experienced so many years before. The request for their daughter’s favourite songs had opened the gate to their own healing. They began visiting Billy on a regular basis again and delighted in his progress.  I am so grateful for their trust and their willingness to implement the suggestions made. During the twelve month therapy period , although Billy did not speak to me at all, his communication continued to improve in his residential home. This had an impact on his quality of life, as he began to speak up and make choices which gave him some control over his day to day routine.

Staff members regularly attended our monthly meetings and were eager to continue the work we had begun together. They no longer put pressure on Billy to communicate with them and allowed choices wherever possible, happily responding to his attempts to communicate with them and relationships were forming. Music and singing became an integral part of the daily routine with other residents as well.

Postscript

Four years later I met Billy again. He had moved to a much larger communal home in beautiful surroundings where he shared his life with a mixed group of men and women who were able to communicate freely with one another but who were struggling socially with a variety of mental health problems.  I remember standing in the kitchen chatting to one of the residents when Billy arrived to make himself a drink; he looked well and had lost a lot of weight.  Although he did not appear to recognise me,  he acknowledged my presence as he reached across me to fill the kettle to make himself a drink and he smiled and nodded at the member of staff I was talking to. It was good to see him again, seemingly totally at ease with the task in hand and comfortable in his surroundings.

You may like to check out my adults with learning disabilities page which documents further case studies . Here is a link to my  research .