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Occasionally, fortune presents to us an unexpected opportunity to teach basic dynamic facts in a form as transparent and clear as a precise laboratory experiment. Such an opportunity occurred a few years ago during a clinical conference at the New York Neurological Institute. These weekly conferences are attended by the house staff, clinical psychologists, psychiatric social workers, nurses, medical students and a scattering of visitors. The leader of the conference never knows what clinical problem will confront him until he arrives for the session.
On this particular morning a crib stood outside of the conference room. In it sat a gaunt child of five with pale, parchment skin and deep circles around her dark eyes. She sat erect, motionless and mute in the middle of the crib, touching nothing, saying nothing, merely turning her head silently to follow the doctors as they filed by on their way into the conference room. The leader of the conference stopped by the crib, leaned down to smile and slowly put his hand out toward her. The child neither drew away nor moved toward him, but looked at him unsmiling and without a sound. He checked his tentative overture and went on into the conference room, where the house officer told the following story:
The child was the younger of two children. The older was a boy of twelve. About the relationship between the two, little was known except that the boy had teased the little girl. The child was a bright youngster who had learned to speak at an early age. Suddenly, a few weeks prior to her admission to the hospital, which had been a few days before the