Time, Reconstruction and Psychic Reality

I once was asked to see a seven-year-old boy who had recently told his parents that he wanted to die. In my initial meeting with the parents alone, his mother confessed, in the midst of a long and detailed history, that she had breast fed her son for six weeks, but then her milk had dried up, and he had been abruptly weaned. When I met with my patient for the first time, he looked thin, slight and undernourished, but there was a driven, determined quality as he walked past my greeting. Nearly pushing his way into the playroom, he picked up the plastic, toy cow from my table and awkwardly began sucking on its udder. With equal abruptness he discontinued the activity, after a glance to note my reaction, and went on to more diffuse, sadistic play. I was struck by the symmetry in the histories I was being told, the boy's gestural reenactment complementing the mother's story and her articulate anguish and guilt. At what level did he know what had happened?

I learned later of the developmental vicissitudes that might have kept alive such an experience for him, such as his parents' separate and chronic depressions. The gesture at the udder took on subsequent meanings at different developmental levels, but in the first few seconds of our meeting, it merely stated a fact: he told me where the trouble was, and perhaps where it had always been. The gesture echoed a concrete past history, preserved perhaps in the