Jose was a bubbly three year old boy with big brown eyes and dark brown curls. He lived with his loving parents on the first floor of a small, red brick apartment building. It was 8 p.m. on a cold November night. Jose was cuddled by his mother’s side on the couch, in the living room reading a book before bed. His father was watching football. Suddenly, Jose’s building was surrounded by flashing lights. Huge men in strange uniforms, carrying enormous guns, broke down the door to the apartment, tore apart the furniture, pushed Jose’s beautiful mother to the floor, and took his beloved father away in handcuffs. Jose shivered in the corner, unseen. As the FBI departed, the life that Jose knew was over.
Jose’s mother was in shock. She learned of her husband’s criminal activity just as Jose did, in the middle of the chaos and fear of that night. She felt sick with guilt and shame. Instead of furniture, her husband was selling illegal drugs. After all, in the past, he had “the vicio,” as the Puerto Ricans call substance abuse. Jose’s mother tortured herself. She felt she should have known; she lived too well. Her family isolated her. Shamed by the nature of her husband’s offense, too wounded to ask for help, Jose’s mother abandoned herself to the darkness of her depression. She did not get dressed. Lights remained off and shades pulled. The plants died. She did not leave her bed for weeks, except to care for Jose and the baby in the most basic sense: food, clothing, daycare. She was numb. Who would ever listen or understand?
One bitter day in March, the phone rang. The call’s sense of urgency demanded every ounce of energy Jose’s mother could muster. “Come and get your child. He is a terror. He kicks, hits, and never stops crying. We cannot take it anymore.” Jose was expelled from daycare.
Jose’s mother was so numb; she was unable to see what was happening to little Jose. He was too scared, too lonely, too forgotten, too angry. Jose’s mother initiated a timid search for help. She could not, would not do it for herself, but she tried for her son. A neighbor told her of a special school for children with problems, with professionals who worked for the school system. She called. They placed Jose in a classroom with trained teachers who could support him, but clearly, this was not enough. Jose lashed out at the other children, throwing toys, kicking, biting. His abandonment and rejection only deepened, while Jose’s mother sank deeper into her depression.
The professional staff were seriously worried. They recommended that Jose’s mother go for treatment for her depression, and that she bring her son to outpatient mental health services. Jose’s mother could not. She was frozen. She had no energy. No one would understand. Jose’s behavior continued to deteriorate. The preschool teachers talked about expulsion, and whispered about delinquency, hospitalization, medication, and incarceration. They had seen children like this before. They called Child First, an intensive home-based intervention that had helped many of their hardest to reach families. Child First agreed that this family was in imminent crisis and agreed to begin immediately. A team of a bilingual Mental Health/Developmental Clinician and Care Coordinator were assigned. Silvia, the Clinician, called the next day, and the next, and the next. Calls were ignored. Letters with smiley faces were discarded on the floor. Jose’s mother’s ambivalence about getting help was very evident. “I am not sure I want to know what I feel…I do not think I want to show the mess inside of me to anybody.” Weekly calls continued. Silvia’s sweet voice only asked, “Is there anything that I can do for you?” After one and a half months, the Team was allowed to come to the home.
Jose was now in his third school, still full of rage, tearing through the classroom, lashing out at children and staff. When Silvia entered the home, Jose emerged, his face contorted with anger. This little four year old rammed his foot into his mother’s leg, banged the cabinets, and “accidentally” slammed Silvia’s fingers in the door. His screaming was constant, his face raw and stained with endless tears. More of the story unfolded. Jose’s mother drove three hours to a high security federal prison each week, so Jose could see his father. And after every visit, Jose’s emotions overwhelmed him and he would vomit uncontrollably and become febrile.
The treatment began, as Silvia gave voice to the hurt, anger, fear, and sadness that boiled inside Jose, as well as the shame, guilt, sadness, and fear inside his mom. Silvia gave Jose a little plastic toy; it was a fat man with a big mouth in his belly. She told Jose that when little boys and girls have trouble finding words for the feelings they have, it sometimes comes out in other ways. Maybe they speak through their bellies. Maybe they have to vomit instead. This was Jose’s favorite toy. He kept it with him at all times.
Every week, through play, through words, through song, the feelings were heard, and things began to change. Jose’s mother’s somber presence became an articulated voice, with clear maternal authority. “In this family, we do not hit. Hitting hurts very much. We can have angry feelings because daddy is not here, but we cannot use our feelings to hurt anybody.” The house became more alive: a picture here, a plant there, good Puerto Rican recipes cooking on the stove. Jose’s compulsive play of children eaten by dragons, with fathers dragged away to be killed, gradually stopped. A smart and playful little boy, who could be comforted by a loving and energetic mother, slowly emerged.
Then, one Monday afternoon, Jose’s mother called Silvia. “Jose did an incredible thing. Yesterday, we went to see his father. He looked at his daddy, grabbed his face and said: ‘This is not right; you are a bad daddy. You left us alone. I do not like you. I am angry with you. I love you.’ Jose’s father hugged him and cried and said, 'You are right. I am so sorry. I love you so.'” When Jose and his mother left, for the first time in many months, Jose did not get sick – no vomiting, no fever.
That week, when Silvia came to play, Jose smiled and handed her his special, fat little man with the big mouth in the stomach. “Here Silvia, this is for your box of toys. Other kids may use him. I do not need him anymore.”