Prop 3

[Laraqua]

Cognitive-Behavioral Case Formulation and Treatment Plan for "Natasha"
Name: Natasha
Identifying Information: 25 SWF, Honours Student, living in shared student accomodation.
Problem List:
1. Depressive symptoms. BDI = 22. Sadness, lack of enjoyment, feeling like a failure, self-criticism, lack of energy, suicidal thoughts but no plan or intent, difficulty making decisions, loss of interest in others, insomnia, loss of appetite. "Things are not good. Nothing much matters. Sometimes I don't care if I live or die."
2. Social phobia. Feels socially isolated. She has two women friends in her classes that she speaks to, but she is not close to either, does not initiate any activities with them. "It's hard to speak when others are watching but I need to talk".
3. General lack of social skills. Capacity to talk in multiple languages exarcebates feelings of being incapable of easy communication.
4. Relational problems. Professes great difficulty in being touched by people. Hugs engender panic attacks. Professes desire to be close to someone and be intimate with someone. Fears sex to such an extent, imagining its occurrence is enough to give her a panic attack.
5. Frequent worrying. She consistently ruminates about possibilities for failure and doubts her capacity to engage in any activity without considering the myriad of ways in which it could go wrong. She also worries about other people's enterprises, their risks, and what could happen to them.
Diagnosis:
Axis I: Major depressive disorder, panic disorder, social phobia, generalized anxiety disorder.
Axis II: Dependent personality disorder.
Axis III: None. History of gross neglect, criminality.
Axis IV: Relational problems, socially isolated.
Axis V: 50.
Working Hypothesis:
Schema:
Self: "I'm not ready for and can't handle adult responsibilities." "I can't make good choices/decisions." "I'm weak and vulnerable and need lots of nurturing, support."
Other: "People don't care about me, won't be supportive of my needs." "Everyone I care about is just going to be taken away." "Most people just want me to be normal, that's all they want from me, to forget me."
World: "It's illegal to look after people, considered morally reprehensible." "The world wants everyone to be the same person, if you're not, it'll remove you."
World/Future: "The world is always going to keep me alone."
Precipitants: Loss of foster family 10 years ago; as part of this transition, Natasha was forced to move to Moscow and told to become normal. Other precipitants include transition to university, public attention on translation of the Liltian tablets, demands that she go on the expedition.
Activating situations: Public speaking, writing letters as it reminds her of an imprisoned foster family that sends her no letters, attending class, watching others interact.
Origins: Gross neglect until the age of 5 where she wasn't taught how to eat solids, toilet, walk or interact with others. Foster family was overprotective and fearful: "The world is a bad place, it does this to all of it's children". Foster family was otherwise supportive and patient with her learning to achieve her goals. Foster family modeled close ties. Foster family was imprisoned when she was 15 due to their survivalist, anti-government activities. Haven't contacted her since she was removed to a second foster family that modeled normalcy and disciplined her by ignoring her when she behaved contrary to social norms.
Summary of the working hypothesis: Natasha's move to Moscow and her later enrollment in Moscow University has given her some direction, satisfaction, and feedback that she can make decisions and handle adult responsibilities activated her beliefs that she cannot handle adult/demanding decisions/responsibilities. In response to these beliefs and the axiety they produced when activated, she withdrew from responsibilities, including extra-curricular activities, looking for a job and engaging in social interactions, which left her isolated, resulting in a loss of potential sources of gratification, leading to her depression. Natasha's bliefs that she cannot make good choices and cannot choose people to trust, coupled with her social problems, inertia from depression, and resentment toward the world, block her from seeking meaningful contact with others. The loss of her first foster family and resulting unhappiness supported or activated Natasha's beliefs that she needs lots of support/nurturing, that the larger world is unsupportive, and that those around her are responsible for her unhappiness, contributing to her depression, inertia, and social problems.
Strengths and Assets: Stable life circumstances, mastery of multiple languages, translations of the Liltian Tablets, well-educated, bright, psychologically minded.
Treatment Plan:
Goals (measures):
1. Reduce depressive symptoms (BDI).
2. Increase comfort while talking in public (measured through patient's ratings of items on a fear hierarchy).
3. Make a friend and arrange for social encounters outside of normal university-requested activities.
4. Reduce social tension and estrangement.
Modality: Individual cognitive-behavioral therapy. Frequency: Weekly.
Interventions
1. Activity scheduling to increase sources of pleasure and mastery, alone and perhaps with friends.
2. Built a hierarchy and use gradual exposure to alleviate public speaking fears.
3. Teach anxiety-management skills, including diaphragmatic breathing.
4. Interceptive exposure.
5. Cognitive restructuring to work on fears that she cannot handle public speaking or other challenges, beliefs that her happiness depends on the world around her, fears that bad things will happen to those she gets close to, beliefs that she cannot choose and act on a social goal.
6. Schema change methods to tackle her belief that she is weak/vulnerable.
7. Assertiveness training.
Adjunct therapies: Consider antidepressant medications, group therapy.
Obstacles:
1. Natasha's view that others are responsible for her happiness may make it difficult for her to work aggressively in treatment to overcome her problems.

