Free The Skeleton Cupboard by Tanya Byron

however, told the real stories: tales of furtive couplings, a need for contact and connection. There were awful stories about those villas: of the rape and sexual exploitation of residents by the people charged to care for them.
    Considering the history of the place I was working in, I began to resent the word “pathology.” Taken from medicine, in the mental health setting it nailed a boundary between “normal” and “abnormal” as if such a division existed. The language itself seemed to suggest it was right to segregate those with mental health difficulties from the rest of the “healthy” world. So much for our believing we’re so enlightened nowadays. We might not still think mental illness is contagious, but the environment in which we treated the mentally ill hadn’t changed a bit. Here we were trying to help these kids on the grounds of an early-twentieth-century asylum.
    I thought about Imogen’s skipping, her counting and those deep, parallel cuts into the soft skin of her left arm and both thighs—behaviors that had been labeled as pathological anxiety-management strategies, maladaptive coping techniques. The “wrong” sort of coping.
    Which of course they were—excessive obsessional and ritualized behaviors do not make for an effective way of managing anxiety in the long term. Anxious thoughts may be managed in the short term by elaborate counting and other behavioral rituals, but long term, that kind of compulsive behavior would not enable Imogen to get to the root of her anxiety, her need to control.
    This kid, unbelievably controlling in the external world, was, I began to realize, internally in complete turmoil. She felt out of control and afraid. Skipping was a way to keep it all together.
    By pathologizing those behaviors, all we had done was see them as symptoms of an underlying condition. We’d responded with anxiolytic medications and behavioral boundaries—no skipping, no counting out loud and definitely no cutting while in the unit—and by doing that, we had effectively removed Imogen’s only way to manage herself. We had left her with no way of coping with her painful and overwhelming inner world. We couldn’t bear what she was doing and what we were seeing and so we had taken it on ourselves to put a stop to it. No wonder the poor kid wanted to kill herself.
    Imogen is anxious, I thought. Why? That was easy:
    1. Emotionally uncontained by an absent mother.
    2. No connection to an absent father.
    3. Nurtured by a woman, Miriam, who could be kind in a task-oriented way but did not have the language skills to enable her charge to learn to verbalize feelings.
    4. The loss of Miriam when she was fired after Maisie’s drowning.
    5. Nurtured by a stepfather who was so able to emote that he was too consumed in his own grief to attend to that of his stepdaughter.
    6. Guilt at finding her little half sister, Maisie, drowned but not being able to save her.
    7. Perhaps even frightened by her own unconscious desire to get rid of Maisie, who had come into her life and so taken away everything that was once only Imogen’s.
    I was out of new ideas. Imogen needed help and I needed to find a way to give it to her. Maybe I would have to talk to the analyst after all.
    These were real anxieties, understandable and obviously overwhelming for one so young. Imogen had no emotional constant to help her make sense of it all. No ability to verbalize what she felt tormented by. No one to help her understand that this wasn’t her fault; she wasn’t to blame; she didn’t cause or will her sister to die.
    But that didn’t answer Chris’s suggestion about getting into Imogen’s painful world. I still didn’t know how to do that. She still wasn’t speaking. If she can’t do words, what can she do?
    And then, just as I parked outside the unit and turned off the engine, I got it.
    She can skip.
    I scrambled to