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Dr Bolton and I had worked for many years in a hospital setting with children with serious physical symptoms of non-organic origin. We found that when there was motor dysfunction with established secondary consequences, both physical and psychological, then in-patient treatment offered the best diagnostic and therapeutic tool. Our experience taught us the value of addressing the symptom directly as well as the psychological determinants.
The case we are describing concerns a 10-year-old girl with ‘locked’ shoulders. Mrs Barbara Grant, a psychiatric social worker at the Anna Freud Centre, asked us for our opinion on the child since she felt that the Centre could not respond to the father's urgent request for reassurance about an immediate cure. We agreed to investigate. The child's case had already been diagnosed and dismissed as ‘non-organic’ by a neurologist who referred her to Dr Yorke at the Anna Freud Centre. When Mrs Grant saw the father she was struck by his panic and frantic anxiety about the symptom. The family were due to return to Peru in a few months and short-term intervention was urgently required to alleviate the symptom. I had, by chance, seen the girl waiting for her father with the receptionist and had assumed that she was a crippled hunchback.
By the time Anya was seen by Dr Bolton her shoulders had been locked for a month. It had begun with slight shrugging, coinciding with the father's return to Peru for ten days at the time of an earthquake there, and when he returned he found ‘a hunchback’.
Dr Bolton described her appearance in the following