CASE STUDY: GEORGE SCHOLTZ

PRESENTING PROBLEM:

When I came upon this case it was 1970 and George Scholtz was 50 years old. George had grown up in Berlin, Germany during their great depression prior to World War II. World War I had devastated the German economy and had set the scene for the rise of Nazi Germany and Adolph Hitler. In the late 1930s George was a student of Psychology at the University. Although he was a Protestant, he was aware of the oppression of the Jewish people and was secretly working with other concerned citizens to try and help them. His activities were discovered and he was placed into a concentration camp during World War II. He survived this horrific experience primarily because he used his time as a prisoner to help others in need in the camp. Over the camp gate was a motto that said: "Arbeit Macht Frei." Loosely translated, this meant that if you worked hard while a prisoner you would gain your freedom. This was a vicious lie as no one was ever freed by the Nazis except via the crematorium route when they were gassed and their bodies burned. However, for George it had another meaning. Work for others does liberate, does set you psychologically free even when your body is imprisoned. (Review the work of Hans Selye on stress or read Norman Cousin's book HEAD FIRST which provides an excellent review of the research on stress and the mind-body connection.)

George got out of the prison when Germany was defeated. Berlin at that time was a divided city with the Russians controlling the Eastern part of it and the Western Allies controlling the Western sections. He attempted to return to his life as a student, however, this was close to impossible. The Nazi government had made him a non-person by eradicating all records that pertained to him. No record existed of his ever having been a college or even a high school student. He would have to start all over again and the fact that, prior to his imprisonment, he was almost ready to graduate from the University, had no relevance. Also, at this point, much of Berlin was little more than rubble due to the saturation bombing of it by the British and American forces.

George's father had died during the war. His mother was still alive and George and his mother were living together in their somewhat damaged apartment in Berlin. One day when George returned home from looking for work and food, he entered the apartment to find his mother being raped by Russian soldiers. George picked up the fireplace poker and hit the soldier who was on top of his mother, however, he was quickly overcome by the other soldiers and arrested. In those days the Russians, with understandable anger from the millions of their people that were killed by the Germans, felt that they had a right to treat Germans any way they wanted. So George was placed into a Russian concentration camp and told that he was sentenced to death because the soldier he had hit with the poker had died.

Every day, eight or so prisoners were taken out of the small crowded room where George was kept, led into a field where they dug their own graves, and then were shot in the head. Other prisoners would shovel dirt over the still warm bodies. One day it was George's turn to be executed. He dug his grave. He was at the end of the line. He would hear a shot, the thud of the prisoner falling into his freshly dug grave, then the next shot, the next thud, until his turn came. George felt the hot muzzle of the gun against the base of his skull and knew that life was about to end.

Months later, a man puzzled over why he could not sweep up the footprints in the soil. He would meticulously try to get the yard all clean and clear of any footprints without success. Broom in hand, he marched backwards sweeping up the endless footprints. Then he suddenly realized that he was making the footprints as he marched along and so obviously he could never finish the task. Since he was making the footprints, then he was alive, he existed, and it was through this somewhat childish revelation that George's mind returned to him. For months he ate, worked at sweeping the footprints, slept, and went about the routines of life but his mind had blanked out, he was like a robot and had no memory of having ever done anything during this period of time. When he thought he was about to be executed, then his mind shut down and now it finally returned to him. Eventually George learned that the Russians had only been playing a game with him. That he had not killed the soldier that he had hit with the poker and he was not under a sentence of death. Eventually they released him.

George's mother had died. He had been an only child. The only relative that he had was his father's sister, an Aunt that had moved to America before the war had broken out. George wrote her and through her help he was able to come to America.

George's Aunt Hilda was a very good person. She had never married and had no children or other relatives and she welcomed George into her home. However, not every day was a good one for Aunt Hilda, as George soon learned. She was Schizophrenic.

Prior to World War II little was known about how to effectively treat schizophrenics. During the war we began to look to ways to keep as many soldiers in the front lines as possible. Psychiatry took on a new importance as part of the war effort. By the end of the war we had started to develop alternative treatment methods. In the old days we locked the mentally ill away in hospital back wards and in many respects tried to forget them. Huge town-like mental hospitals had been created, often in remote areas, with their own farms and orchards, where the mentally ill would be sent for the rest of their lives. Often, parents would deliver their child to such places when they could no longer cope with the emotionally disturbed infant and the child might literally spend the rest of their lives growing up in the mental hospital. Those patients that would not respond to other forms of treatment, were given lobotomies---a scalpel would be inserted into the prefrontal lobes of the person's brain and some of the brain would be destroyed as a way of reducing their acting out behavior. After WWII, the Mennonites and others concerned about the way people were being treated in these facilities, began the community mental health movement. With the awareness that some patients could be effectively treated in the community and with the advent of the major tranquilizers, the deinstitutionalization movement began.

