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Ghost in the tree
Clinical Picture
Ghost in the tree Alain Di Gallo, Thomas Kuehne Lancet 2008; 372: 1570 Department of Child and Adolescent Psychiatry, University Psychiatry Hospital (A Di Gallo MD), and Department of Oncology and Haematology, University Children’s Hospital (T Kuehne MD), Basel, Switzerland Correspondence to: Dr Alain Di Gallo, Kinder-und Jugendpsychiatrische Klinik, Schaffhauserrheinweg 55, 4058 Basel, Switzerland [email protected]
“The inner world flows when children forget all time playing and drawing.”
A 6-year-old boy choked on a piece of chicken at lunch. Fearing the food could get stuck in his throat, he panicked. A laryngoscopy was done, but nothing was found. In the next 5 weeks, the boy refused to eat solid food; his weight fell by 4 kg. Meanwhile, extremely worried, his parents took him to hospital. Bronchoscopy and oesophagoscopy showed nothing abnormal. Finally, the child was referred to a psychiatric unit. At the initial consultation, the boy was self-conscious and silent. Two family therapy sessions were arranged. The parents reported that the many medical examinations had bequeathed a deep uncertainty, and they feared their son
had a malignant disease. In the second session, the boy drew a picture for the therapist (figure). The ghost, he reported, had been living in a tree and had put a spell on it, but would now no longer live there. After this meeting, the boy was able to eat without fear, as avidly as before the episode of choking. Children’s spontaneous drawings portray an inner world which sometimes cannot easily be put into words. Pictures are influenced by conscious and unconscious motivations, and always have to be interpreted cautiously, in their specific context. In this case, the ghost and its spell may have represented the boy’s and the family’s anxiety. The drawing helped the therapist to support the parents’ conclusion that further treatment was unnecessary. 6 months later, the boy was still free of symptoms.
Figure: The ghost in the tree
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www.thelancet.com Vol 372 November 1, 2008
Ghost in the tree Alain Di Gallo, Thomas Kuehne Lancet 2008; 372: 1570 Department of Child and Adolescent Psychiatry, University Psychiatry Hospital (A Di Gallo MD), and Department of Oncology and Haematology, University Children’s Hospital (T Kuehne MD), Basel, Switzerland Correspondence to: Dr Alain Di Gallo, Kinder-und Jugendpsychiatrische Klinik, Schaffhauserrheinweg 55, 4058 Basel, Switzerland [email protected]
“The inner world flows when children forget all time playing and drawing.”
A 6-year-old boy choked on a piece of chicken at lunch. Fearing the food could get stuck in his throat, he panicked. A laryngoscopy was done, but nothing was found. In the next 5 weeks, the boy refused to eat solid food; his weight fell by 4 kg. Meanwhile, extremely worried, his parents took him to hospital. Bronchoscopy and oesophagoscopy showed nothing abnormal. Finally, the child was referred to a psychiatric unit. At the initial consultation, the boy was self-conscious and silent. Two family therapy sessions were arranged. The parents reported that the many medical examinations had bequeathed a deep uncertainty, and they feared their son
had a malignant disease. In the second session, the boy drew a picture for the therapist (figure). The ghost, he reported, had been living in a tree and had put a spell on it, but would now no longer live there. After this meeting, the boy was able to eat without fear, as avidly as before the episode of choking. Children’s spontaneous drawings portray an inner world which sometimes cannot easily be put into words. Pictures are influenced by conscious and unconscious motivations, and always have to be interpreted cautiously, in their specific context. In this case, the ghost and its spell may have represented the boy’s and the family’s anxiety. The drawing helped the therapist to support the parents’ conclusion that further treatment was unnecessary. 6 months later, the boy was still free of symptoms.
Figure: The ghost in the tree
1570
www.thelancet.com Vol 372 November 1, 2008