Wednesday, August 27, 2014

ASPERGER'S;THE MISSED DIAGNOSIS PART TWO



                                             PART II: Edward Arrives

          I was well settled into the routines of the ward when seven-year-old Edward arrived on the ward one sunny morning with his mother, a tall, anxious blond woman with sharp facial features. She had brought clothes for her son in two brown grocery bags.  When she introduced him to me I noticed that Edward avoided eye contact.   Head bowed, he stared at the floor just in front of his feet.  I assumed he was shy in meeting strangers for the first time, not uncommon among children his age.   I could see he was tall for a seven-year-old and resembled his mother.  She left the ward, explaining that she had to sign some papers in the admissions office, and I showed Edward to his room.  Then I took him on a tour of the ward, which was mostly one large room with a dining area and a lounge area with furniture gathered around a TV screen.
          I noticed that Edward moved slowly and deliberately.  It was as if he had to think about each movement before he began it.  His body movements resembled a character in a slow motion movie and were awkward.   Later, as I entered his room to begin the day, I would find him standing in the middle of the room, nude and not moving.   When I greeted him with “Good Morning, Edward.  How are you this morning?” he would slowly turn his head in my direction but avoid eye contact and say nothing.  Then he began the laboriously slow process of dressing himself, a task that could require 20 minutes and more.   I learned Edward could not tolerate being touched.  If touched accidentally, he would flinch, draw back and would bark “Don’t do that! Do NOT touch me.”  He also objected to anyone, usually another child, entering what he considered to be his space.  
          A few days after he arrived he began identifying his psychologist, nurses, attendants and even children on the ward as automobiles.  His psychologist, a rather conventional looking man, became Dr. Ford Falcon.  One of the nurses, a beefy woman, he named Nurse Mack Truck.  A pretty petite nurse on the ward became Mini Minor.  A handsome, powerfully built psychiatric resident from Columbia became Dr. Chevy Corvette.  His choice of car models for human beings showed remarkable insight into personalities as well as physiques.  The names he gave doctors, nurses, attendants and even some of the children, seemed to fit. 
          But in the first week or so Edward did not give me a name at all.  I was wondering what model of car or truck I would become in Edward’s personal garage.  Then one morning Edward was going through his impossibly slow dressing routine with his back to me, picking up each piece of clothing, inspecting it, and then slowly putting it on.  Suddenly he turned his head but not his body and said in his normal slow, deliberative manner,  

“You are a bear, Mr. Bear.” 

So that is how I became Mr. Bear and how he addressed me and what he called me in the presence of others.  It was progress of sorts.  Rather than identify me as an inanimate object he had conceded that I was a living creature like himself.   
          But not one gifted with speech.  As the days passed, each morning I entered his room, greeted him, and asked how he had slept and how he felt.   And each morning he would turn his head in his peculiar awkward slow motion without making eye contact, and would say,

“Please don’t talk, Mr. Bear.  You know bears can’t talk.”  

          I did not know why my talking bothered Edward but I supposed it was because he was not yet prepared to accept that I was capable of human speech.  Nor did he begin to welcome any physical affection.  He continued to flinch when anyone accidentally touched him and that included me.  But I continued to greet him each morning as I entered his room and continued to talk to him throughout the day.  But I respected his desire not to be touched.
          Edward did not interact with the other children at all.  He was a poor eater and when after a week or so he agreed to sit at the dining table with the other children, he sat as far away from them as he could. One boy tried to befriend him, asking him questions about himself, in the hope he could start a dialogue.  Edward ignored him.   It was the custom to say a brief grace before meals.  Some of the older children would say a prayer to which the others responded with,” amen.”  But Edward did not respond.  Annoyed, one pious little girl who compulsively washed her hands a dozen times each day challenged him.    

“You did not say amen, Edward!  Say amen!” 

