Hysteria, belief, and magic.

(a) A courageous OP refers a boy aged eight who has †̃¿ gone off his legs' that morning. The OP says he knows it is hysterical but that he cannot stop it. The boy is brought by car. A kind psychiatrist negotiates through the window the need for the boy to mount the steps to come and talk. The boy comes. He talks about how his estranged father had promised first a trip to the cup final and then to the replay and had twicelet him down. The anger, love,disappointment, and the humiliation in front of his friends took his legs from under him, turned him weak at the knees, turned his legs to jelly. He walked out of the consultation and remained well. (b) A 14-year-old boy has a fixed flexion deformity of the right hand. Sudek's atrophy is beginning. The psychiatrist is the 11th sort of specialist to be consulted. A sudden painful inexplicable bruise on the back of the hand has been casually dealt with by a locum OP; after a sleepless night the mother and child waited in casualty for hours, finally to be told that spontaneous bruises were not treated there. The casualty department of an orthopaedic hospital, however, provided a plaster, an appointment to review in two days' time, then admitted him because of pain in plaster, an admission which had lasted for eightweeksbefore the psychiatristwascalled.Several persuasive chats and devices were needed before the hand was able to recover fully. (c) A very mature 13-year-old girl has twice been admitted for abdominal pain. Following the removal of a normal appendix, anaesthesia develops round the wound and gradually spreads. When encouraged to be upstanding she shows marked astasia abasia. The psychiatrist is called synchronously with a surgeon who, “¿ not g ing to be caught out―,orders a myelogram and a scintillation scan. The family meeting is angrily supportive of the child's right to be ill. The mother works in the medical field, the father is affable but largely absent on business and is said to havea chronicillness,a brother isdescribedas having had an accident in which “¿ he left most of his blood in the road but was otherwise alright―,and another brother's school and university careers were ruined by †̃¿ lymphoma', which turned out to be spastic colon. Over the ensuing years, despite treatment, the girl works her way through a variety of illnesses including one from which she emerges with the sort of scar she might otherwise have derived from wrist slashing. (d) A girl of nine vomited her lunch when her sister and boyfriend started to punch one another. The fighting stopped and she was “¿ rushed to hospital―.Later, a recurrence of vomiting led to another admission and then one lasting sixweeks, needing intravenous fluids. The psychiatrist met her gently mewing into the steel bowl provided. Her trick of deliberate vomiting con tinued inexorably. Her mother had died of an overdose of drugs and alcohol, her father was a recidivist gaol bird. Both her brothers wereingaol for seriousoffences. No negotiation with her about her facility to vomit proved possible over 18months in psychiatric care nor during a subsequent stay at another hospital. There she suffered a rupture of the oesophagus from the stomach and, following a heroic repair, she requested orange juice by mouth. When refused this she made to vomit, reopened her wound, and bled to death.