I saw an eight year old girl a couple of weeks ago whose therapist smiled and said, "She’s afraid the sky is going to fall." I said, "You’ve got to be kidding! Is her mom named Henny Penny?" We had our laugh about this case of Chicken Little. But when I saw the little girl, this was no laughing matter. She had a big time fear about the sky falling, and an escalating apprehension about weather in general. She would anxiously go to the window peering at the sky, often asking if it was going to rain. At school, she was particularly afraid in the cafeteria [lots of windows?] and was becoming phobic about going outside for any reason.
She was a cute kid with lots of personality. I saw her with her mother, and the little girl followed our conversation with interest, commenting helpfully except when asked anything like "why?" She said she didn’t know. Her mother thought the fear started a couple of weeks before around the time school started, but the child assured us that it was there before. I started fishing around for things that might have happened, but it took a while for her mom to get with the program. She finally came up with two episodes over the late summer. The first was a camping trip over the 4th of July, a usual activity they all looked forward to. A strong summer storm came "out of nowhere" as is common around here. Limbs began to fall and they sought shelter in the concrete block shower/bathroom facility. She remembered that the little girl had "gone hysterical" and they had to pack up and go home. As we talked about it, Chicken Little chimed in about the limbs falling and almost hitting her Dad. I thought I was getting somewhere. So did her mom.
There was another time that she had "freaked out." They’d gone to a parade downtown. At some point, a color guard had fired a 12 gun salute, and the child had become upset and demanded to go home. As an aside. This is rural Georgia. During deer season, the place sounds like Viet Nam. The point being that this kid had heard guns all her life and wasn’t afraid. Her reaction at the parade was unusual.
In the movies, about this time, the patient becomes aware of some dark repressed event that pulls the story together. But this was real life. The person who recalled the missing event wasn’t the patient, it was me [followed shortly by her mother]. Back in April [a rainy night in Georgia…, survivor guilt…], a series of tornadoes swept across the south from Mississippi, through Alabama destroying a big piece of Tuscaloosa Alabama, then into Georgia. The one that had torn through Tuscaloosa came directly at us, destroying 20+ homes on the west side of our county then going right over us [without touching down], and continued northeast doing more damage. It was an event of major proportions that we all watched on television [before retiring to the hall closet as it howled over us]. When I started asking her mother about their experience of it, it was similar to ours. We all watched the footage from Alabama on television before it got to us. There was a school building in Tuscaloosa that was torn apart, and cell phone videos of the twister from various angles – live footage of roofs flying off.
As the mom and I talked, the girl became animated and basically took over the discussion. She remembered every detail on the television and told us all about it. At one point, she talked about the tornado "falling out of the sky" [I recall that shot too]. She talked about the school and how they said that everyone went "to the cafeteria." By this time, it was downhill. I asked, "So you’re afraid of tornados?" She said "yes," as if it were a dumb question. She confirmed that the fourth of July episode was similar, she was sure "it was a tornado." The color guard? It sounded like thunder and she thought the "boy scouts were going to shoot the sky down." The cafeteria? obvious from the television set – that’s where kids are when tornadoes come. A good time was had by all from that point on in the interview. I felt kind of stupid for not "getting it" immediately.
I love this!!
Yeah well in addition to being plain fun, your vignette illustrates the importance of taking a careful history of events and circumstances surrounding the formation of the symptom. In the old days, we did this as a matter of routine clinical interviewing. Modern psychiatry (and I use the term “modern” loosely) sees little need or use for this approach. Heck, if Chicken Little had been seen in a clinic at a major academic psychiatry department, she would have been immediately medicated with a SSRI or some other agent.
Good work!
Thank you for this. If all of us would have someone like you to talk to the world would be such a wonderful place to grow up in, Mickey.
I completely agree with Tom…most other people would have offered meds, probably anti-anxiety meds. To an 8 year old.
Strong work; Many of my colleagues will wonder how you accomplished this without Abilify