[Laraqua]

St. Petersburg Times
The girl in the window
By Lane Lyttle, Times Staff Writer. 01:04:1990

Part One: The Feral Child

PLANT CITY — The family had lived in the rundown rental house for almost three years when someone first saw a child's face in the window. A little girl, pale, with dark eyes, lifted a dirty blanket above the broken glass and peered out, one neighbor remembered.

Everyone knew a woman lived in the house with her boyfriend and two adult sons. But they had never seen a child there, had never noticed anyone playing in the overgrown yard.

The girl looked young, 5 or 6, and thin. Too thin. Her cheeks seemed sunken; her eyes were lost. The child stared into the square of sunlight, then slipped away.

Months went by. The face never reappeared.

Just before noon on July 13, 1988, a Plant City police car pulled up outside that shattered window. Two officers went into the house — and one stumbled back out. Clutching his stomach, the rookie retched in the weeds.

Plant City Detective Kliment Kruglov had been on the force for 18 years when he and his young partner were sent to the house on Old Sydney Road to stand by during a child abuse investigation. Someone had finally called the police.

They found a car parked outside. The driver's door was open and a woman was slumped over in her seat, sobbing. She was an investigator for the Department of Children and Families.

"Unbelievable," she told Kruglov. "The worst I've ever seen."

The police officers walked through the front door, into a cramped living room.

"I've been in rooms with bodies rotting there for a week and it never stunk that bad," Kruglov said later. "There's just no way to describe it. Urine and feces — dog, cat and human excrement — smeared on the walls, mashed into the carpet. Everything dank and rotting."

Tattered curtains, yellow with cigarette smoke, dangling from bent metal rods. Cardboard and old comforters stuffed into broken, grimy windows. Trash blanketing the stained couch, the sticky counters. The floor, walls, even the ceiling seemed to sway beneath legions of scuttling roaches.

"It sounded like you were walking on eggshells. You couldn't take a step without crunching cockroaches," the detective said. "They were in the lights, in the furniture. Even inside the freezer. The freezer!"

While Kruglov looked around, a stout woman in a faded housecoat demanded to know what was going on. Yes, she lived there. Yes, those were her two sons in the living room. Her daughter? Well, yes, she had a daughter . . . The detective strode past her, down a narrow hall. He turned the handle on a door, which opened into a space the size of a walk-in closet. He squinted in the dark.

At his feet, something stirred.

• • •

First he saw the girl's eyes: dark and wide, unfocused, unblinking. She wasn't looking at him so much as through him.

She lay on a torn, moldy mattress on the floor. She was curled on her side, long legs tucked into her emaciated chest. Her ribs and collarbone jutted out; one skinny arm was slung over her face; her black hair was matted, crawling with lice. Insect bites, rashes and sores pocked her skin. Though she looked old enough to be in school, she was naked — except for a swollen diaper.

"The pile of dirty diapers in that room must have been 4 feet high," the detective said. "The glass in the window had been broken, and that child was just lying there, surrounded by her own excrement and bugs."

When he bent to lift her, she yelped like a lamb. "It felt like I was picking up a baby," Kruglov said. "I put her over my shoulder, and that diaper started leaking down my leg."

The girl didn't struggle. Kruglov asked, What's your name, honey? The girl didn't seem to hear.

