Monday, June 13, 2005

Batman Begins- - A Personal Memoir

I notice that another Batman movie will be released this week, Batman Begins.

Although I was a fan of Batman comics for most of my youth, since I went into psychiatry, Batman has become inextricably bound up with a young patient I met many years ago during my residency.

When I first met him, Luke was wary of me like he was of most of the adults in his life. He was 9 years old and an absolute terror. His biological father had abandoned him and his mother. Both his pregnant mother and his stepfather were completely fed up with his behavior at school and home and wanted to place him in some sort of institution permanently. They were afraid of him, particularly since he had threatened to kill the baby as soon as it was born. As a second alternative, they brought him in for a child psychiatric evaluation, perhaps hoping they could get some additional ammunition for their plan from the mental health professionals.

Luke had no friends because he had alienated everyone. He was violent, angry, and a bully. Teachers despised him because he routinely--and deliberately, it seemed to them--disrupted class. He had once turned over every desk in the classroom and threw one of them at the teacher who tried to calm him down. He had been placed on detention, suspended, and sent to a special remedial school with other difficult children. His parents were at their wits end trying to deal with him.

Since I was a resident doing my child psychiatric service, the task for his evaluation came down to me, with a supervisor watching through a one-way mirror. When you evaluate a young child, you generally try to engage them in play as you talk with them; to make them comfortable and to observe what issues come naturally out of the play. Children are not just "little adults" who you can talk to about their feelings--most of them don't have the vocabulary or the necessary ability to think in the abstract. That is why they "act-out" what they are feeling, not having the words to describe their inner state. This fact is taken advantage of in the play therapy.

So Luke and I met together for the first time in a playroom, filled with toys and dolls and everything imaginable for kids to play with.

I have to say that I had dreaded the child psychiatry rotation from the start. Basically my dread arose because I had been miserable on 3rd year clerkship on pediatrics. I couldn't bear to watch children suffer. I could barely function when I was assigned a s a 3rd year medical student to pediatric oncology. Watching small children deal with pain and then die tore me up inside. I spent hours crying, both on and off the ward. I knew I could never manage to survive in a specialty that dealt with children.

Likewise, on child psychiatry, the psychological suffering, carefully masked by the adult and covered in layers of defenses and rationalizations, was so blindingly and painfully obvious in the children I saw, that is left me completely defenseless and constantly feeling helpless and hopeless.

When I suggested to Luke that we play with some of the toys, he looked at me trying to decide how much I would be willing to tolerate. I picked up a Batman doll and held it out to him. "How about playing Batman?" I asked.

His eyes lit up and he said "Sure!" with some enthusiasm, but didn't reach for the Batman doll. Instead he rummaged around and came up with a second doll--the Hamburglar from MacDonalds (don't ask me why that was in the box of dolls).

"Don't you want to be Batman?"

"No," he responded, "I want to be the Joker."


"Because I'm really bad."

His matter of fact way of saying it took me aback. Clearly he was aware on some level of how most of his world thought of him. I let him take the lead in the play, asking him to tell me what I was supposed to do. It came down to a very basic plotline. He was going to do bad things and then eventually, Batman would capture him.

After a bit of destructiveness on his part, my doll managed to capture his. "Aha!" I cried, "Got you!" I whispered to him on the side--"What do you want Batman to do now?"

He shrugged and said placidly, "I need to be locked up for a long, long time before I do more bad things."

What to do? I hesitated for a few moments. "Joker, you must go before the Judge to determine your sentence!" Picking up a female doll, I christened her the Judge.

"How do you plead?" said the Judge.

"Guilty, guilty, guilty." said the Joker

"You are hereby sentenced to get treatment to help you be a good person, " said the Judge.

There was a long silence. I did not break it. Luke finally looked up and stared at me for the first since the session had begun.

"Is that possible?" he asked.


"Could the Joker become a good person?"

"Does he want to, do you think?"

I could see wheels spinning in his brain as he considered this new idea. My heart clenched painfully as I waited for his response.

Slowly he nodded. "What would the Joker have to do?"

"Well," I responded as lightly as possible, "he could go talk to someone and try to understand why he does bad things; then maybe he could decide not to do them anymore."


What followed in the next 10 weeks or so, was the rehabilitation of the Joker, as Batman and the Judge worked with him to help him find other ways to appropriately express his ambivalent feelings, particularly his anger and resentment at his absent father; his mother (who he loved dearly);his stepfather (who he resented but wanted to love) and his baby brother (who was born during the time I saw him.

After each play session, I would go to my office and just cry, because his pain was so undisguised and fulminant. His innocence so teetering on the brink. Eventualy the clinic referred him for longer-term therapy to a private analyst. It was hard for me to see him go because I had become so attached to him. We both cried then, and I thought at the time that his being able to be openly sad was a good thing.

It has been more than 20 years since I saw Luke. I have thought about him many times, and hoped that those first sessions with me made some sort of a difference in his life. I have fantasized that maybe he became more like Batman (I can see him becoming a policeman or even a lawyer) and that he eventually abandoned his life of "crime" and learned to deal with his chaotic and ambivalent feelings toward those he loved, in a manner that brought him some joy and love and contentment with life.

It is possible that Batman did begin then.

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