Born Again

“Rebirth therapy” was meant to help a troubled girl start over, but it ended her life instead.

Michelle Dean Topic | April 2017 | 13 minutes (3,100 words)

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Candace Newmaker was 10 years old when she died in 2000. There are only a few pictures of her, and even fewer biographical details. Here is what we do know: she had dark brown hair and eyes, she liked dogs and horses, and she enjoyed arts and crafts. Candace had been a ward of the state of North Carolina since she was about 5 the daughter of a very young mother who hadn’t been able to hold her own life together, and who had lost her very young children to the Department of Children and Family Services. Jeane Newmaker, a kindly nurse-practitioner who was single and in her early 40s, found Candace in the system when she was 6 and adopted her in 1996. It’s not clear exactly when things got difficult between Newmaker and her adopted daughter. Maybe things were difficult from the start. (Newmaker declined to comment for this article; this account is based on contemporaneous press reports in the Denver Post and the Rocky Mountain News.) Candace, one of the girl’s therapists later said, could be sweet, but she could also be “mean.” One therapist said it just seemed like Candace had a “defense mechanism for being through so many places” — that “it was like having the average 18-year-old adolescent in your house,” one who was trapped in a 10-year-old’s body.

As Newmaker tried to figure out what was wrong, she took Candace to a traditional therapist. They tried talk therapy and drugs: Candace was put on Effexor (for depression), Dexedrine (for attention deficit disorder), and Risperdal (for psychosis). But Newmaker felt her behavior did not change. Sometimes, Newmaker told her friends, Candace could be “assaultive.” It’s not clear what exactly she meant by that, but it’s clear that she felt things were dire, and she was desperate for help.

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Newmaker managed to find one potential explanation for Candace’s behavior, first suggested by a social worker: a diagnosis of reactive attachment disorder. Children with RAD have usually had chaotic upbringings and been frequently separated from caregivers; they tend to be either extremely remote or extremely aggressive. It’s a controversial diagnosis, but one which has been applied to “troubled” children adopted out of the foster-care system who failed to adjust to their new homes — who failed, in other words, to “attach.”

There were enough such cases, in fact, that Newmaker found a professional association called ATTACh — the Association for Training on Trauma and Attachment in Children. Newmaker attended one of its conferences in Alexandria, Virginia, in 1999 and met a therapist who, without seeing Candace, concluded that the girl’s RAD must be “fairly severe.” He referred Newmaker to a therapist named Connell Watkins, of the Attachment Center at Evergreen, Colorado.

Evergreen was full of so-called “attachment therapists” who claimed their radical therapeutic techniques could help RAD children. It had been a central destination for families desperate to connect with their children since the 1970s, when a doctor named Foster Cline established his practice there. Watkins, who had studied under Cline, had cultivated a reputation for success in some of the worst cases. Newmaker contacted her, and in April 2000, Candace went to Colorado.

I can’t breathe, I can’t breathe, Candace yelled over and over.

The parameters of the treatment were, to say the least, idiosyncratic. The course was to last two weeks and cost $7,000. The Newmakers stayed with a couple named Brita St. Clair and Jack McDaniel. The idea of hosts serving as “therapeutic parents” was a common practice in Evergreen; the idea was that the child would be in a 24-hour therapeutic setting. Except, of course, St. Clair and McDaniel were not actually licensed therapists — they were Watkins’s office manager and assistant. Nonetheless, they were considered integral to Candace’s therapy. The girl was told, reportedly, to call McDaniel “Daddy Jack.”

Watkins would work with Candace in her office, doing what looked like more traditional talk-therapy sessions, but they sometimes included an aggressive physical element called “holding therapy.” Watkins and another therapist, Julie Ponder, supervised as Candace was wrapped in sheets, covered in cushions, and held in place, sometimes by Jeane Newmaker and sometimes by other therapists. Holding therapy was thought to break down a child’s defenses by making her physically helpless: after an initial period of struggle, attachment therapists believed, a child would eventually relax and succumb to the practice, and even derive comfort from the person holding her, allowing a new bond to be forged.

But there were likely many variations on the practice, even among therapists in Evergreen. Sometimes the therapist would do the holding alone, sometimes the adoptive parent would, and sometimes they’d do it together. Which is how, just over a week later, Newmaker, Watkins, Ponder, McDaniel, and St. Clair found themselves doing a unique kind of holding-therapy session with Candace called “rebirth therapy.” The child was wrapped up in a flannel sheet that was twisted at both ends, intended to be a simulation of the womb. Watkins, Ponder, McDaniel, and St. Clair pushed against her, making it hard for her to wiggle out of the blanket, and be — in the way they envisioned the therapy — “reborn” into a new, more emotionally healthy life.

“I can’t breathe, I can’t breathe,” Candace yelled over and over, according to a transcript of a tape of the session that was later played in court. “I can’t do it. I’m gonna die.”

“Do you want to be reborn or do you want to stay in there and die?” Ponder said.

Candace’s last word, according to the transcript, was a weak “no.” Then she suffocated inside the blanket.

