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Chapter 3

Eleven year old Tom slowly walked into Dr Jeffries’ reception room, followed by his parents. After they checked in, the three sat in a corner of the room.

“I’m nervous,” Tom sighed.

Angela took his hand. “Hey. Nothing to worry about, honey. She’ll just talk to us, okay? Ask some questions, ask about things that you remember. Just try to remember and answer what you can, okay?”

“I guess...”

Angela looked at her husband. “Duncan, our appointment was for an hour and a half, right?”

“True—I think it’s a long appointment—maybe because it’s his first visit. Ah, just heard a door close, so I guess we’re next.”

In another minute, the receptionist called them. “Dr Jeffries asks that Mr and Mrs Armstrong go in first. Tommie will be okay waiting out here for a few minutes.”

They rose and Duncan laid his hand on Tom’s shoulder. “You good, sport? Hang in there; we won’t be long.”

Tom smiled faintly. “Sure, Dad, I’m okay.” He held up the tablet with his game in progress.

Duncan gripped his shoulder, gave it a little shake, and grinned. “Good man.”

When the adults entered Dr Jeffries’ office, she rose to shake their hands. After a few brief pleasantries, she remarked, “Dr Gleason sent over some notes from Tommie’s records; he’s written that Tommie is excessively shy about body exposure. He’s tried to talk to Tommie about it and says that Tommie seems to know that his extreme reluctance to be unclothed with anyone is unusual and Tommie appears to be concerned about it too. Dr Gleason notes that he resists taking off his shirt for his exams, for example.”

“Correct,” Duncan agreed, “He won’t take off the shirt at the beach either, or even around home when it’s hot. We recently had an experience at an amusement park that triggered our request for an evaluation.”

“Hmmm, we’ll get to what happened there in a few minutes; first I’d like to go in order and hear about any prior examples of his modesty, to see if there may be any changes over time, and later I’ll talk to Tommie about them. Just so you know, kids Tommie’s age sometimes do have problems with modesty but in his case, it appears to be more severe, perhaps involving some body-image issues. The most common problems like this happen with the onset of puberty but from Dr Gleason’s notes, he’s not there physically yet. Let’s start—personal modesty issues can be associated with social interaction problems. How is he in school? Any reports of his not participating in class, like avoiding verbal presentations or not asking questions?”

Angela shook her head. “Not at all; he’s a good student and the teachers say he participates quite well. He had a big social studies project with two classmates finish last week and they got an ‘A’ on their presentation.”

“Oh, good. What about in social settings? How does Tommie interact with peers?”

Angela nodded. “Well, he only has one real friend—someone who I’d say was a ‘close’ friend, another boy. He’s the only kid who comes to our house. Maybe he doesn’t have more friends because he and his sister—stepsister actually—are so close. They’re always together.”

“His sister is...?”

“Lynette.” Angela offered.

“Lynette is how old?”

“Almost eleven; same age as Tommie; in fact he was born December 10 and she on the twelfth.”

Dr Jeffries nodded. “And how is Tommie with you and other family members? Well behaved? Any unusual behavioral problems?”

“No,” both parents shook their heads. “He’s a good kid. Does his schoolwork and chores without much complaint. Um, usually,” Angela grinned.

“Is he modest with you at home too? Like when bathing or just lounging around?”

Duncan shrugged. “I guess. He never appears out of his room unless he’s fully dressed. I rarely see him wearing his pajamas—and then only in his bedroom. He won’t let his brother or me into the bathroom with him.”

“Does he get along with his brother? How old is he?”

Angela smiled. “Andrew is 13—almost exactly two and a half years older. Andrew dotes on his little brother. He’s very protective of him. And Tommie loves him fiercely.”

Duncan nodded. “After my ex-wife left us, when Tommie was two, Andrew sort of took on the role of his brother’s protector.”

Dr Jeffries made some notes. “May I ask why their mother left?”

