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SEVERAL YEARS AGO I was asked to see in consultation a seventeen-year-old girl who was a patient in the medical section of a general hospital.
For two or three months prior to hospitalization, the girl (Kay) had been noted by her parents to be increasingly preoccupied, withdrawn, and seemingly depressed. Although she insisted that there was "nothing wrong" with her, after much urging she did consent to meet with a school counselor. During the fourth interview with this man Kay became mute, sitting with her eyes closed, her muscles rigid, and saliva drooling from the corner of her mouth. She did not visibly respond to a physician or her parents, and after about four hours in this withdrawn state she was transferred to a hospital, where she was examined by a neurologist who found no evidence of organic disturbance other than a minor elevation of cerebrospinal fluid protein and a slight—and transient—weakness of the left arm and leg. Kay spoke on the third day of hospitalization, but it was reported that what she said "didn't make much sense." I visited Kay during the second week of her hospital stay.
Alone in the room, propped up in bed, was a small, blonde girl, a large toy stuffed animal held close to her by her right arm, three fingers of her left hand in her mouth, and her eyes tightly closed. She at first made no response to my presence. I