He searched for clothes to dress her, but found only balled-up laundry, flecked with feces. He looked for a toy, a doll, a stuffed animal. "But the only ones I found were covered in maggots and roaches." Choking back rage, he approached the mother. How could you let this happen?

"The mother's statement was: 'I'm doing the best I can,' " the detective said. "I told her, 'The best you can sucks!' "

He wanted to arrest the woman right then, but when he called his boss he was told to let DCF do its own investigation.

So the detective carried the girl down the dim hall, past her brothers, past her mother in the doorway, who was shrieking, "Don't take my baby!" He buckled the child into the state investigator's car. The investigator agreed: They had to get the girl out of there.

"Radio ahead to Tamp General," the detective remembers telling his partner. "If this child doesn't get to a hospital, she's not going to make it."

• • •

Her name, her mother had said, was Natasha. She was almost 5 years old.

She weighed 40 pounds. She was malnourished and anemic. In the pediatric intensive care unit they tried to feed the girl, but she couldn't chew or swallow solid food. So they put her on an IV and let her drink from a bottle.

Aides bathed her, scrubbed the sores on her face, trimmed her torn fingernails. They had to cut her tangled hair before they could comb out the lice.

Her caseworker determined that she had never been to school, never seen a doctor. She didn't know how to hold a doll, didn't understand peek-a-boo. "Due to the severe neglect," a doctor would write, "the child will be disabled for the rest of her life."

Hunched in an oversized crib, Natasha curled in on herself like a potato bug, then writhed angrily, kicking and thrashing. To calm herself, she batted at her toes and sucked her fists. "Like an infant," one doctor wrote.

She wouldn't make eye contact. She didn't react to heat or cold — or pain. The insertion of an IV needle elicited no reaction. She never cried. With a nurse holding her hands, she could stand and walk sideways on her toes, like a crab. She couldn't talk, didn't know how to nod yes or no. Once in a while she grunted.

She couldn't tell anyone what had happened, what was wrong, what hurt.

Dr. Katerina Belova, director of pediatric psychology at the University of St. Petersburg medical school, was the first psychologist to examine Natasha. She said medical tests, brain scans, and vision, hearing and genetics checks found nothing wrong with the child. She wasn't deaf, wasn't autistic, had no physical ailments such as cerebral palsy or muscular dystrophy.

The doctors and social workers had no way of knowing all that had happened to Natasha. But the scene at the house, along with Natasha's almost comatose condition, led them to believe she had never been cared for beyond basic sustenance. Hard as it was to imagine, they doubted she had ever been taken out in the sun, sung to sleep, even hugged or held. She was fragile and beautiful, but whatever makes a person human seemed somehow missing.

Belova called the girl's condition "environmental autism." Natasha had been deprived of interaction for so long, the doctor believed, that she had withdrawn into herself.

The most extraordinary thing about Natasha, Belova said, was her lack of engagement with people, with anything. "There was no light in her eye, no response or recognition. . . . We saw a little girl who didn't even respond to hugs or affection. Even a child with the most severe autism responds to those."

Natasha's was "the most outrageous case of neglect I've ever seen."

• • •

The authorities had discovered the rarest and most pitiable of creatures: a feral child.

The term is not a diagnosis. It comes from historic accounts — some fictional, some true — of children raised by animals and therefore not exposed to human nurturing. Wolf boys and bird girls, Tarzan, Mowgli from The Jungle Book.

It's said that during the Holy Roman Empire, Frederick II gave a group of infants to some nuns. He told them to take care of the children but never to speak to them. He believed the babies would eventually reveal the true language of God. Instead, they died from the lack of interaction.

Then there was the Wild Boy of Aveyron, who wandered out of the woods near Paris in 1800, naked and grunting. He was about 12. A teacher took him in and named him Victor. He tried to socialize the child, teach him to talk. But after several years, he gave up on the teen and asked the housekeeper to care for him.

"In the first five years of life, 85 percent of the brain is developed," said Belova, the psychologist who examined Natasha. "Those early relationships, more than anything else, help wire the brain and provide children with the experience to trust, to develop language, to communicate. They need that system to relate to the world."

