The staff at his elementary school eventually takes action and David is removed from his parents custody. From there, he spends his teenage years in various foster homes while he struggles with the emotional scars left by the trauma he endured. His search for answers to why he was treated this way and effort to understand the frightening nightmares and emotions he experiences becomes a long journey toward self-love and forgiveness.
David meets the criteria for Posttraumatic Stress Disorder firstly because he has been exposed to a traumatic event in which he both experienced events that involved actual or threatened death or serious injury, or a threat to the physical integrity of himself and his response involved intense fear, helplessness, or horror. After being caught by his mother begging for food on the way to school because she was starving him, Davids mother decides to punish him by forcing him to swallow a spoonful of ammonia. David says that, I could feel the force of my pounding fists weaken¦
The colors seemed to run together. I began to feel myself drift away. I knew I was going to die (Pelzer, A 75). In addition to beating David on a regular basis and accidentally stabbing him, his mother would order him to clean the bathroom with a mixture of Clorox and ammonia, after which he says he coughed up blood for over an hour (Pelzer, A 109). David has illustrated a markedly diminished interest or participation in significant activities at school, including difficulty concentrating, by the time he is removed from his home.
As David is taken into protective custody, he exhibits symptoms of increased arousal through an exaggerated startle response. When the officer reaches out to touch Davids hand in a reassuring way, David flinches by reflex (Pelzer, T 27). Furthermore, once David enters his first Foster home with Aunt Mary, his behavior is uncontrollable. He runs from room to room, jumps on mattresses, and nearly knocks over a lamp. He explains, By reflex, Aunt Mary grabbed my arm. She was about to scold me until she looked down at me. I covered my face, and my knees began to shake (Pelzer, T 43).
At ight, David has recurrent distressing dreams of the event, including a nightmare about The Mother marching toward him with a knife. He can feel her rancid breath on his neck and he hears her chanting that there is no escape and that she will never let him go. He becomes fearful of sleeping because he doesnt want to fall into the nightmare again. For many nights he stays awake while the other children sleep; holding on to his knees while rocking back and forth and humming to himself (Pelzer, T 45). This is also another example of a persistent symptom of increased arousal because he has difficulty falling or staying asleep.
David exhibits persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness in his efforts to avoid thoughts, feelings, or conversations associated with the trauma. When David gets his first visit from a Child Protective Service worker, Ms. Gold, he feels as if he does not deserve her kindness and is too scared to have her touch him and hold his hand. She slowly gains his trust and becomes his friend. During their long talks, David says, At times I was too scared to talk and long moments of silence followed.
Other times, for no apparent reason and not understanding why, Id burst into tears (Pelzer, T 46). Davids mother comes to drop off some clothes for him at his foster home. While Aunt Mary is in the other room, his mother tells him shes going to get him back for telling the family secret of abuse (Pelzer, T 53). This very direct exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event causes David intense psychological distress. The next day Ms. Gold tells David that they are going to court in two days and that she needs to ask him a few questions to clarify their case.
However, David is consumed with fear because of his mothers threat and proceeds to retract as many statements he could; claiming that he had lied about everything, had beaten himself, and that everything was his fault (Pelzer, T 55). In doing so, he is making an effort to avoid activities, places, or people that arouse recollections of the trauma. David illustrates another symptom of increased arousal through his irritability and outbursts of anger. After another of his mothers visits, David has a breakdown. He cries as he rants and raves to Mrs. Catanze about his mother, asking why she treated him so viciously.
He proceeds to tell his foster mother some of the horrendous abuse he suffered at the hands of his mother (Pelzer, T 100-103). After his revelation to his foster mother, she sends him to a therapist. While in the therapists office, David starts to feel as if one of the traumatic events were recurring and has a sense of reliving the experience of when his mother held him over the gas stove. He explains, I lost track of the doctors voice. My right arm began to itch. I scratched it before I glanced down. When I did, I saw that my right forearm was engulfed in flames.
I nearly jumped out of my seat as I shook my arm, trying to put out the fire (Pelzer, T 130). Lastly, David shows that he has a feeling of detachment or estrangement from others when, after being set up to get caught shoplifting, he says to himself, I should have known better¦I knew they couldnt have liked me for just being another kid (Pelzer, T 156). While David wants to avoid his mother, he does not make really make an effort to avoid activities, places, or other people that arouse recollections of the trauma. In fact, he continues to keep hope that his father will visit him.
He is also able to have loving feelings toward his social worker and certain foster parents. The duration of the disturbances is much more than 1 month and has caused David clinically significant distress or impairment in social and other important areas of functioning. Treatment considerations for David should involve individual therapy including a goal that involves getting his nightmares and flashbacks to stop. David should be gradually exposed to more stressful stimuli in exposure therapy and be taught relaxation techniques to set free all negative consequences and to achieve extinction.
He should be offered support and empathy in therapy and be encouraged to express his feelings and to let things out. Also, cognitive restructuring in the form of Rational Emotive Therapy is recommended to help David think rationally and clearly about the abuse and neglect he suffered and about his present situation. It is expected that this form of therapy will also improve his self-esteem, destructive thought patterns, and help him to sleep better. The use of medication does not appear to be necessary.