June 10, 2009


Sometimes not knowing a diagnosis is more frightening than the diagnosis itself. Sometimes it’s frightening to suspect a serious diagnosis. It’s part of the job to share bad news if there is bad news. But what about a suspicion? Should everybody be worried or just me?

Stephen’s fifth birthday was just a month away when he was brought to me by his concerned mother. A PhD candidate at Berkeley, she had noticed some recent changes in his behavior. He was fighting more with his older sister, and was calling her bad names. Nothing in their situation had changed, she insisted. She said that the older sister did indeed tease and provoke him sometimes. They had a pretty normal sibling relationship.

But she was worried about some of the things he said in order to explain his actions. His mother had asked him why he said those mean things to his sister. She asked me to ask him in the office to see what the answer might be. I asked why he kept getting into trouble. He looked sad and said, “It’s not my fault.” I asked whose fault it was. “He made me do it,” he said. When I asked who was making him, he refused to say. I was wondering about bullies or somebody not treating this child right. I asked about the hurtful things he said. “I didn’t want to say them!” he insisted, “he tells me what to say!” This was confusing to me, and I asked the obvious question.

“The mouse tells me,” he said, looking down.

“What mouse is that?” I asked.

“The mouse that lives in my head.”

At that, the mother got up for a tissue for her tears. This made the child start to cry. Luckily, there were tissues enough for your unbiased reporter as well.

I asked him to tell me about the mouse. He said that he wasn’t sure when the mouse arrived, but there’s a mouse that lives in his brain. It tells him things to say and do, almost always to his sister. He always says the mean things, and the mouse doesn’t listen to him when he tries to explain to the mouse that he wants to say nice things.

I had a lot of questions. No, the mouse didn’t eat anything. The mouse didn’t have any friends or other animals living in his brain with him. The mouse never asked him to hurt himself or anyone else. When I asked, he said that the mouse was kind of brown. It didn’t interfere with his sleep or doing any particular activity. But he could hear it speak, and reluctantly admitted that he sometimes did what it told him to do.

Was this mental illness? I asked Stephen’s mother about all sorts of things that didn’t seem connected. Did he show a typical range of emotions for his age? Did he do anything strange, that she hadn’t seen before? Did what he say make sense? How distracted was he? Stephen, it turns out, was playful and had lots of friends. He liked playing soccer and was not moody at all. His behavior was usually completely appropriate, and he was a bright and articulate kid to talk with. Not depressed, not anxious.

Further questioning about the range of the mouse’s abilities showed it to be limited to naughty thoughts and actions having to do with his older sister. He seemed pretty well-adjusted for his age. It’s important to look for signs of dysfunction. From my point of view, I wanted to know if the mouse was interfering with his life or the tasks kids his age usually do—it wasn’t. Was the mouse there at his invitation? If it had been scary to him, if it had forced its way into his awareness and was there against his will, holding him hostage in some way, that would be concerning to me. And my global impression is important. He was a happy kid, who acted like a happy kid. He acted like a pesky younger sibling to his sister, and they sometimes fought. But even the parameters of their feuds were not out of the ordinary.

This time, I could be reassuring to Stephen’s mother, who listened to my questions with occasional alarm. This was magical thinking, which was completely normal for his age. Magical thinking is what kids do when they experience something happening, and they try to find a logical cause for it. There are so many mysteries in the lives of preschoolers, that they have many magical explanations. Maybe daddy came home late today because Stephen didn’t want to eat his vegetables. Maybe Santa brought a certain toy because he did eat his vegetables. Maybe it wasn’t his fault for calling his sister a lizard-head. In a world populated by anthropomorphic talking animals, it is perfectly rational that he could have a rodent of his own. Its home in his head gives it ready access to making him move his mouth in just the right way. About 6 months later, the mouse was gone.

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