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Tuesday, May 11, 2010

Treatment Tuesday - Selective Mutism

This week's assessment comes courtesy of Kelly. She's writing historical fiction, set in the roaring 20s in Georgia. Her point of view character is 12 at the beginning of the story, and she witnesses someone raping her 17-year-old sister. The older sister is bloody from being beaten unconscious. The terrified 12-year-old hides until the man leaves and in the morning, she doesn't talk.

Kelly wants to know: Is witnessing something like this enough to cause my character to go mute? If this was a temporary condition, how long would it last?

I was happy to get to this sketch, as I've never done a post on mutism, so thanks Kelly!

The key to answering your question lies in the fact that you are writing this character in the 1920s. Prior to 1980, there was nothing "on the books" about mutism, and by books, I mean one: the Diagnostic and Statistical Manual (DSM). Without a doubt, if your character--who had originally been able to speak just fine--all of a sudden stops, her friends and family would for sure think she was refusing to speak.

When the first diagnosis came out in 1980, it was called Elective Mutism. It's now more appropriately called Selective Mutism (as of 1994). The previous name conjures the idea that the person elected not to speak. A deliberate withholding of words, which also carries the idea that the child would be willful, controlling, and manipulative. In the DSM-III (1980), some predisposing factors were listed, such as maternal over-protection, abuse, trauma, or family dysfunction. My educated guess is that even in the 20s, the prevailing thought would be similar.

What does this mean for your character? It would have been thought that she was either doing this all on purpose, for no other reason than to be difficult, or that she had experienced or seen some sort of trauma. Throw in a difficult relationship with her mom, and you've got a situation ripe for perpetuating this rare disorder (less than 1% of the population).

The only wrench in the plot plan is her age. In all of the DSM editions since 1980, the age of onset (when symptoms begin) was before age 5, although there was some allowance made for this condition not coming to light until a child enters school (which would be at age 6 for some children). So a 12-year old would have a much-delayed age of onset.

I looked into other diagnoses that could fit, but she fits Selective Mutism the best, minus the age of onset. Selective Mutism is found in the Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence, not in Communication Disorders (because the people who get Selective Mutism know the language and had no prior problems expressing it) or Anxiety Disorders (although most people with Selective Mutism also get a diagnosis of Social Phobia, because it's now considered to be heavily influenced by the person's social anxiety). Selective Mutism carries with it the idea that the person isn't refusing to speak so much as they are failing to speak in social situations.

So how long might this condition last? The latest information in the DSM regarding the course of this disorder is that it can last anywhere from a few months to a few years, although the caveat is there that it can be "chronic" if severe social phobia is also present (meaning that the person is so shy or afraid of social embarrassment that could happen as a result of speaking). They want to speak, but simply can not force themselves to do so.

As a result of not speaking, in school she'll either be harassed or left completely alone. Think of how awkward it would be to be a mute's friend. I guess you could give her a sidekick who loves to listen to the sound of her own voice, though. If she does have social anxiety of some sort, then when spoken to, it wouldn't be abnormal for her to freeze in place. It's also possible for her to not speak at all in one social context (like school) but feel comfortable speaking at home. if that doesn't fit your plot, though, don't stress. (For a comprehensive list of possible accompanying behaviors, click here.)

I suggest thinking about these two things to make this plot deeper and really true-to-life:

1) Why doesn't she come forward and talk about what she saw? You wrote that you're character would die at the "ripe old age of 104," and that she might "remain mute as long as it is convenient to her." Could it be that she's scared for her life? Could it be that she's scared of what will happen to her sister if she spoke up (like her sister being ostracized, socially outcast) or that those things might happen to her or her well-to-do doctor's family? What about casting a pall on her father's practice? If her reason for keeping silent is along these lines, then you've got Selective Mutism almost to a "t." See #2.

2) Consider starting your story off with a child of 5 or 6 instead of 12. Then you'd have it in the bag. Was there a reason (other than arbitrarily picking a number out of a hat) that you have her at age 12? Would you need to adjust the older sister's age as well?