“Um, no problem,” Duncan responded. “We met in college; she was a communications major but was really into theater and acting in school performances. After graduating, she got into the local community theater and was quite good, actually. But she wanted to spread her wings and see if she could go pro. There wasn’t much in Toronto for her; she wanted the big time, like Hollywood. Her friends, and also the directors of the plays she was in, told her she wasn’t at Hollywood level but she wouldn’t hear it. My own career opportunities relied on my staying here; I couldn’t think of relocating to the west coast of the U.S. for the remote chance that she’d succeed, and my moving there would net the family a huge pay cut. She was also... how should I put it ... very self-centered—I guess that’s kind of common in actors... and... um... really wasn’t a very good mom to the kids. She kind of made it clear that they were a drag on her. She became very... ah... distant, both to the kids and me, and we parted before our sixth anniversary. Um... she wasn’t abusive, if you were going to ask that, just very aloof with the kids... and me.”

“You’re saying that your sons didn’t really have the influence of a loving mother.”

Duncan nodded his head. “Not at all. But I tried to give them as much love as I could, despite her coldness toward them.”

Angela broke in, “Duncan is incredible with the boys—with my daughter too. It’s what drew me to him. They all confide in him about everything; makes me a bit jealous at times,” she grinned. “They go to him first ‘cause he’s kind of a softie but he listens to them so well.”

“You mentioned that your daughter...” Dr Jeffries consulted her notes, “Lynette... and Tommie are close. Your kids first met when the two of you met?”

“Pretty much,” Duncan agreed. “When we saw that the two of us were clicking, we began to have some ‘family outings’ all together.” He made finger quotes. “Lynette and Tommie, well, they seemed to gravitate together. You’d assume they were twins, they think so much alike.”

“So tell me, before the amusement park incident which you say triggered your seeking help, what prior instances of his modesty can you recall?”

Duncan leaned back in his seat. “This also was earlier this summer. Here’s what happened. You’ll recall how really hot it was then...”

~~~~

“Hey Mom, Lynette and I wanna go play in the park, okay?” Tom called.

“Just a minute, young man, remember your dad mentioned at dinner last night that he wanted you to help him and Andrew with the lawn?”

“Oh, gee, yeah. I forgot, sorry. Aww...”

Lynette came downstairs. “I heard, Mom. It’s okay, Tommie; say, I’ll stay home and help you. Can I, Mommie? I already finished my own chores. Maybe we’ll finish quicker so we can go to the park?”

Tom turned to her. “Would you help too? Super! Thanks!” He hugged her.

Angela nodded, “Okay, but only if your dad says you can. He should be back from his errand with Andrew any time now.”

Within a few minutes, Duncan pulled into the drive and Tom ran out to the car.

“Hi there, sport,” Duncan called. “Ready to get started?”

“Yeah Dad... Lynette said she’d help so-if-we-get-done-quick-can-we-go-to-the-park?” Tom asked in a rush.

Duncan turned to Andrew. “What ‘ya say, son? If they work hard, can we let them go?” He winked.

“Sure, Dad,” Andrew smiled. “Not a problem.”

“Okay, you two.” Duncan looked at the ten-year-olds. “I’m on the rider mower and Andrew is using the push mower where the rider won’t go. Tommie, you’ve used the string trimmer before, so you’ll do that. And Lynette, can you do around the edges? Using clippers and this spade here?”

“Yeah, Dad,” she nodded.

Soon they all were at work and before an hour was up, so was the temperature, and Duncan and Andrew had removed their shirts; Lynette was just wearing a bathing suit top with her shorts. When Duncan rode past Tom, he stopped and looked at him. Tom was trimming the grass near a tree, wearing goggles, a tee-shirt, and shorts and sweating profusely.

“Hey, guy,” Duncan called to him, “it’s almost 34 degrees [93̊ F] now and getting hotter! Look how you’re sweating! Take off your shirt, son, and you need to put on your cap, too”

Tom stopped the trimmer. “Um, I’m okay, Dad.”

Duncan got off the rider. “I mean it, son. It’s hot. You need to cool off—you could get heat stroke, you know.” He reached for Tom, who pulled away.

“No, Dad! I’m okay! I’ll... uh, just get some water—and a hat.”

He ran off to the house and returned several minutes later. When his father looked again, Tom had a cap on but was still in his shirt, so he swung around to him again.

“Aren’t you taking off the shirt?” he called.

“No! I can’t,” Tom responded.

Lynette ran up to them. “Dad, please don’t yell at Tommie; he has to leave his shirt on. Please don’t make him take it off, he can’t do it!”

“What’s this?” Duncan muttered. Aloud he asked, “Lynette, what do you know about Tommie’s shirt? Why he won’t take it off?”

She looked at Tom. “He’s scared or somethin’, Dad.” Tom nodded. “He told me he gets bad feelings if he has no shirt on. He won’t take it off at any time.” Tom nodded again.

Duncan shook his head. “Okay, but I don’t want you to get overheated, son—say, take the hose and wet your shirt—is that okay, sport? That should cool you off a bit.”

Tom nodded and smiled. “Thanks, Dad.”