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The death of a child will always provoke strong reactions, but salt that with the odd sound of “rebirth therapy,” and the condemnation from the public came fast and swift. The practice sounded ritualistic, the product of faith rather than science. But for Watkins, as for most therapists who worked in Evergreen, her practices were simply an extension of a long-accepted tenet of psychoanalysis: the theory of attachment.

The first person to clearly articulate the concept of attachment was a British psychoanalyst named John Bowlby. One of his first publications was the 1944 study “Forty-four Juvenile Thieves: Their Characters and Home-Life,” which appeared in the venerable International Journal of Psychoanalysis. Bowlby had collected the case histories of children caught stealing while he was working at a child-psychology clinic in London during World War II. Then he compared those case histories with those of 44 children who were referred to his clinic for other reasons.

At the outset, Bowlby admitted he lacked the proper resources for his research and described his group of thieves as “unselected.” He wrote, too, that his data had been collected unsystematically, but he still thought, perhaps, that it might have something to say about the nature of a criminal personality. He had come to believe that the roots of bad behavior were in childhood. With these thieves, he wrote, he intended to prove that “theft, like rheumatic fever, is a disease of childhood and adolescence.”

The practice sounded ritualistic, the product of faith rather than science.

He sorted the little thieves into categories — normal, depressed, circular, hyperthymic, schizophrenic — but the group that stood out to him the most were those he called “affectionless.” These children, Bowlby wrote, lacked shame or a sense of responsibility. They were cold, distant. They didn’t have good relationships with their parents, or with other children. Today, people might say such children exhibited psychopathic or sociopathic traits. Bowlby guessed that something in their backgrounds might explain it.

The commonality he found might seem obvious to us now: 12 of the 14 children Bowlby characterized this way turned out to have endured prolonged separation from their mothers as infants. This, Bowlby thought, had marked them for a life of crime, and their bad behavior was all about trying to get the things they lacked as children. “The food they stole was no doubt felt to be the equivalent of love from the mother whom they had lost, though probably none was conscious of the fact,” he wrote. This insight intrigued him on more than a professional level. Bowlby did not have the greatest relationship with his own mother (as was common to upper-class British mothers, she’d left his care to the servants), and he felt her lack of mothering had stunted him.

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From those two seeds, Bowlby came to develop a theory that children who did not properly bond with their mothers early in life would come to have trouble bonding with anyone later. Gradually he articulated a theory of “maternal deprivation”: children deprived of their mothers were more likely to have emotional problems later on.

After that, the theory blossomed and grew. Some female psychotherapists built on it; others mounted feminist critiques of it, complaining that it overburdened mothers with the responsibility for their child’s entire psychic well-being. Most people today are familiar with, for example, the notion of “attachment parenting,” a theory popularized by William Sears in 1993 by his wildly popular The Baby Book. That school of parenting, too, is thought to be hard on mothers, demanding that they be in constant contact with their children.

Candace Newmaker was not a thief, but she was — like many children who spend time in the American foster-care system — damaged by her upbringing. Foster care is and was an imperfect solution to a problem that modern Western societies have never really known what to do about in the first place. Before the 18th century, American children whose parents had died or couldn’t properly care for them were often left to their own devices. The first orphanages in the United States were founded in the 1700s, but they were hardly nurturing environments; when foster care became a more popular solution, in the 1960s, it was seen as a way to get children out of institutions and into family homes.

I failed Candace. I failed to keep Candace out of harm’s way.

In spite of what we know about the failings of state care for children, our templates of orphanhood remain mostly romantic, the relics of early-20th-century optimism. Sara Crewe, in Frances Hodgson Burnett’s A Little Princess, is a rich girl who is forced to become a servant to her cruel schoolmistress after her father dies, but never gives up; Anne of Green Gables remains dreamy and optimistic, in spite of her time spent in an institution; Little Orphan Annie is a plucky survivor whose spirit survives her treatment by the cruel caretaker Miss Hannigan. One suspects that even if prospective adoptive parents have been told that children who spend time in the care system are often very unhappy souls, when they go out to find a child, it’s still Annie they hope to encounter. It’s Annie they hope to raise.

The diagnosis of RAD can be read as a by-product of that fantasy: the monstrous RAD child is the logical inverse of the good orphan Annie. RAD first appeared in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) used by psychiatrists in 1980, though doctors had been describing children with the major features of the disorder in studies dating back at least to Bowlby’s studies of the 1940s. Over the years, the definition has undergone several revisions; it was first linked with the diagnosis that an infant had “failed to thrive,” but that was later abandoned. Today the definition mostly requires that the child show difficulties in forming attachments before age 5, and that they react in one of two ways: by becoming exceptionally withdrawn, or exceptionally aggressive, in seeking out the comfort of others.

These symptoms tend to map easily on to some of the older children in the foster-care system. They may be angry. They may be cold. And their adoptive parents — out of what appears to be an entirely sincere belief that they have a sick child on their hands — may turn to medicine for answers. Doctors have repeatedly insisted the RAD diagnosis is rare; there are no good epidemiological studies of it, but around 1 percent of American children are thought to have RAD. Nonetheless, people like Jeane Newmaker have found the diagnosis online and turned to it as a beacon of hope. It’s what brought her, and others like her, to the center in Evergreen, Colorado.