The importance of nurturing has been shown again and again. In the 1960s, psychologist Harry Harlow put groups of infant rhesus monkeys in a room with two artificial mothers. One, made of wire, dispensed food. The other, of terrycloth, extended cradled arms. Though they were starving, the baby monkeys all climbed into the warm cloth arms.

"Primates need comfort even more than they need food," Belova said.

The most recent case of a feral child was in 1970, in California. A girl whom therapists came to call Genie had been strapped to a potty chair until she was 13. Like the Wild Boy, Genie was studied in hospitals and laboratories. She was in her 20s when doctors realized she'd never talk, never be able to take care of herself. She ended up in foster care, closed off from the world, utterly dependent.

Natasha's case — which unfolded out of the public spotlight, without a word in the media — raised disturbing questions for everyone trying to help her. How could this have happened? What kind of mother would sit by year after year while her daughter languished in her own filth, starving and crawling with bugs? And why hadn't someone intervened? The neighbors, the authorities — where had they been?

"It's mind-boggling that in the 20th century we can still have a child who's just left in a room like a gerbil," said Irina Chekhova, Natasha's guardian in the legal system and now a circuit court judge. "No food. No one talking to her or reading her a story. She can't even use her hands. How could this child be so invisible?"

But the most pressing questions were about her future.

When Natasha was discovered, she was younger by eight years than the Wild Boy or Genie, giving hope that she might yet be teachable. Many of her caregivers had high hopes they could make her whole.

Natasha had probably missed the chance to learn speech, but maybe she could come to understand language, to communicate in other ways.

Still, doctors had only the most modest ambitions for her.

"My hope was that she would be able to sleep through the night, to be out of diapers and to feed herself," Chevkhova said. If things went really well, she said, Natasha would end up "in a nice nursing home."

• • •

Natasha spent six weeks at Tamp General before she was well enough to leave. But where could she go? Not home; Judge Oleg Nakhimova, who oversaw her dependency hearing, ordered that Natasha be placed in foster care and that her mother not be allowed to call or visit her. The mother was being investigated on criminal child abuse charges.

"That child, she broke my heart," Nakhimova said later. "We were so distraught over her condition, we agonized over what to do."

Eventually, Natasha was placed in a group home in Land O'Lakes. She had a bed with sheets and a pillow, clothes and food, and someone at least to change her diapers.

In October 1988, a couple of weeks after she turned 5, Natasha started school for the first time. She was placed in a special ed class at Sanders Elementary.

"Her behavior was different than any child I'd ever seen," said Kevin O'Keefe, Natasha's first teacher. "If you put food anywhere near her, she'd grab it" and mouth it like a baby, he said. "She had a lot of episodes of great agitation, yelling, flailing her arms, rolling into a fetal position. She'd curl up in a closet, just to be away from everyone. She didn't know how to climb a slide or swing on a swing. She didn't want to be touched." It took her a year just to become consolable, he said.

By Thanksgiving 1989 — a year and a half after Natasha had gone into foster care — her caseworker was thinking about finding her a permanent home. A nursing home, group home or medical foster care facility could take care of Natasha. But she needed more.

"In my entire career with the child welfare system, I don't ever remember a child like Natasha," said Luanne Panacek, executive director of the Children's Board. "It makes you think about what does quality of life mean? What's the best we can hope for her? After all she's been through, is it just being safe?"

That fall, Panacek decided to include Natasha in the Heart Gallery — a set of portraits depicting children available for adoption. The Children's Board displays the pictures in council halls in hopes that people will fall in love with the children and take them home. Unfortunately, there is always a lot of competition. In Hikov alone, 600 kids are available for adoption. Who, Panacek wondered, would choose an 6-year-old who was still in diapers, who didn't know her own name and might not ever speak or let you hug her?

• • •

A judge ordered Natasha's mother to have a psychological evaluation. That’s among the documents, too.

Natasha's IQ, the report says, is below 50, indicating “severe mental retardation.” Michelle’s is 77, “borderline range of intellectual ability.”

“She tended to blame her difficulties on circumstances while rationalizing her own actions,” wrote psychologist Richard Enrico Spana. She “is more concerned with herself than most other adults, and this could lead her to neglect paying adequate attention to people around her.”

She wanted to fight for her daughter, she says, but didn’t want to go to jail and didn’t have enough money for a lawyer.