~~~~

Duncan finished his recollection, “I told Angela about it later, and she told me she’s noticed that Tommie never goes without a shirt.”

Angela nodded, “I had a similar experience about a week earlier when I took Lynette and Tommie to the beach. It was another pretty hot day. When we got there, it was past noon and the temperature was already pushing 32 degrees [90̊ F]. We were wearing our suits under our clothes, so we took them off, except Tommie kept his shirt on. I asked him if he was planning to go in the water wearing his shirt and he said he was. I couldn’t convince him to take it off and Lynette came to his defense then too.

“Oh, that reminds me; at the neighborhood pool too, he keeps his shirt on. And we’ve tried to give him swimming lessons but he refuses. He’s content to just stay in the shallow end. I know why he’s afraid of the water; he almost drowned when he was eight when some kids pushed him into the pool.”

“Oh really—what happened then?” Dr Jeffries asked.

Angela responded, “He was at the municipal pool with two of his school friends back then and the mom of one of them. Some older kids, maybe 11 or 12 years old and known bullies, as we found out later, began teasing the three 8 year olds, and then they threw Tommie into the deep end of the pool. The deck was crowded and the kids—his friends—didn’t know Tommie couldn’t swim but when they didn’t see him pop up in the water, they got help. He got pulled out but he wasn’t conscious; he had swallowed a lot of water and the lifeguard had to pump it out of him. Getting water in the lungs is really serious! Tommie was in the hospital for three days.”

“Oh my. How was he after that experience?” Dr Jeffries asked.

“Anxious. Withdrawn,” Duncan said. “We got him some therapy, that got him to go back into the water and he got used to it, but he won’t go near water above his waist. He still refuses to learn to swim. The therapist told us when he’s a teen, he’ll probably agree to learn then. I think it’s a high school requirement anyway.”

“Perhaps he will agree to learn,” Dr Jeffries mused. “I think that was good, to expose him to getting back into the water so quickly.... And you mentioned an amusement park incident; one that was the main impetus for bringing Tommie to be seen about his modesty, right?”