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It’s not clear exactly when or why so many attachment therapists established themselves in Evergreen specifically. In her ethnography, The Road to Evergreen: Adoption, Attachment Therapy, and the Promise of Family, published in 2010, the anthropologist Rachael Stryker ventured that “the area’s isolated feel and tranquility made it an especially attractive site in which to conduct family and child therapies that included a retreat-like setting.” Colorado has also long been a popular place for New Agers and other counterculturists, not all of them cranks; the state has a reputation for cultivating rugged individualism in a beautiful setting. It attracts people who want to experiment.

Among the people attracted there was Connell Watkins’s mentor, the controversial doctor Foster Cline. Cline was interested in emotionally disturbed children and, at his practice in Evergreen, he advocated for a therapy borrowed from the treatment of autistic children known as the “Z-process.” Developed by a doctor named Robert Zaslow, it involves the therapist holding a child tightly, then provoking them, in order to teach them how to properly articulate rage. Zaslow’s medical license was stripped in 1972 after one of his sessions caused severe injury to a patient. But Cline still thought the idea had value; he used it to gradually refine and develop the practice which came to be called attachment therapy.

Candace wasn’t born again; she wasn’t saved.

In its own literature, attachment therapy can seem benign, or at least borderline helpful. In its most basic form, after a few introductory “getting to know the therapist” sessions, the disturbed child is instructed to lie prone in the therapist’s lap. The child is then, essentially, under the adult’s physical control. Cline recommended that the therapist start stimulating the child by talking to or even tickling them. “All of this varied, high-intensity stimulation is necessary to break up the child’s habitually rigid and stereotyped responses,” Cline explained.

The logic of attachment therapy is that, by persuading a child to let go of control, accompanied by intense physical contact with either a therapist or a parent, they are given the chance to forge a new kind of bond. As Stryker reports in her book, there were children for whom this seemed to be effective: she observed at least one 15-year-old completely succumb to the therapy, crying as he talked to his therapist about his feelings of abandonment by his mother.

Watkins may have been following Cline’s teachings, but she was also, apparently, something of a radical. There is no record of how she came up with rebirth therapy. There are, however, a lot of records of her regret over what happened to Candace Newmaker. At sentencing, she called it “the dark night of my soul.”

“I failed Candace and I failed her mother,” she said. “I failed to keep Candace out of harm’s way.”

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In 1990, a year after Candace was born, HBO aired a documentary called Child of Rage. The film was allegedly drawn from real therapy sessions between Ken Magid, a clinical psychologist, and 6-year-old Beth Thomas. Beth and her younger brother were adopted by the same family, and she immediately began to display violent behavior. She hurt her brother, and threatened to hurt her parents with knives — “big sharp ones,” as she tells the doctor. In the documentary, she openly recounts the physical and sexual abuse she suffered as an infant, speaking softly as she relates these horrors. She was diagnosed with severe RAD.

When it premiered, the documentary was a sensation. “She has the face of an angel, a heart of stone,” read the headline of a review in the Chicago Tribune. Within two years, a made-for-TV movie based on Beth’s life aired on CBS, with thirtysomething actress Mel Harris as Beth’s long-suffering adoptive mother. Twenty-four percent of the American television audience — around 14 million people — watched it when it first aired.

The documentary and the fictional film were both produced by Magid, who also co-wrote a book called High Risk: Children Without a Conscience. As it happened, his practice was located in Golden, Colorado, close to the center where Connell Watkins worked. Beth Thomas even did therapy with Watkins, who also appears in the original documentary. In her 2010 memoir, titled Dandelion on My Pillow, Butcher Knife Beneath, Thomas describes spending weeks with Watkins (called by another name in the book) doing “rage-release therapy,” which involved holding and “primal screaming.” She doesn’t appear to have undergone rebirth therapy — she saw Watkins about a decade before Candace Newmaker would — but she says that Watkins’s methods worked for her.

Even without undergoing the therapy of that name, the success story of a childlike Beth is, in its way, a story of rebirth: where once there was an angry child who trusted no one, there is now an articulate young woman who says she was saved by special techniques. This is the promise attachment therapists hold out for — and the one that desperate parents have responded to.

But the fact remains that Candace wasn’t born again; she wasn’t saved. After she died, Watkins and Ponder were charged with reckless child abuse resulting in death. They were both convicted and served time in prison. Newmaker was charged with the slightly lesser offense of negligent child abuse leading to death, though she would later plead out and serve no jail time.

Today, Beth Thomas, now 35, and her adoptive parent Nancy Thomas offer therapeutic seminars to others about their experiences with RAD and attachment therapy. They are based near Evergreen, Colorado.

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Michelle Dean is the author of Sharp: The Women Who Made an Art of Having an Opinion.

Karen Barbour‘s illustrations have appeared in The New York Times, Vogue, Playboy, Rolling Stone and on the cover of The Atlantic.

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