Chapter 1
Dr. Malcolm
Child psychiatry is a tricky field. There are, of course, recognized disorders that can explain the peculiarities of a growing child. They range from Social Anxiety Disorder to Histrionic Personality Disorder, from mild depression to eating disorders. Even in a small town such as Leadworth, there's no shortage of atypical children. The problem here, as it is everywhere, is teaching parents to tell the difference between the terrible twos and Oppositional Defiant Disorder.
I have been a child psychiatrist for seventeen years and I have seen my fair share of everything I read about in medical school, but more often than not, it is my duty to chase parents' fears away rather than putting a name to those fears. Every month, I will consult with a father who is worried that his energetic five-year-old has ADD or a mother who has convinced herself that her fastidious child is obsessive-compulsive.
And then I have days like today. Laura Amos called a few days ago on a referral from her family physician to have her eight-year-old Maya treated. My original notes from the phone call left a variety of options open, but after a half hour spent with the little girl, I was not convinced that we had an abnormality on our hands. She spoke to me openly of her friend Lucy, the imaginary little girl of whom her mother had spoken in the phone call. Lucy, she said, spoke only to her, sometimes out loud, sometimes not. Lucy was kind and needed a friend. As far as I could tell, this Lucy was not the only one who needed a friend.
As usual, I let my receptionist entertain Maya while I had a brief chat with Mrs. Amos. Maya had an assignment to draw a picture of her and Lucy while I chatted with Mrs. Amos. I left plenty of crayons and paper for her to use.
"Your daughter is a charming girl," I commented as soon as Laura had taken a seat.
Mrs. Amos twisted the strap of her purse between her hands, her knuckles white and her expression that of someone in the midst of a long vigil. "What do you think is wrong with her?"
"Wrong?" I tried to offer a reassuring smile, but that only seemed to put her on edge. "Mrs. Amos, were you never an imaginative child?"
"Of course. But this is different."
"Every child is different," I reasoned. "My sisters crafted wild adventure stories set in our attic. My mother says that I entertained an imaginary friend named Nigel for half a year. Children daydream. It does not necessarily mean that there is anything wrong with Maya."
I glanced at my notes. Our original phone call had me leaning towards a Schizotypal Personality Disorder. Delusions of telepathy, bodily illusions, vague or metaphorical speech and eccentric behavior as well as her social isolation all pointed to that diagnosis. Then again, it would be ill-advised to jump to conclusions and my initial interview with Maya had put those things into context. I would tread very carefully before putting any diagnosis with the prefix of schizo- into a mother's mind. Mrs. Amos didn't deserve that kind of grief unless there was concrete proof that it was the appropriate diagnosis.
"I had an imaginary friend myself," Laura interrupted my thoughts. "I was an only child and invented someone to accompany me when I went exploring. I never sat for hours, staring into a mirror and claiming to see something there."
"It may be a different manifestation…"
"Too right it's different," she interjected again. "A thousand times I've told her 'don't touch Mummy's makeup.' Two weeks ago, my compact disappeared from my things and I found it on her vanity along with her hand mirror. She told me she wanted to see if Lucy was in there as well. Surely that's not typical for a childhood delusion."
"Who are we to say what is typical?" I rejoined. "It may be atypical to your experience, but it does not seem to be abnormal."
"Oh, no?" she challenged. "You think it's normal, do you, for a girl to spend her afternoons indoors staring at her own reflection?"
Actually, that sounded just like my thirteen-year-old daughter. I restrained myself from sighing in frustration.
"Mrs. Amos, I do not wish to cause you further distress. I am not here to tell you that you are imagining things, but I am here to put your fears to rest as best as I can. Your daughter has given herself a friend and a protector. She shows no clear signs of delusion…"
"But the mirrors," she insisted. "It reminded me..."
She broke off abruptly, looking slightly embarrassed. "Go on," I invited.
"My grandmother died a few years ago," Mrs. Amos commented. "She suffered from dementia and at times, she would be extremely lucid, but at other times, everything would change. I remember spending the better part of an hour trying to get her to respond, but she would just stare intently out the window without budging an inch. It was as if she was waiting for someone and nothing else was more important to her."
The mother's projected fear of her grandmother's mental incapacity being passed on to her own daughter explained a great deal. It was a common thing among the parents I encountered for them to believe that the worst was not only possible, but right around the bend.
"I understand how frightened you must be that Maya will develop the same behaviors," I said sympathetically. "I would advise both you and your husband to keep an eye on her behaviors as you always have."
She stared at me for a long moment as if daring me to contradict my earlier assertion that her daughter was normal. She seemed to think that being told to "keep an eye" on things was synonymous with watching for more concrete evidence of psychosis.
Had there not been such a thing as patient confidentiality, I might have referred her to the aunt of one Amelia Pond for sympathy. After hearing how Sharon had returned home one night to find her orphaned niece waiting in the yard for a possibly-imaginary man to take her away, Mrs. Amos might feel better about the relative normalcy of her daughter's fixation.
"You must think I'm an idiot," she muttered at last.
"Come now," I said before she could go any further, "it is only natural for a parent to fear for their child's well-being. This could turn out to be nothing at all, but if things do get worse, we have a precedent for her behavior."
"But you don't think it will get worse," she pressed.
"Oh, I'm not saying that," I responded. "She will be a teenager someday. Just think of all of the joys you have to look forward to then."
She smiled for the first time since entering my office and her fingers relaxed a little. "Thank you, Doctor."
"It was my pleasure," I assured her. "Please let me know if there are any significant developments."
We left my office in good spirits and Maya skipped over to us, presenting a brightly-colored picture to each of us. Her mother's was full of flowers and red balloons and a stick-figure family obviously enjoying the absurdly-blue skies and yellow sunshine.
"Thank you, sweetie," she said. "Have you got your jacket?"
As Maya ran off to fetch the garment from the couch, I gave my own present a once-over. Under the picture were the words "Mummy," "Daddy," and "ME" with the 'e' turned backwards. The last word was, of course, Lucy, but it took me a moment to find the person in question. Maya had drawn a mirror to her left and, reflected in its surface was a door standing slightly ajar and a sad-faced girl with a red balloon who was looking in on the fun she could not join. For a wild moment, I wondered if Maya ever let Lucy out of the mirror or if this friend was always a benevolent bystander.
"Say thank you to Dr. Malcolm," Mrs. Amos prompted.
"Thank you," Maya chirped. "Good bye."
She obviously thought that things had went well; as she left, she began begging for an ice cream. All things considered, it could have been worse.