“Correct. Let me set the scene; this was about a month ago. We were visiting that big park, you know, Canada’s Wonderland. There was a swimming pool and the kids wanted to use it and unlike the water rides, bathing suits and showers were required. So we told the kids that they needed to go to the locker room to shower and put their suits back on before going in the water. Angela was with Tommie and Andrew and she pointed them to the locker room....

~~~~

“Go ahead, dear. Andrew will go with you,” Angela said. “You have to take a shower with soap, it’s the rule here.”

Tom frowned. “Um. I changed my mind. I don’t want to go in the water.”

Andrew looked at his anxious brother. “It’s okay, trooper, they probably have shower stalls for privacy. I’ll be with you and watch out for you.”

He reached his hand out and Tom reluctantly took it; then they walked to the locker room. Entering the room, Tom looked around. One half of the room had small lockers and the rest was filled with rows of showers, ten heads along each wall and four heads on each one of four posts which stood in a row down the room’s center. There were about a dozen men and boys showering in the room.

“Andy—wait,” Tom stammered, covering his eyes. “Look, I... it’s all open! It’s a big room and the showers are... uh, it’s all open... no curtains...” He turned away from the showers, still holding his hands over his eyes, and started to cry.

“Oh, okay, you’re right,” Andrew replied as he looked at the large open shower area. He noticed several shower heads in one far corner of the room; none were occupied. “Look there, bro, you can shower in the far corner there and I’ll stand in front of you and hide you, okay?”

Andrew looked at his brother, who had a distressed, no, it was a panic-stricken, look on his face. Tom looked like he was about to throw up.

“No! No... I ca... can’t d... d... do it, Andy,” he stuttered and sunk to the floor.

“Sure you can... you can be brave, guy, right? I’ll even hold my towel in front of you, see, like this, okay?” he said, spreading the towel widely.

Tom, sitting on the floor, peered up at his brother and then glanced at the corner shower. Andrew shook the towel temptingly but Tom shook his head and looked down again.

“How’s about if I shower and change first? You can hold the towel for me, then you’ll see there’s nothing scary, okay?”

“Um... maybe... I guess...”

Andrew held his hand down and Tom took it, allowing himself to be pulled to his feet.

“I am so scared, Andy.”

Andrew looked at his brother; his face was ashen and he was trembling.

“Let’s go over there, trooper,” Andrew urged, and started to draw Tom over to the far shower while Tom was trying to cover his eyes.

A man showering near them called as they approached the shower area, “Say kids, you need to get the clothes off before you come in the showers, you know.”

Tom pulled his hand out of Andrew’s, turned, and blindly retreated to the locker area where he dropped onto a bench, bent over, and wrapped his arms around his thighs. Andrew came over to him and squatted down.

“Hey, guy... you okay?” Tom shook his head. Andrew put his hand on Tom’s back; he was trembling violently. “Hey, I think I changed my mind too, bro, maybe I’ll go in the water later,” Andrew said softly to him. “Let’s go back out, okay?”

Tom looked up, his cheeks were streaked with tears. “C... can w... we go? Th... thank you!”

When they returned to their parents, Duncan gave them a questioning look. “What’s up, guys?”

Tom looked at the ground while Andrew whispered to his dad, “Um... the modesty, Dad. He had a meltdown. The showers are all in the open; there’s no private area.”

Duncan squatted down in front of Tom; then his mother, who quickly whispered something to Andrew, came over.

“Hey, son,” Duncan asked, “how’re you doing? We kind of assumed that there’d be some privacy in the showers but there wasn’t, huh?”

“No, Dad... I’m sorry... I just... can’t... too scared to even take off my shirt. My heart’s pounding; I couldn’t breathe and felt like throwing up... what’s wrong with me?” he wailed. “Why does that happen?”

Duncan held him in a hug. “Something’s scared you badly, Tom. Your body is just reacting to that scare. I’m not sure why, so... why don’t we ask Doc Gleason about it? You need to see him for your school physical; that’s next week. Say, feeling better now? You wanna hit some of the rides now? Okay for that?”

“I guess... You think Doc Gleason can help?” Tom asked.

His parents exchanged glances. “He can help,” his mother said softly, but mouthed to her husband, “I hope.”

~~~~

“So he panicked in there?” Dr Jeffries asked.

“Yeah, that’s what Andrew told us. His face was pale and he was still trembling when we saw him come out.” Duncan told her. “Andrew also told me that when Tommie saw the people in the showers, he averted his eyes, covering them like he didn’t want to see them.”

“Hmmm. That fits with your description of his other reactions, too. Okay, one last question before we invite Tommie in. Are you aware of any sexual abuse or contact, say from a friend or relative?”

Tom’s parents looked at each other. Duncan answered, “No, there isn’t anything we’re aware of. Tommie’s never stayed overnight anywhere and has only one friend he’s close with. I don’t see how anything like that could happen, do you, honey?”

Angela shook her head. “No. Except for the modesty, Tommie seems very happy and not needlessly afraid of situations, other than being in deep water, that is.”

Dr Jeffries finished writing and looked up. “Let’s fetch Tommie now, okay?”

Tom took a seat between his parents and Dr Jeffries introduced herself. Then she smiled at him and began asking him about his school, friends, favorite activities, music, and his siblings, drawing him out and getting him to relax. Then she sat back, and catching his eye, grinned at him.

“So Tommie, sounds like you like school and have a nice time with your activities too. And your mom and dad have been telling me how good you are, both in school and at home, that you love your brother and sister, and do all your chores. So whatever do you need to talk to me about? You seem to be a perfect kid!”

His parents chuckled.

Tom looked at them both. “Um... did they say... about... ah, I’m scared... to be undressed...?”

“Yes, they told me what happened, but I’d like to know what you think about that too. Are you okay talking about that with your parents here?”

He nodded, shrugging. “They’re okay being here.”

“Good, tell me how you feel when you’re undressed when you’re alone?”

“Um, I don’t think I really know... um, when I’m alone I guess I don’t even think about it.”

“But if Dad is around, then how do you feel?”

“I’m not undressed if he’s there.”

