Step kept himself from saying, That's precisely what DeAnne and I thought before we ever brought him to you. "What do we do about it?" he asked.
"That was a hypothesis," she answered, "not a diagnosis, and therefore we will do nothing about it."
"But if it turned out to be the true diagnosis, what would be the right course of action?"
"We are getting into dangerous territory, here," said Dr. Weeks. "Highly speculative."
"I understand that, and I'm not proposing that you do anything improper. I just want to have some idea of what the treatment might consist of if this turns out to be the diagnosis."
"Well," she said, "we might begin by having you contact the parents of some of his former friends back in Indiana, to get them to write to him or telephone. However, that may not be effective because at his age children are not very adept at making meaningful emotional contact through indirect media like the telephone or letters."
"And?" asked Step.
He meant for her to propose other possible treatments that might be used if Stevie's condition really was adjustment disorder with depressed mood and withdrawal. But she took it as a request for the third hypothesis.
"The third possible diagnosis, and the one that I think is most likely, is also the one that will be most difficult for you to hear impartially, and therefore I ask you to keep an open mind as best you can."
Step nodded, even though it was clear that she didn't think him capable of it.
"I think we can best account for Stevie's behavior if we view it, not as a new condition brought on by the move to North Carolina, but rather as an exacerbation of a preexisting condition of some severity, one which remained unobserved because it had gone on so long that you thought it a part of Stevie's underlying character."
"So why would we only have noticed it since-'
"Please," said Dr. Weeks. "An open mind. The stress of the move changed his pattern, you see, and it was the change you noticed, not the actual onset of his condition."
"And the condition would be..."
"Atypical dissociative disorder," she said. "This has been primarily documented in people who have undergone int ense brainwashing experiences, but it is my belief that it shows up far more commonly and merely remains undiagnosed."
Step was baffled. What experience could Stevie have undergone that would produce the same effects as brainwashing?
"Actually, most children in America are subjected to a particular form of indoctrination from their earliest years, in which they are repeatedly reinforced in their belief in a powerful figure who does not actually exist.
However, evidence is given to them to sup port that belief, accompanied by stories to make the child believe that the whole world believes in this particular mythic figure."
"You're saying Stevie's problems are because we taught him to believe in Santa Claus?" asked Step, incredulous.
"On the contrary. I think Santa Claus is, by and large, quite beneficial, for when the child is finally allowed-or forced-to recognize the nonexistence of Santa Claus, then the child is able to go through the vital intellectual process of reconstructing reality in light of new evidence, complete with back-forming new stories to account for past events. This prepares the child for many other disillusionments and gives her vital and well-supported experience in maintaining her grip on reality independent of the stories told to her at any given time."
"So Santa Claus is good," said Step.
"Santa Claus is usually not maladaptive," said Dr. Weeks, "and can be turned to a good end. I doubt many parents actually have that outcome in mind when they tell their children the ludicrous chimney story."
"No, I imagine not," said Step.
"Santa Claus is certainly not at the root of Stevie's problem. He has a healthy skepticism toward that story already."
We paid you ninety bucks an hour to find out whether Stevie believed in Santa Claus?
"Stevie has been subjected to another nonconsonant belief system whose implications are far more all-pervasive in his interpretation of events in his life. He feels an enormous weight of pressure to demonstrate his loyalty to this belief system, and therefore has for a long time been forced to come up with sup porting personal experiences to tell you and your wife about. However, Stevie also has been taught to have an absolute commitment to truth, and cannot do as many children do and simply lie, claiming to have experiences that they do not have. Nor, being a child of a rather placid temperament, has he been able to work himself up to a level of emotion in which hysterical phenomena appear, which is the most common means of satisfying these expectations."
"You're talking about religion, aren't you?" asked Step.
"And the Mormon religion in particular, since yours is, as I understand, a somewhat, though not extremely, charismatic sect. As I have learned from Lee, there is considerable emotional dis play at your testimony meetings once each month, at which many people stand up and weep while they speak. This is clearly a hysterical phenomenon, and is not unhealthy- many churches throughout the South have long had a similar tradition and it has served them well as an emotional release. However, Stevie is one of those unfortunate enough not to be able to produce the appropriate hysteria, and he is also unwilling or unable to lie or pretend. Therefore, he produces hallucinations."
"Dr. Weeks, the only hallucinations Stevie has had are his imaginary friends, dating from our arrival in Steuben."
"On the contrary," said Dr. Weeks. "Stevie has told me that he had several experiences in early childhood in which he sensed a very evil presence, threatening to destroy him. I immediately recognized this as the father- fear that is not unusual in boys of that age and which they usually outgrow. However, he says that he told you and your wife about these 'frightenings' and 'bad feelings,' as he called them, and you both informed him that these feelings were from the devil."
"We said they might be," said Step. He was trying to stay calm, but it made him feel invaded, to have her skeptical eye turned on those tender moments from Stevie's childhood, when he and DeAnne had tried so carefully not to impose their own interpretation on Stevie's dreams.
