Case I. ‘Iiro’ aet 9 Years 9 Months

During a visit to Lastenlinna1 (Children's Castle)–the Children's Hospital at Kuopio in Finland–I was invited to describe a case to a gathering of the staff. This heterogeneous group included the doctors, the matron, several of the nurses, the psychologist, the social worker, and some visitors; and it seemed to be better on this occasion that I should describe to them a case that they already knew, rather than give a case of my own. For this reason a child was chosen from the orthopaedic ward and I interviewed him without there being any urgent presenting problem that would ordinarily involve a child psychiatrist.

I learned that there had been certain symptoms of a vague kind, including messing and headaches and abdominal pains, but the boy was in hospital on account of syndactyly, a congenital condition for which he had had almost continuous attention from infancy. He was well known in the orthopaedic department and was generally liked. The outcome of this interview could not in any way be predicted. Iiro could speak only Finnish, a language of which I had no knowledge. We used Miss Helka Asikainen as interpreter, she having some knowledge of the case and having been involved as a social worker with the mother. Miss Asikainen proved to be an excellent interpreter in that she became quickly forgotten by both Iiro and myself, and it could be said that she did not influence the course of events. Indeed, there was not much talking, and therefore the part she played was minimal. Iiro and I and the interpreter sat down to a small table where there were two pencils and some paper already laid out, and quickly we were involved in the squiggle game which I briefly explained.

I said: ‘I shut my eyes and go like this on the paper and you turn it into something, and then it is your turn and you do the same thing and I turn it into something.’

(1) I made a squiggle which turned out to be of the closed variety. He quickly said: ‘It's a duck's foot.’