“Could you get undressed if he were there, though? Are you okay talking about this? And with Mom here?”

“Um, yeah. I, ah, um, don’t really know... oh, well, when Andrew and I were in a shower room at the amusement park... ah, I think if we were both alone, I could get undressed then... but there were people... um...” His face turned bright red and he couldn’t continue.

Dr Jeffries nodded. “So someone in your family, then, if it was your brother or father, you could be undressed?”

“Um, maybe, I guess...” He looked very tense.

“Tell me what happened at the amusement park, if you can.”

Tom described his locker room experience.

“Can you describe how you felt then, Tommie, right before you decided to leave the room without showering?”

“Unh, well, like I was dizzy, you know? My heart was pounding and I couldn’t catch my breath—like I was running, I guess. Chest hurt. Oh, it felt like I was gonna throw up.”

“How do you feel right now, talking about it?” Dr Jeffries asked. “Do you have the same feelings?”

“It’s okay, I don’t, but I feel a little nervous,” Tom acknowledged. “But feeling like that in the pool shower scared me. I, um... don’t know why I get that way, but I feel scared that somethin’ bad’ll happen if I take off my clothes.”

“Do you mind if I ask you about other times when you couldn’t take off your clothes—like your shirt at Dr Gleason’s office?” He shook his head. “How did you feel at Dr Gleason’s office?”

“He... no, I like him, he’s really nice, but when he asked, I got scared, like I wanted to run out, away from him. It made me feel bad, but he said he could examine me even with my shirt on. Then I felt better.”

Dr Jeffries continued to question Tom gently, then asked for a few minutes alone with him, so his parents left the room.

“Tommie, now I’m going to ask you some really personal, sensitive questions and I’ll be the only person ever to know your answers, so you can be honest and I’ll keep your secrets. Is that okay?”

“Uh huh...” He looked at her questioningly.

“Tommie, how do you feel about yourself? Do you think you’re a happy person, or a sad one—I mean, do you look forward every day to doing exciting things, or it doesn’t really matter what happens each day?”

“Oh, no, I pretty much have fun every day... um, except when I have a test at school. They’re no fun,” he giggled.

“But you don’t mind the tests...?”

“Oh, they’re all right. I do okay, I guess,” he answered.

“That’s good. Does doing anything give you too much stress—you know what I mean, right? Like the stress, or anxiety, you feel about being undressed, okay? Anything else stress you, like being alone with someone, even a family member, or being in a certain place?”

“Mmmm, no... you mean, do I feel like I don’t want to be there?”

“Well, like you said when you were with Dr Gleason. When you said you wanted to run out of the room.”

“Oh. No, well, when I’m playing ball, I stress out about getting a hit—is that what you mean? I’m not as good as some other kids...”

“No, that’s actually a good kind of stress, Tommie. It makes you want to play better. I’m talking about a stress that makes you feel bad.”

“Okay, then, no. I can’t think of anything like that.”

“Has anyone ever threatened or hurt you where you’re now afraid of them, or touched you inappropriately? You do know about ‘inappropriate touching,’ right?”

Tommie shook his head. “No, never had any bad touching. Um, when I was little, some kids threw me in the pool and I almost drowned, so now I’m scared of deep water. Is that what you mean?”

Dr Jeffries nodded. “Something like that. Are you afraid of being where that can happen again, Tommie? Like being near a pool where kids can do that to you again?”

“Um, no, never thought about that, you know? I’m bigger than most kids my age now and can take care of myself,” he said proudly. “I’m not afraid of being bullied now. I wrestle with Andrew and I can almost pin him,” he grinned.

“So you don’t recall anything that makes you so anxious that you can’t get undressed around other people?” she asked.

“No. I just get scared and don’t know why,” he responded sadly.

“Do you have any questions, Tommie? Is there anything else you want to tell me?”

“No. Can’t think of anything except why I feel that way.”

“Well, we’ll try to find out something more the next time we talk about it, okay? Let’s get your folks back; I want to chat with them for a minute, so please ask them to come in, and wait for us out there for a bit; sound okay?”

“Sure.”

Tom left the room and the Armstrongs returned, looking at Dr Jeffries with anticipation.