However, when George first arrived and found his Aunt to be mentally ill, the alternatives for her were not very nice. George wanted to keep her out of the mental hospital and at home for as long as possible and he devoted his life to helping his Aunt Hilda. For years he was successful, and during those years the conditions in the hospitals began to improve. Eventually Hilda became physically abusive. George at first was able to handle her attacks. However, he then contracted multiple sclerosis, and as he became progressively handicapped, he found that he could no longer care for his Aunt and had her institutionalized. Years later, I entered the picture.

I was working as a psychiatric social worker for the State of California. I was assigned to be Aunt Hilda's social worker, and, after my evaluation, it was determined that she could be more effectively treated outside of the large state mental hospital. In fact, we were finding that so many of the patients could be served in the community that we were beginning to close down some of the state hospitals. Some patients went home to friends and relatives; others moved into board and care homes where they were provided a degree of supervision, but were, for the most part, on their own; others were moved into nursing homes. Aunt Hilda was scheduled to go into a nursing home and since George was her only living relative, I went to visit him and explain what we were planning to do for and with his Aunt. The presenting problem for Aunt Hilda, who was my official client, was her need and right to treatment in a community facility where the quality of care would be better and the cost lower. Tragically, thousands of mentally ill persons were either released from mental hospitals or denied admission under the premise that they should be treated in the community, only to have them receive no effective treatment there and end up as homeless street people. My job was to see that that did not happen to my client, and, as part of my plan, I wanted to make sure that the relatives of my client were involved, so that they could help to ensure that Hilda did not fall between the bureaucratic cracks of the mental health system. However, I had not anticipated meeting anyone as interesting as George, so after successfully placing my client, I took an interest in George and decided to do what I could to help him.

At this point in George's life he could not get a job due to his illness and unemployability, as he had no college records, and could not meet the requirements of insurance agencies. He was a prisoner once again, confined to a wheelchair and tied to the welfare system, where he could obtain a small amount of income and medical insurance. In those days, the welfare policies were inflexible. Today, in some states, a person like George is able to work and receive state subsidized medical coverage---assuming he could find an employer who appreciated his considerable skills at helping a person and did not require a degree as proof of those skills.

When I asked George what he wanted to do with his life, given the inflexibility of the system, he said that he didn't mind all the problems, as long as he could continue to help other people. He said that what he really would like to do is to be a psychiatric social worker like me. I responded that somehow...since I by that time had learned how capable George was...that somehow I would find a way to put him to work and we made a deal...if he survived his next brain operation, he could start work when he was well enough to do so. At that point in his life, George was having periodic brain operations by one of the leading neurosurgeons in the country, Dr. Feinstein, in San Francisco. Dr. Feinstein was experimenting on new techniques and George was the volunteer subject as he felt he had little to lose. Eventually, after opening up George's brain some six times, Dr. Feinstein was able to implant electrodes into his brain with wires leading subdurally (under the skin) to his chest. George could then place an electric motor against his chest and shoot a current of electricity directly into his brain. He would do this periodically when the symptoms of his multiple sclerosis became intolerably painful and he would obtain relief.

George went off for one of these operations and returned improved to the point where he was able to get out of his wheelchair and walk with the help of a cane. It was now up to me to deliver on my end of the deal. At that time, in addition to being a psychiatric social worker for the state of California, I was working part-time as a consultant for Yuba General Hospital, where I had an office that I rarely used. Being on good terms with the administration of the hospital, I was able to get their permission to let George use my office. As George was on welfare and could not afford to go off of it and lose his medical benefits, I did not officially pay him for the work that he did for the hospital. Instead, I took the money that the hospital was paying me and I bought George the things he needed in order to help others---new clothes, a car, gas and auto insurance.

Over the years, George became an institution at the hospital. Patients used his services, doctors and hospital administrators used his services, and most importantly, the nursing staff used his services. Typically, George worked seven days a week and usually ten or more hours a day---and never charged anyone for his services. He became a much-loved person in that community. He was happier than at any other time in his adult life. After almost 30 years of prisons and pain, he was now freer to help others than he had ever been.

One of the most important lessons from this case study is for us to understand just how George was able to survive those 30 years!?

THE EARLY YEARS

To understand how George Scholtz, the adult, was able to suffer almost endlessly, and at the same time still have the positive attitude that he did toward others, still have the will to help people in need even when he was desperately in need of help himself, several factors need to be examined.

First of all, as the Minnesota Twins study clearly documents for us, to understand the personality of anyone, you must be aware of the influence of genetics. What we are born with strongly influences whom we become. Also, as in George's case, when we deal effectively with stress by having a positive attitude and reaching out to help others, we in turn receive help from our internal chemistry system, which helps us live healthier lives both emotionally and physically. However, in George's case, as in almost all the cases you will ever encounter, the first six years of his life, helped to determine what would happen with his life more than any other single force. We can begin to appreciate how this works through an understanding of LEARNING THEORY.

If we examine George's childhood we will discover that his parents applied learning theory in the practical parenting that they did. George was an only child. He grew up in Berlin after World War I had devastated Germany's economy and a deep depression plagued the land. Fortunately, George's father had a job, and although the family was not well off, it had a stable income that provided George a reasonably predictable environment.

