We relaxed. It was possible to act naturally with this kind, bright man who seemed to trust us. I began one of our games with Elly. I had brought a bag of candy to occupy her when she got restless. I took a piece out and popped it into her mouth. She did not ignore me. She did not take another for herself. Instead, she reached her own hand into the bag and fed one to me. Not a high degree of interpersonal activity for an hour-long session between three adults and a three-year-old child, but we were satisfied. Dr Blank had seen Elly at her best, such as it was. What he told us we would trust.
We had asked him at the outset: ‘What is the very worst possibility we might have to face?’ We are ready, expecting it: to be told that, like so many parents of retarded children, we have been kidding ourselves, that there is no mystery about our Elly, that her strange abilities are no more than the creations of our desperate imaginations, that she is simply a retarded child, so severely retarded that, almost three years old, she still has no comprehension of human speech.
I had no doubt of what the worst possibility would be. Off and on, over the years, I had come across a few retarded children and heard stories of others. No family is exempt — my own uncle, injured before birth when my grandmother’s carriage- horses went out of control, had never learned to walk or talk. Uncle Will had died at twenty-one, still an incontinent baby, a generation before I was born. My grandmother, a strong- minded woman, had done what was very unusual at the time — after keeping him at home for years, she had put him into an institution. To spare the family, I suppose, but I think also to spare herself. She couldn’t bear it. I had a horror of retardation.
I assumed I could rise to most challenges if my children presented them, but I had wondered about that one. Myself proud of intellect, in my husband, in my children, in myself, I had thought that retardation was the worst thing that could happen to a baby, to a family, and to me.
But apparently this was not the worst possibility. There was another. The worst diagnosis he could give us would be a different word altogether — autism. Dr Blank had seen other children like Elly. At Johns Hopkins, in Baltimore, the psychiatrist Leo Kanner had for twenty years been studying a strange category of children, children who were like and yet not like the psychotic, neurotic, brain-damaged, and retarded children with whom he was familiar. It was hard to say what they were. They had Elly’s blank remoteness, her inability to relate to others. They had her imperviousness to speech; several of them had previously been diagnosed as deaf. They, like her, did not talk or, if they did, reeled off long formulas without communicative significance — television commercials, nursery rhymes, even lists of presidents. They had the same dexterity, the same interest in exact and delicate arrangement. They had the same unusual physical health, the same alert, attractive good looks. They even had the same intellectual parents: my husband and I, while scarcely typical of the population as a whole, were typical of the parents of autistic children.
Many psychiatrists called this condition childhood schizophrenia. But Kanner, who had many schizophrenics among his small patients, felt that this condition presented a rare but distinct syndrome. He named it Early Infantile Autism. And it was autism which Dr Blank considered the worst possibility we had to face. The retarded child’s abilities are limited, but he can progress. The autistic child’s intelligence, on the contrary, may be normal or superior. There is no way of finding out. Locked in himself, secure and satisfied in his repetitive activities, he will not use it, or even display it for testing. His condition, which so mimics retardation, for practical purposes may be indistinguishable from it.
The defect seemed psychological, not physical. Yet Kanner, himself a psychiatrist, had tried the techniques of psychotherapy. He had concluded they were useless. Dr Blank wanted to hospitalize Elly for further tests; two autistic children had recently been found suffering from an obscure metabolic defect. Such a defect, if he could find it, would be something tangible, perhaps treatable — with the techniques of the future if not of today. But if the trouble were all in Elly’s small psyche then the outlook was dark indeed. There was little — Dr Blank felt there was nothing — that professional knowledge could contribute to help her.
We took Elly home. In a month we brought her back again to Boston, for another three days in a hospital. If the trouble were psychological — I tried not to think what those hospital visits could do to Elly. So quiet, so remote — it was best to think that she, who had almost never been away from me, who had only once been away from home without me, would retreat into her self-sufficient contentment and make use of it to protect herself from this upheaval of her settled world. It was even plausible: Elly did not notice people, ergo, she would not mind the hospital. Yet I knew it was not so. During those three days a year ago she had cried, she had refused to feed herself or let the nurses feed her. She was in better contact with us now than she had been then. To abandon her again, with no explanation even possible? It broke my heart to do it. Yet it had to be done, and I was already becoming adept at putting out of my mind things that were likely to break my heart. Since Elly would never tell me how she had suffered it would be almost as if it hadn’t happened. It was in any case outside the area of my control. There was no better care in the world than was to be found in the Children’s Hospital. The doctors would be humane, the nurses experienced. Experienced enough to understand the needs of my wordless baby, to meet them in a way she could accept? Best not to form the question.
David and I went together to take Elly to the hospital. It is a very large building, with many wings and many floors on those wings. Or perhaps it hasn’t got many wings at all, perhaps it merely seems enormous, easy to get lost in, and threatening to someone who has not the expertise of illness. I had never been in a hospital in my life except when I was perfectly well. A hospital had been a service station where I was relieved of my tonsils, and later, my babies. This hospital was different. For one thing, it was full of children, children from all over the city, the state — from all over the country children came to this famous hospital. Not one of them was perfectly well, and my Elly, cheerful in her pretty dress with no idea of what was about to happen to her, was not perfectly well either.
Elly was to be admitted at ten o’clock. There was some waiting in the lobby; she was already restless by the time we entered the elevator. There was some discussion with representatives of the administration. The ward where Elly would normally be put was full; she would have to go into another where there was more room. Occupied with Elly, we paid little attention. We had hoped to cushion our departure by making it quick and inconspicuous. Upstairs, however, it seemed there would be a considerable delay. Nobody in this ward was ready to think about Elly. Quiet and preoccupied, everyone here was obviously engaged in some serious business. We were shown into a four- bed ward, and left alone with Elly and her hospital nightgown and the small white crib we hoped a blanket and a teddy bear would convert into an acceptable home.
There was indeed room in this ward. Only one of the other beds was filled. In it lay a pale still child with sunken eyes, her curling hair a dark cloud rising off the pillow. She looked about nine. A thin tube ran from her nostril to some apparatus by the bed. Beside her sat her mother, her hair also dark and curly and her face nearly as pale. They did not speak, and when we came in they did not turn their heads.