She invited them to sit and smiled at them. “Cute kid. He’s sweet, smart too. Okay, he didn’t tell me much more than you folks did, except that my chat with him confirmed that he had a classic panic reaction when he and his brother were in that locker room. The other times you described, he was exhibiting anxiety; he possibly was close to panic then too. The amusement park episode wasn’t just a severe anxiety attack, mom and dad, the description of how Tommie reacted shows a classic panic reaction and implies that he has a phobia against being undressed. That’s a known social phobia and has a name; it’s called ‘gymnophobia,’ or fear of being naked—gymnos is Greek for ‘naked.’ Many times the panic reaction can happen when the person simply sees someone naked. Actually this phobia is not uncommon in children undergoing puberty but it usually results from a triggering cause like negative peer pressure, bullying, or the fear of exposing one’s genitalia. There’s a more serious social phobia—a social anxiety disorder—which has gymnophobia as one of its symptoms. Tommie certainly doesn’t have that disorder. But none of the triggering causes appear to be operating here.”

Duncan nodded. “Okay, so we now have a name for Tommie’s condition. Is there a treatment or what?”

“Well, I’d like to see him for one or two more sessions. I’ll explore his memories further; maybe he’ll reveal something he hasn’t mentioned yet. But he was very open with me today so I don’t think I’ll hear any surprises. Here’s my opinion on treatment. The typical treatment for phobias is usually either something called ‘cognitive behavioral therapy’ or ‘exposure therapy.’ I think he’s much too young for the former—you can look it up on the web. It involves doing exercises to alter the inappropriate patterns of thinking and results in changing the body’s responses, in cases like Tommie’s situation, to being unclothed. He’s way too young for CBT; it probably works best with a much older person—a late teen or a young adult. Exposure therapy might work, but again, without knowing the cause, the treatment might actually induce more trauma. That method is actually a structured form of cognitive behavioral therapy and involves putting the person into increasingly stressful situations and overcoming his fear by showing him, in a structured way, that being unclothed will not cause him physical harm.

“Exposure therapy works by desensitizing the person to being naked. But some therapists, myself included, believe that it’s actually important for the person to remain being ‘sensitive’ about the feelings one has about oneself, like when being undressed. The nudity phobia is triggered—that is, the physical phobia symptoms will appear—when the person is threatened by the idea of nudity; his body senses its change of status, like anticipating being seen naked or seeing others naked. That’s the triggering part, the body’s sensing a potential threat through vision or thought. The sensing then triggers the symptoms; it’s all done by the body with no thought processes involved. Desensitization actually works by training the body to tolerate its anxiety about the triggering condition, such as being naked, it doesn’t really remove the person’s anxiety—so it’s not a cure. Tolerance may look like a cure but could leave hidden problems or even cause others to develop. Follow so far?”

“Okay,” Angela nodded, “so what do you recommend?”

“I think he’s much too young for CBT. And while you could help him in doing the exposure therapy, where you’d gradually get him to accept being undressed in the presence of others, that almost certainly would not be a good idea either. We’d need to treat the underlying cause that originally triggered the phobia, or else I feel that by desensitizing him, we would be masking an unknown underlying problem. None of the usual causes seem to apply and Tommie appears to be otherwise a very well adjusted young person, so pushing him to do something which bothers him terribly might trigger an unwanted response, like resentment against you, which would be awful. I don’t see him trusting a stranger, a therapist like myself—and you should know that I’d never take on treating gymnophobia with exposure therapy with any male, let alone a boy. I strongly feel that it would have to involve a loving partner or someone very close like a parent. So unless we can learn the underlying cause, which would become the target of the therapy, my advice would be to wait until he’s much older. Just watch to be sure that this phobia doesn’t develop into other social problems, but that’s very unlikely. Perhaps he could even outgrow it. That happens too.”

“I see,” Duncan mused. “So you suggest that we don’t pressure him.”

“That’s correct. He’s not hurting himself, right? Perhaps something will happen where you’ll learn what triggered the phobia. Okay, let’s do appointments for another two sessions for Tommie alone, we’ll do 45 minutes the next two times. How’s next and the following Thursdays at 3:30?”

Ultimately the two remaining sessions with Dr Jeffries did not reveal the underlying cause of Tom’s phobia, so the Armstrongs decided to follow her advice and let him be comfortable being himself. They did get a note for his school, however, instructing that P.E. teachers should not pressure him about his keeping his shirt on or not showering.

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