"To a child of his age at the time, of course, there was no meaningful distinction between 'might be' and 'is.'
But I would not have expected you to know that, since you are also caught up in the same belief system. In any event, Stevie began to associate all spiritual phenomena, about which he heard much but of which he experienced nothing, with this oedipal anxiety from his earlier childhood-"
"When he felt afraid at night," said Step, "I would lie by his bed for an hour or two hours, until he fell asleep, singing or humming to him. It wasn't me he was afraid of."
"Of course he did not know it was you he was afraid of. He had displaced the fear and shifted it to a nameless imaginary entity which you conveniently named for him. From that point forward, then, his response to the pressures of your culture was to hallucinate, and in every case you labeled these hallucinations as spiritual experiences. Thus he was able to be part of the culture. He was brainwashed."
"I'm surprised that you allowed Lee to join our church if that's what you think we're about," said Step.
"I'm a scientist, Mr. Fletcher, " she said. "I mean no offense by this. I simply feel that we would be doing Stevie a disservice if we did not recognize that he has long had hallucinations unconnected with the move to North Carolina, and therefore treating only the symptoms that arose since your move here would leave his basic underlying condition unresolved."
"1 f it turns out that this is the correct diagnosis," said Step.
"As I said, I only lean toward this interpretation. But you must understand that when he told me about his baptism, and how during that experience he saw a bright light in the water, which entered him and drove all the darkness out of his body, well, that shows me that he is hallucinating more than just imaginary friends."
Stevie had told no one about this experience, no one but Dr. Weeks, who thought of it as madness. "Do
you know that it was a hallucination?" asked Step.
"You were there, Mr. Fletcher," said Dr. Weeks. "Did you see that light?"
"No," said Step.
"When one person in the midst of witnesses sees something that no one else sees, we are generally safe in identifying these experiences as hallucinations."
"Or maybe he has clearer sight than the others," said Step.
"Oh? You think there really was some underwater light source that no one else was able to see?"
"I think," said Step, "that it's possible for something to be both subjective and real at the same time. Just because only one person sees something doesn't necessarily mean that what he sees isn't there."
"But by that standard, Mr. Fletcher, I fail to understand why you have even brought Stevie to me. After all, what worried you and Mrs. Fle tcher was the fact that Stevie was seeing imaginary friends that no one else could see."
Step had never thought of the imaginary friends this way. It made him angry, her linking spiritual experiences with Stevie's delusions. But she had linked them, and if she was right, if they really were alike, then all of Stevie's extraordinary sensitivity to other people, his ability to perceive good and evil, his aliveness to the spiritual side of life-all of that was also imaginary, hallucinatory.
On the other hand, it might also mean the opposite. That just as Stevie's sensitivity to spiritual things was real, so also his ability to see imaginary friends was real. In which case Dr. Weeks was right, and they had made a colossal mistake bringing him to her. Just as he had been telling them the truth with his absurd-seeming story about Mrs. Jones's mistreatment of him, so also he was telling them the truth about these imaginary friends.
Which meant there really were invisible boys playing in their yard whenever Stevie went outside.
No, thought Step. No. The reason this is not true is because Dr. Weeks is wrong from the start. His imaginary friends are not the same thing as his spiritual sensitivity. The other thing she said-adjustment disorder with depressed mood and withdrawal-that was enough to account for all his symptoms, or at least all of them that Step and DeAnne thought were symptoms. Dr. Weeks simply hated religion, and so she was going to read psychological disorders into the cosmology of Mormonism.
Of course, if she hated religion, why was she driving Lee Weeks to church every week?
"Is there any other possible diagnosis?" asked Step.
She spoke briefly about residual-type schizophrenic disorder, but it was clear she didn't think much of the possibility. "But I can see that you would prefer almost any diagnosis to the one that casts doubt on your cherished belief system."
"I prefer whatever is best for Stevie," said Step. "I'm perfectly able to see how our religious beliefs appear to those who don't believe in them."
"Do you intend to let Stevie continue receiving treatment?"
"I don't make such decisions alone," said Step. "I'll have to confer with my wife."
"Bring her in," said Dr. Weeks. "I think it really is time for you to join in the treatment process. I think that if the constant insistence that Stevie demonstrate loyalty to your belief system were toned down- note that I do not say they should be stopped-he might be able to relax back into more normal strategies for dealing with these parental and societal expectations. We may be able to extinguish the hallucinations in a year or two, provided that the entire family cooperates."
"Thank you for your willingness to tell me all of this, Dr. Weeks," said Step. "I can see that you've been doing your best to understand our son's situation."
"Then there is hope that I can continue working with this very sweet boy?"
"I don't know what will happen," said Step. "As I told you from the first, money is a serious concern for us right now. But if we discontinue Stevie's treatments, it won't be because we think you've been doing less than your best with him as a doctor."
Dr. Weeks nodded graciously. She was too professional to allow herself a smile-but Step was reasonably sure that he had left her feeling good about him and about Stevie, and good enough about the Church that she would not stop bringing Lee. Why she was bringing Lee to church, given the attitudes she had toward religion, was difficult for Step to understand. But she was doing it, and he didn't want it to be his fault if she stopped.