Positive, socially adaptive behavior for George was reinforced when he was a child in a number of ways. First, George was given MATERIAL REINFORCERS such as an allowance for washing dishes and helping with household chores. He was not paid to clean his room, as that was a given expectation, as he was the person who made it dirty and he was the person who benefited from its being cleaned. He was taught that humans as social animals helped each other. Mother cooked, father worked to earn money for the food, so George did age appropriate tasks to assist, such as washing dishes, and received an allowance. As the tasks increased with age, so did the allowance.

Secondly, George was reinforced in his behavior through ACTIVITIES. Every night his father put him to bed and told him wild (but not frightening) imaginative tales that stimulated George's creative thinking and his visualization skills. As George grew older, the tales did not stop; instead, George became an increasingly active participant in the tales...which typically would have no ending except sleep. This was but one of many activities that encouraged George and stimulated his reasoning, his creative and visual powers. The family traveled, went on picnics, visited the famous Berlin zoo, and when they did these things, the parents helped make them fun learning experiences. The Elephant at the zoo helped George, with his parent's help, understand the wonderful civilizations of Africa and how Timbuktu in Africa was once one of the world's leading centers of knowledge. Here also, George in his younger years was a receiver, but quickly and increasingly, he became a giver in these activities by looking up things in books and telling his parents about the world.

Thirdly, George was involved with SOCIAL REINFORCERS. His parents never failed to praise him for a job well done and they did this verbally and tactily as well as non-verbally---with pats and smiles. Here also George was encouraged to be a giver as well.

Finally, George was involved in reinforcement through TOKENS. George's allowance was always viewed as meeting immediate and short-term needs. For larger goals, an account of his "Golden Rule Activities" was maintained. When George did something special for an Aunt, a stranger, his parents, or even for himself, he earned points, and when enough points accumulated, he could buy the bike, the chemistry set, the special item, or go on a special trip. As George got older, the tokens never stopped, but the goals grew apace and so did the forms of behavior needed to earn points.

By no means were George's parents perfect. They were fallible and sometimes were under stress so that they got upset at George or used some form of punishment. However, they understood the dangers of punishment. Five negative consequences of punishment as a form of changing behavior are: (1) The response tends to be a negative emotional one, and, thus, the child may come to dislike the learning situation and even become uninterested in learning in general and react negatively toward the person using the punishment; (2) Avoidance is often the result---avoid the parent/teacher, avoid the home/school and you avoid the punishment, avoid the truth through lies and you can, if lucky, avoid the punishment; (3) Punishment teaches a negative form of aggression and models aggressive behavior. The child tends to learn to hit and scream as ways of getting what they want; (4) Punishment teaches what not to do but doesn't teach what should be done. Understanding the dangers, his parents tried not to use punishment. If under stress they did use it, then they would, when things calmed down, go to George and apologize. They would then talk to him and explain why they got angry and punitive and tried to develop ways to avoid any recurrence.

As you can begin to see, George's parents gave him TIME more than money. They gave him LOVE more than things. Today, parents often don't feel that they have the time needed to apply effective learning theory in raising their children. What they fail to appreciate is that, when you don't spend time preventing negative behavior patterns, you end up spending even more time dealing with the consequences later on. The whole issue of TIME in recent years has become a central concern to anyone who is genuinely interested in the well being of America's children.

Today parents spend 40% less time with their parents than they did in 1965. (Mattox, William R.,Jr. "America's Family Time Famine." CHILDREN TODAY, Nov/Dec 1990, pp. 9-11, 31.) And, don't tell me that they make up for this deficit with "quality" time because that is not happening in the vast majority of the cases. America's children are increasingly raising themselves and even feeding themselves with microwave heat-n-eat meals! The whole socialization process is dramatically changing and it is very doubtful if it is changing for the better. Children are getting less parenting because of divorce, single parenting, and the increase in families where both parents are working. Children are also getting less opportunity to socialize with siblings as the number of one-child families is growing. The average family makes less money today and expects more so that they are run, run, running to try to keep up. Many of today's increasingly well-educated women expect a career---motherhood and parenting has been devalued. In 1973 the median priced home mortgage consumed 21% of parental income. By 1987 this had risen to 40%. "Increasingly, Americans are pursuing a selfish individualism that is inconsistent with strong families and strong communities," writes University of North Carolina Sociologist Peter Uhlenberg. "This movement is fueled by the media, most especially television (both in its programming and advertising), which suggests that personal happiness is the highest good and that it can be achieved by pursuing pleasure and material goods." When 1,500 school children were asked, "What do you think makes a happy family?" they did not list money, cars, fine homes, or TVs---instead the most frequent answer was DOING THINGS TOGETHER!

If George's parents had not had the time for him as a child, if they were not doing things together, George would have been very ill equipped to deal with the tremendous hardships that awaited him in his adulthood. He most likely would have died in the first concentration camp. Or, he might not have cared enough about the well being of others to have resisted Hitler's oppression. In either case, George would have been a liability rather than an asset to society. Today, we must be vigilant to the forces that are creating tomorrow's problems. Inadequate and inept parenting is today creating the most awesome and dangerous problems we can imagine for tomorrow.