Edward did not look at her nor did he say amen.  A fourteen-year- old red headed boy with Tourette's syndrome had punctuated the prayer by repeating, “Shit, shit, shit, shit” which caused the little girl to frown and some of the boys to giggle but Edward did not react at all.  
          Edward was willing to talk to the other children as long as the subject was cars or trucks, but not willing to respond to their questions or carry on a dialogue of any kind. He had an amazing knowledge of automobiles and peopled his world with them.  He drew automobiles and trucks and nothing else incessantly and his drawings were unusually detailed and accurate.
But he always sat apart from the other children and the adult personnel on the ward.  In the evening before bedtime, children’s stories were played on the large TV screen in one corner of the ward.  The children, all in their pajamas, would crawl into the laps of the nurses and attendants for some good night comfort.  But not Edward.  He always sat apart and did not invite or seek any physical affection. 
          One morning at the end of Edward’s first month on the ward I walked into his room and as I began the morning greeting, he turned slowing, looking at the floor in front of me and said, “You are Talking Bear.”  So if Edward could not accept that I was fully human, he had conceded that I had at least one primary quality of human beings.  Speech.  And from that moment I became “Talking Bear.”      
          Edward’s world included unusual fears.  He would sometimes say,
“I do not like this two-piece kitty.”  I had no idea what that meant.  I could think of no story books with two-piece kittens.  And then days later, I heard, 
“I do not like this two piece kitty.  Iowa Kitty is a two piece kitty.” 
          The light dawned.  He meant city, not kitty, and what disturbed him was how the Iowa River divided the city as it flowed through the middle of the university campus.  We sometimes had to cross the bridge over the river on our recreational walks and our twice weekly trips to the university’s natatorium to swim.  At first Edward balked at crossing the bridge above the river.  I finally persuaded him to come with us by picking him up and carrying him on my back, a routine we followed from then on.  Once at the pool he would, again with some persuasion, walk into the shallow end of the pool and stand upright and walk around. He did not go into the deeper water and did not swim.  He insisted that no other children come into the zone he considered was his alone.  If they did so or if a water polo ball landed in “his” zone, he became very upset. 
          The medical staff of the hospital had not settled on a diagnosis for Edward.  At a Grand Rounds attended by all those with an interest in him a psychologist, a short woman with short brown hair and a solid figure, presented an analysis of Edward’s voluminous drawings of cars and trucks.  What I remember from her presentation is the number of penises she found in his drawings but I no longer remember what that finding was intended to illustrate.  A psychiatric resident, an ascetic looking man with rimless glasses, presented his view that Edward’s condition resulted from an imbalance of chemicals.  While there was no final agreement on a diagnosis for Edward, the consensus seemed to be that Edward was suffering from a form of schizophrenia.  No one seemed to have suggestions to help him.  He would continue to be under observation.  I dreaded the thought that Edward could spend years in an institution as had Willie, the boy who had touched my heart the summer before.  
          As the days passed I realized that despite my effort not to do so, I was becoming fond of Edward.  I am not sure why because he did not welcome affection and gave none.  And while it was true I had become his “Talking Bear,” I did not seem to be helping him either. 
          One evening we were all gathered in front of the television for the usual good night cartoon stories, the children in their pajamas.  Edward was sitting apart from everyone else. Suddenly I was surprised to find him climbing into my lap.  He leaned into my body and I gently folded my arms around him.  We sat like that for the rest of the stories.  Later I walked him back to his room.  I turned off his bedside light but we could see each other in the half light from the ward hall.   

“Good night, Edward,” I said.  Happy dreams. Sleep well.”

“Good night, Lewis,” he said, looking up at me and using my proper name for the first time. “Good night, Talking Bear.” 

It’s clear today that Edward was not schizophrenic.  He had Asperger’s Syndrome, a condition first described in l944 by Hans Asperger in Austria. Asperger’s work was probably unknown to many in the American psychiatric community in l959 when Edward was a patient at the hospital in Iowa City.  Asperger’s Syndrome fit Edward’s behavior. This syndrome is similar to autism but children with Asperger’s Syndrome typically function better than do those with other forms of autism.  Their intelligence and language skills are often extraordinary.      





1 comment:

  1. There is no such thing as "asperger's". Psychiatry itself is a bogus science. The following articles and essays explain this:

    12 Part essay that exposes psychiatry as a bogus science
    http://antipsychiatry.org/

    Inventor of ADHD: “ADHD is a fictitious disease”
    www.currentconcerns.ch/index.php?id=1608

    Co-Founder of DSM admits there is no way to scientifically prove that mentall illness is real
    www.cchrint.org/psychiatric-disorders/psychiatrists-on-lack-of-any-medical-or-scientific-tests/

    One year old babies and younger being put on psychiatric drugs
    http://www.infowars.com/babies-on-psychiatric-drugs-crime-with-no-punishment/

    Psychiatric Drugs Shorten Life Span by 15 years on average
    www.stopshrinks.org/reading_room/antipsych/psych_drugs_shorten_life.html

    Psychiatry is based on lies and falsehoods
    http://jonrappoport.wordpress.com/2013/05/07/the-lying-liars-who-lie-about-psychiatry/

    Psychiatry is a fake science
    http://jonrappoport.wordpress.com/2012/09/05/more-evidence-psychiatry-is-a-fake-science/

    http://www.bibliotecapleyades.net/ciencia/ciencia_industrypsychiatry26.htm

    Every human emotion is now a "mental illness"
    http://www.bibliotecapleyades.net/ciencia/ciencia_industrypsychiatry27.htm

    Ten Myths about Psychiatric Drugs
    http://www.metzelf.info/information/myths.html

    Studies show psychiatric drugs have no benefits and are dangerous
    http://childhealthsafety.wordpress.com/2011/08/17/three-new-studies-show-%E2%80%9Cpsychiatric-drugs-provide-no-benefit-and-are-dangerous%E2%80%9D/

    Psychiatry is now giving 3 year old children drugs
    http://www.anh-usa.org/medicaid-psychiatric-drugs/

    Psychiatric drugs make you sicker
    http://blogs.scientificamerican.com/cross-check/2012/03/05/are-psychiatric-medications-making-us-sicker/

    A few free eBooks talking about how psychiatry is a massive hoax
    http://www.psychiatric-help.org/PSYCHIATRIC-HELP/default.asp

    A list of THOUSANDS of psychiatrists who have committed crimes against their patients
    http://www.psychcrime.org/database/

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