At the receptionist's desk he even confirmed next week's appointment with Stevie. Then he walked out of the office, switched off the tape recorder, and headed home. DeAnne would listen to the tape with him tonight, and he seriously doubted that Stevie would ever go back to Dr. Weeks again.
DeAnne had a frustrating morning with the baby. He simply couldn't be roused enough to eat anything at all. A nurse helped her pump her breasts, something that she had never done with the other three kids, and stored the milk in the freezer to feed to little Jeremy later, but it did nothing to calm DeAnne's anxiety.
When she expressed her worries about the baby's excessive sleepiness to the neonate, he simply nodded patiently and then said, "Of course you know that you can hardly expect a baby who's taking seizure-control medication to be as responsive as your other children were. And until we know what is causing the seizure activity, we would be irresponsible to remove the medication. Seizures can lead to serious brain damage or even death."
"Can't too much phenobarbital cause problems, too?"
"It could if he were getting too much," said Dr. Torwaldson. "But he's not." And that was that.
But DeAnne couldn't get her worries out of her mind, and so when Dr. Greenwald, the pediatrician, came by, she explained it all over again. "He's losing weight, isn't he? More than the normal amount. Isn't that one of the things we're worried about? And if the pheno is making him so sleepy he won't eat ..."
"Well, I'll tell you what," said Dr. Greenwald. "Let's just happen on down to the ICU and let me take a look at the dosage. It never hurts to doublecheck."
So DeAnne and Vette followed him to the ICU, where he stopped and looked at several of the babies before finally getting to Jeremy. "Hey Zap," he said. He reached his hand into the builtin gloves in the side of the incubator and began probing a bit, touching the baby here and there, lifting his arms and legs, lifting an eyelid.
"Some of these babies here just break my heart," said Vette. "So tiny or so-wounded."
"Ah," said Dr. Greenwald. "But they don't break my heart, because on this particular day all my babies in here are doing quite well. I think we're going to keep them all. Especially Zap here. He looks downright husky."
DeAnne noticed with resignation that everyone was picking up the name Zap, despite her resolute use of Jeremy. But as long as he was telling her that her baby was doing well, DeAnne really didn't care all that much what Dr. Greenwald called him.
"He's pretty nonresponsive, isn't he?" said Dr. Greenwald.
"Like a rag doll," said DeAnne.
Dr. Greenwald looked at the chart. "Hmm," he said. "Quite a dose of pheno, too."
"Is it too much, do you think?"
"No," said Dr. Greenwald. "It's a normal dose."
"Oh," said DeAnne. "I just thought-it can't be right that he's so sleepy that he doesn't eat."
"No, it isn't right. In fact, I'd say he's got way to much pheno in his system right now."
"So it isn't a normal dose?"
"Phenobarbital's a funny kind of drug. Everybody's body uses it differently. I'd say that it looks like your little boy's system just isn't flushing that drug out of his body as fast as most people do, and so it's getting built up inside him. Normal dose going in, but then it's building up, you see."
"Can you do anything?"
"Well, it isn't very hard. We just cut way back on the dosage until we find it maintaining at the right level in his blood. It means a few more blood tests."
"Do they have to keep taking the blood out of his head like that?"
"Oh, don't you like his haircut? Kind of punkish, I'd say. You see, this is a newborn baby. It isn't like his veins are particularly big or easy to find. Heck, we've
got needles bigger around than his finger."
"That's all right, I know it can't be helped, it just looks so awful. Dr. Greenwald, would you mind telling me what his current dosage is?"
"Would the numbers mean anything to you?" asked Dr. Greenwald.
"No," said DeAnne. "But if the number's not lower tomorrow, that will mean something to me."
He grinned. "You're pretty stubborn, aren't you?"
She didn't smile back. "This is my baby," she said.
"Dr. Greenwald," said Vette. She was over at one of the other incubators. "Is it right for this one to have liquid dripping from this needle?"
Greenwald immediately went to the incubator where Vette was standing. "Not one of my babies, but I'll say that it doesn't look right. Hasn't been going on long, though, the sheet's not even marked yet. Dana!" he called.
One of the nurses immediately came toward him.
"Have a look at this while I call Dr. Yont."
The nurse named Dana came and immediately shook her head. "Have you been a bad girl again, Marisha?
Pulling out your needles. We're going to have to staple this next one on." She looked up at Vette. "Thank you for noticing this. We check every baby every five minutes, besides constantly checking the monitors, but every moment counts. This one is so small we have a very hard time finding a vein, don't we Marisha? And when she makes some sudden movement, out it comes."
"She's so tiny," said Vette.
"Yes," said Dana. "We're probably going to lose her. She's not getting any better, and sometimes she's a bit worse."
"Her poor parents," said DeAnne, thinking of the anguish she'd feel if someone had just said that about Jeremy.
"I don't know," said Dana. "If Marisha lives, she'll be severely brain damaged. Not much of a life.
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