5 months ago



Zachary 51 silent. He

Zachary 51 silent. He was never interested in reading picture books with his mother but became fascinated with the phone book and loved to watch the credits at the end of TV shows. His favorite show was the Business Report because letters and numbers from the stock market were constantly being flashed across the screen. Zachary was first seen by his family doctor because he was considered a difficult child and a bit of a loner in day care. However, as his language and motor skills were quite good, the family doctor did not feel there was a significant developmental problem requiring intervention. He was not assessed again until kindergarten, when his teacher noted that he was having difficulty paying attention in class; he seemed absorbed in letters and numbers and spoke little to her or to the other children. As a six-year-old, he had a few friends but would play alongside them rather than together with them. If his friends were not interested in Thomas the Tank Engine or watching the Business Report, Zachary would play by himself. Adults found him entertaining as he could talk to them on a surprisingly sophisticated level. He was especially fond of asking adults what kind of car they drove. He would proudly bring out this information at family gatherings and amaze everybody there with his memory. Zachary liked to be the center of attention as long as people focused on his interests. He always had a very close relationship with his mother; he was quite affectionate with her and would spontaneously give her a hug and come for comfort if hurt. He would sit beside her while watching TV and nestle up to her. But Angela could not get him to look her directly in the eye during a conversation, and they could not play cars together in a truly reciprocal way. Zachary tended to tell her what to do and would resist her attempts to modify the play. Unlike many children with ASD, specific phobias or resistance to change had not been a prominent feature of Zachary’s early development. But there were slight hints of things to come. For example, he would become very upset (possibly anxious?) at the sound of the vacuum cleaner, the blender, or anything else that made a loud noise. But that was it. There was no evidence of difficulty in changing from summer clothes to winter clothes, no problem in changing brand names of food, no difficulty in having his bedroom furniture moved around. Very little had changed in the last three years. Zachary’s language skills continued to improve slowly; he learned more sophisticated rules of grammar, and his vocabulary expanded appropriately. But he retained the same interests and the same fearfulness about loud noises. He mem-

52 A MIND APART orized the dates of all the fire drills at school and became very anxious as the time for a new drill approached. His agitation and restlessness would escalate, and he had more difficulty complying with his mother’s requests. This was the only anxiety I could see that was present in his early history and that continued to be a problem. But there seemed little analogy between this fear and death. The origin of his current anxieties about death were still a mystery to me, but he did seem to have a propensity for anxiety, a temperament to react in an anxious way to stress. I had to seek further for answers. Perhaps thinking more deeply about the content of his anxieties would help me understand. * * * In going over the interview in my mind, I wondered if Zachary was really anxious about death. Was it really possible that he was upset about the death of his two great aunts? After all, he had hardly known them. That he would be upset about his grandmother’s illness was more understandable since he was quite close to her. Yet he had depersonalized her in a sense by calling her “Alice.” After rereading my notes from the interview, though, I realized that his obsession with death was quite different from what I had expected. I had taken his anxiety literally, much as one would do with a typical child worried about death and separation. His concern was not really an existential anxiety about the nothingness that follows dying; neither was it a romantic preoccupation with the glorious death of a childhood hero. He did not seem overly concerned with his own death or with his mother’s death. There was no grief, no sense of mourning, no anticipation of the sadness that follows a death. Neither was there an awareness of the implications of death. There was no confrontation with the impossibility of knowing what happens after, no terrible wager with God. Zachary had never heard of Pascal. Listening carefully to his repetitive questions about family members and other people connected with his interests, it became clear that these were not necessarily people he was close to, but more like objects, small toys off an assembly line. The obsession was not so much with death itself—the absence, the grief, the process of mourning—but with change and replacement. Every person had a replacement; the anxiety involved not knowing who that replacement would be. This was a death reduced to its simplest, most concrete meaning as it related to him personally. What looked sophisticated on the surface