Juvenile sex offenders

Thursday, February 05, 2004 Juvenile Sex Offenders – a first experience

It was an interesting day. I was scheduled to spend the day with Dr. B – a psychiatrist in the Adolescent Unit. I met him at 8:15 am in the unit on the 3rd floor and sat in on the treatment plan meeting. During this meeting, the psychiatrist, therapists and case manager (along with medical students, nursing students and a few other odds and ends) sit in and discuss the progress and plan of each resident. Before the session, I accompanied Dr. Bell to do an H & P on a patient admitted the night before. She was a 14 year old girl. She was admitted for feeling suicidal. I learned that she had been raped by her step-grandfather. She had marks on her wrists from where she has cut and mutilated herself in the past. During the treatment meeting, there were may interesting cases. There is a lot of history of abandonment, neglect, drug abuse and poor parenting. There are also a lot of examples of physical and sexual abuse. The unit we were in was the acute unit: where patients are admitted for short periods of time – upto a couple of weeks. This is in contrast to the unit on the 4th floor, where patients spend 6 months to a year. These are patients with no where else to go – they have been thrown out of practically everywhere else.

After the meeting, I went to the hospital to go psychiatric interviews on two consults for Dr. C (my attending). The first one was a 50 year old Black woman admitted for CHF, hypothyroidism, DM2 and gouty arthritis. She was cooperative and described being institutionalized when she was 11 years old because of physical abuse by an alcoholic mother. She was kept in various institutions until she was 17. The second patient was a contrast. He was a 46 year old white male with a relatively high level of functioning. He felt the human race was nothing but “technologically advanced cockroaches.” He was suspicious and declined to participate in the interview. I managed to get some information about him. He reports being allergic to Thorazine – “causes muscles all over my body to lock up”. He has been institutionalized and used drugs in high school. I wrote up the reports and took them over to Dr. C who by that time had returned from his talk in another city. He felt that the male patient must have been a late onset schizophrenia in view of his high level of functioning and intelligence. He explained that perhaps his animosity to the questions and his decline to participate in the interview was because of a sense of shame and feeling that people treat him differently because of his illness. When I asked him about suicide ideation, the patient had said “I’ve been asked that question so many times and I think it is a personal matter.” He denied homicidal ideation. And admitted to having been given Thorazine for the first time in a state psychiatric facility, I found out later. We also chatted about astronomy and Mars, since the patient expressed interests in those areas. I promised him a magazine on Mars.

In the afternoon, I drove in the snow and rain over to the other campus of our Bahavior Medicine facility on 59th street. This is the facility where the geriatric and juvenile sex offenders units are located. I spend the afternoon reviewing charts and reading about juvenile sex offenders. The first chart I read was the case of a 14 year old boy who had raped his 8 year old half-brother in a foster home. He had had anal intercourse with him. Later, to prevent the child from telling on him, he had suggested to him that he poison the entire household. When that didn’t take, he stole his foster father’s gun and gave it to the boy and suggested that he shoot himself and end his life. The boy eventually told someone and the patient was taken into custody and brought to this facility. His own history is interesting. He is the product of an incestrous relationship between his mother and his maternal grandfather. He was eventually taken away from his mother because of her abuse. He was physically and sexually abused by her boyfriends and male relatives. The stories of most of the boys in the facility – ages 13 to 17 were similar with elements of abuse and neglect. Interestingly, many of them sexually abuse boys 5 years younger than themselves in the same age and in the same way as they themselves were abused. I then sat in on treatment plan meetings, in which the boys were brought in one by one to a meeting with the therapist, the psychiatrist and the Charge Nurse. Besides myself, a social work student who works at the facility doing her practicum were also present.

Rather than be disgusted and feel hatred towards these boys, I felt a morbid curiosity. It is creditable that the state does not just lock them up and throw away the key. After all, they have committed heinous crimes and are in such small numbers that one might not want to invest resources in ‘fixing’ them. As a Christian, I struggle with the finality with which specialists and experts pronounce judgment on the future of these and other pediatric patients saying they are marred for life. The Bible teaches that one can be completely made anew.

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