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Case 8

Alfred L. was brought by his mother in November, 1935, at 3Ѕ years of age with this complaint:

He has gradually shown a marked tendency toward developing one special interest which will completely dominate his day’s activities. He talks of little else while the interest exists, he frets when he is not able to indulge in it (by seeing it, coming in contact with it, drawing pictures of it), and it is difficult to get his attention because of his preoccupation.... there has also been the problem of an overattachment to the world of objects and failure to develop the usual amount of social awareness.

Alfred was born in May,1932, there weeks before term. For the first two months, “The feeding formula caused considereble concern but then he gained rapidly and became an unusually large and vigorous baby.”He sat up at 5 months and walked at 14.

Language developed slowly; he seemed to have no interst in it. He seldom tells experience. He still confuses pronouns. Henever asks questions in the form of questions (with the appropriate inflection), Since he talked, there has been a tendency to repeat over and over word or statement.He almost never says a sentence without repeating it. Yesterday, when looking at a picture, he said many times, “Some cows standing in the water.”we counted fify repetitions, then he stopped after several more and then began over and over.

He dad a good deal Of “worrying”:

He frets when the bread is put in the oven to be made into toast, and is afraid it will get burned and be hurt. He is upset when the su sets. He is upset because the moon does not always appear in the sky at night. He prefers to play alone; he will get down from a piece of apparatus as soon as another child approaches. He likes to work out some project with large boxes (make a trolley, for instance) and does not want anyone to get on it or interfere.

When infantile thumb sucking was prevented by mechanical devices, he gave it up and instead put various objects into his mouth. On several occasions pebbles were found in his stools. Shortly before his second birthday, he swallowed cotton from an Easter rabbit, aspirating some of the cotton, so that tracheotomy became necessary. a few months later, he swallowed some kerosene “with no ill effects.”

Alfred was an only child.His father, 30 years old at time of his birth, “does not get along well with people, is suspicious, easily hurt, easily roused to anger, has to be dragged out to visit friends, spends his spare time reading, gardening, and fishing.”He is chemist and a law school graduate. The mother, of the same age, is a “clinical psychologist,”very obsessive and excitable. The paternal granparents died early; the father was adopted by a minister. the maternal grandfather, a psychologist, was severely obsessive, had numerous tics, was given to “repeated hand washing, protracted thinking along one line, fear of being alone, cardiac feras,”The grandmother, “an excitable, explosive person, has done public speaking, published several books, is an incessant solitarie player, greatly worried over money matters,”A maternal uncle frequently ran away from home and school, joined the marines, and later “made a splendid adjustment in commercial life.”

The mother left her husband two months after Alfred’s birth. The child has lived with his mother and maternal grandparents. “In the home is a nursery school and kindregarten (run by the mother), which creates some confusino for the child.”Alfred did not see his father until he was 3 years, 4 months old, when the mother decided that “he should know his father”and “took steps to have the father come to the home to see the child,”

Alfred, upon entering theoffice, paid no attention to the examiner. He immediately spotted a train in the toy cabinet, took it out, and connected and disconnected the cars in a slow, monotonous manner. He kept saying many times, “More train-more train-more train.”He repeatedly “counted”the car windows: “One, two windows-one, two windows-one, two windows-four window, eight window, eigth windows,”He could not in any way be distracted from the trains. A Binet test was attempted in a room in which there were no trains. It was possible with much difficulty to pierce form time to time through his preoccupations. He finally complied in most instances in a manner that clearly indicated that he wanted to get through with the particular intrusion; this was repeated with each individual item of the task. In the end he achieved an IQ of 140.

The mother did not bringhim back after this visit because of “his continued distress when confronted with a member of the medical profession.”In august, 1938, she sent upon request a written report of his development. From this reprt, the following passages are quoted:

He is called a lone wolf. He prefers to play alone and avoids groups of children at play. He does not pay much attention to adults except when demanding stories. He avoids competition. He reads simple stories to himself. He is very fearful of being hurt, talks a great deal about the use of the electric chair. He is thrown into a panic when anyone accidentally covers his face.

Alfred was again referred in June, 1941. His parents had decided to live together. Prior to that the boy had been in eleven different schools. He had been kept in bed often vecause of colds, bronchitis, chickenpox, streptococcus intection, impetigo, and a vaguely described condition which the mother-the assurances of various pediatricians tothe contrary notwithstanding-insisted was “rheumatic fever.”While in the hospital, he is said to have behaved “like a manic patient.”The mother liked to call herself a psychiatrist and to make “psychiatric”diagnoses of the child. From the mother’s report, which combined obsessive enumeration of detailed instsnces with “explanations”trying to prove Alfred’s “normalcy,”the following information was gathered.

He had begun to play withchildren younger than himself, “using them as puppets-that’s all.”He had been stuffed with music, dramatics, and recitals, and had an excellent rote memory. He still was “terrbly engrossed”in his play, didn’t want people around, just couldn’t relax:

He had many fears, almostalways connected with mechanical noise (meat grinders, vaccun cleaners, streetcars, trains, etc.). Usually he winds up with an obsessed interest in the things he was afraid of. Now he is afraid of the shrillness of the dog’s barking.

Alfred was extremely tenseduring the entire interview, and very serious-minded, to such an extent that had it not been for hs juvenile voice, he might have given the impression of a worried and preoccupied little old man. At the same time, he was very retless and showed considerable pressure of talk, which had nothing personal in it but consisted of obsessive questions about windows, shades, dark rooms, especially the X-ray room. He never smiled. No change of topic could get him away from the topic of light and darkness. but in between he answered the examiner’s questions, which often had to be repeated several times, and to which he sometimes responded as the result of a bargain-”You answer my question, and I’ll answer Yors.”He was painstakingly specific in his definitions. A ballon “is made out of lined rubber and has air in it and some have gas and sometimes they go up in the air and sometimes they can hold up and when they got a hole in it they’ll bust up; if people squeeze they’ll bust. isn’t right?”A tiger “is a thing, animal, striped, like a cat, can scratch, eats people up, wild, lives in the jungle sometimes and in the forests, mostly in the jungle. Isn’t right?”This question “Isn’t it right?’was definitely meant to be answered; there was a serious desire to be assured that the definition was sufficiently complete.

He was often confused about the meaning of words. When shown a picture and asked, “what is this picture about?”he replied, “People are moving about.”

He once stopped and asked, very much perplexed, why there was “The Johns Hopkins Hospital”printed on the history sheets: “Why do they have to say it?”This, to him, was a real problem of major importance, calling for a great deal of thought and discussion. Since the histories were taken at the hospital, why should it be necessary to have the name on every sheet, though the person writing on it knew where was writing? The examiner, whom he remembered very well from his visit six years previously, was to him nothing more nor less than a person who expected to answer his obsessive questions about darkness and light.









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