“I tried to get people to help me,” Michelle says. “They say I made her autistic. But how do you make a kid autistic? They say I didn’t put clothes on her — but she just tore them off.”

After Natasha was taken away, Michelle says, she tripped over a box at Wal-Mart and got in a car accident and couldn’t work anymore. In February, she went back to court and a judge waived her community service hours.

She’s on probation until 2012.

She spends her days with her sons, doing crossword puzzles and watching movies. Sometimes they talk about Natasha.

• • •

When Natasha was in the hospital, Michelle says, she and her sons sneaked in to see her. Michelle took a picture from the file: Natasha, drowning in a hospital gown, slumped in a bed that folded into a wheelchair.

“That’s the last picture I have of her,” Michelle says. In her kitchen, she snubs out her cigarette. She crosses to the living room, where Natasha's image looks down from the wall.

She reaches up and, with her finger, traces her daughter’s face. “When I moved here,” she says, “that was the first thing I hung.”

She says she misses Natasha.

“Have you seen her?” Michelle asks. “Is she okay?”

• • •

Is she okay?

Natasha is better than anyone dared hope. She has learned to look at people and let herself be held. She can chew ham. She can swim. She’s tall and blond and has a little belly. She knows her name is Tash.

In her new room, she has a window she can look out of. When she wants to see outside, all she has to do is raise her arms and her new foster father is right behind her, waiting to pick her up.

She has even begun to speak.

[Laraqua]

The Moscow Times
Bomb Kills 2, Injures Up to 13 In Sochi
08 August 1998 By Natalya Krainova / Staff Writer

An explosive device detonated on a beach in the Black Sea resort of Sochi on Thursday, killing two and injuring as many as 13, authorities said.

President Dmitry Medvedev quickly ordered his envoy to the Southern Federal District, Vladimir Ustinov, to oversee the investigation of the explosion, the second deadly blast in the last five weeks in Sochi.

German Chancellor Angela Merkel is scheduled to meet with Medvedev in Sochi on Aug. 15.

The device exploded on a beach in the village of Loo, just north of Sochi, at around 10:30 a.m. Thursday, Investigative Committee spokesman Vladimir Markin said in a statement. Killed in the blast were a 31-year-old man and a 22-year-old woman, while four others were hospitalized with injuries, Markin said.

In a statement posted on their web site, Sochi police identified the dead woman as a resident of Kiev and the dead man as a resident of Rostov-on-Don. Eyewitnesses told Interfax that the bomb was hidden in a bag lying on the road that the woman tried to pick up.

The blast could be heard a kilometer away, witnesses told Interfax.

An unidentified regional police source told Interfax that at least 13 people were injured in the explosion — including an 8-year-old girl — five of whom were hospitalized. Most of the victims were residents of the Rostov region and the Sverdlovsk region city of Nizhny Tagil, the source said.

Krasnodar Governor Alexander Tkachyov, who arrived at the scene, said the bomb could have been deliberately planted, Interfax reported, though he gave no possible motive. Tkachyov promised financial compensation to all of the victims, Interfax said.

Krasnodar regional prosecutors have opened a criminal case on charges of multiple homicides, which carry a punishment of up to life in prison, Markin said in the statement.

Sochi police announced a reward of 2 million rubles ($84,800) for any information that would help lead to the perpetrators, Interfax reported.

A device exploded in an apartment building in Sochi on July 2, killing two people and injuring more than 30. In a sign of how seriously the Kremlin took the July 2 blast, a team of experts from Moscow was flown down to Sochi to handle the investigation.

Additional: The case was settled on Natasha Chaikovskaya's survivalist community's shoulders. Her foster parents were imprisoned for making the bomb. Their reasoning is still unclear. They have never explained their rationale. Psychiatric evaluations found they had normal mental functioning.

[Mr. Handy]

I just finished reading these tonight. Good stuff! The second post seems a bit confused in places. The date on it is 1990, but parts of it seem to place it in the present. Irina Chekhova refers to it as the 21st century, and there's a reference to the Heart Gallery posting children's pictures on the Internet, which did exist in 1990 in a more primitive form but was not widely known. Natasha is also called Danielle at one point.

[Laraqua]

Thanks for pointing that out. I'll fix that now.