These are just a few questions to get your juices flowing. A great website that I referenced a great deal for this article and tried to synthesize the material in it was found at the Selective Mutism Foundation. There was a very helpful graph that explains how Selective Mutism came to be defined through the years.

Hope this helps, Kelly! As always, any questions are welcome in the comment section.

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist (at) hotmail (dot) com.

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Katie Ganshert said...

So interesting! I have a student this year who is a selective mute.

RedHeadedQuilter said...

Thanks for the great information Jeannie! I originally had this character 10 years old, but realized she had to be a certain age at a certain point in the story, so I think I may leave her 12. I do have an idea for when she may feel it is "safe" to talk though, so I think I can work that in.

Thanks again!

Delia Latham said...

Very interesting! I love what you're doing here, Jeannie!

Jeannie Campbell, LMFT said...

you're so welcome, kelly. story is king, of do what you have to do with her age. i think you'd have a lot of leeway given the time period anyway.

thanks delia! i hope the rest of your blog tour goes great!

katie - i sent you an email. it's been too long!

Elemarth said...

I was searching for images of "selective mutism" and ran across this. Since it was only ("only", lol) posted two and a half months ago (rather than two and a half years or something) and someone might read it, I thought I should comment.

There are actually three problems with this. One is her age. My guess is that maybe 1% of people with this disorder get it past early childhood, and those were predisposed to it. But nobody's ever researched or even hardly recorded late onset. So it's EXTREMELY unlikely.
Second, experts these days say that they've seen hundreds of kids with SM and none got it from trauma, or not this sort of trauma. (Sometimes moving or starting school is a sort of trauma for these young children.) Besides, as was mentioned in the post, why would silence be the response to seeing your sister be raped?
Third, it can't be called selective mutism because IT ISN'T SELECTIVE. It's total, UNLESS she speaks to at least one person.

This may seem minor, just a fun story to you, but almost all portrayals of SM in fiction are completely incorrect in these ways -- unselective, caused by trauma, abuse, or stubbornness, and sometimes appearing late like this. You may not believe it, but even in America, even in these times, even with studies about the disorder proving that trauma isn't the cause, parents ARE STILL sometimes accused of abusing their children because one is selectively mute. This common portrayal of it in fiction is the reason for that. Besides, not to take the time to properly research this is insulting to the people whose lives are controlled by this disorder. I swear it takes five minutes to see that trauma isn't believed to cause this. I'm very glad that you want to show that she isn't being stubborn (which is still the prevailing opinion of the cause of SM by people who aren't selectively mute themselves or an expert on it), but this is almost as bad.

But I do have a suggestion for people who want to write a story like this. I believe (but please look it up) that some people with PTSD avoid things that remind them of the trauma so much that they won't talk about them. What if she really does talk UNTIL someone brings up something that intensely reminds her of the experience? She would fall silent at apparently random times. That would be quite interesting. But as I said, look it up and be sure it's accurate. ;)

Jeannie Campbell, LMFT said...

thanks for chiming in, elemarth. i like the suggestion of PTSD-related mutism. it wouldn't be mutism in the traditional sense, of course, but i know of people who just refuse to talk about anything dealing with their trauma. it could be construed as mutism.

Anonymous said...

I know it's way too late, but I thought I would comment because I suffered social anxiety starting from around twelve, which made it so that I couldn't speak starting from around age fifteen. I couldn't speak at all in any circumstances for about six weeks and then for about two years I could only speak sometimes (less than half of days and not at all with strangers). It depended on how anxious I felt. You are right that people thought I was doing it deliberately and would get quite angry.

At first I deliberately restricted my speech. I didn't want to make anyone upset. I felt that I wasn't quite the same as everyone else, but rather inferior to them, and I didn't want to get in their way or trouble them. So I tried to keep out of people's way and only speak when I felt like I had something to add. But after a while of speaking less deliberately (in order to be less of a nuisance) I found I could not speak even when I wanted to.

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