When he was six, his favorite older brother eloped with a girl of a different faith. David missed his brother. He sensed the family turmoil and his father's anger. He overheard his father say that this was "the worst thing that could ever happen." At age seven, David related a joke he had heard at school about a little boy who took a bath with his mother. The same tale that had evoked uproarious laughter from classmates was greeted by stony silence at home.
His mother said it was not a nice joke and not to tell any more like that.
Shortly before this incident, David had begun playing with
his penis again, this time carefully concealed under the bed-
covers at night. After the joke fiasco he stopped pleasuring
and wondered if dirty thoughts had made him bad, like his
favorite brother who had never returned home. Overwhelmed
by feelings of guilt and worthlessness, David spent
long hours alone and exhibited some puzzling behavior.
He neglected his chores and was reprimanded; he forgot to take
a pencil to school until his teacher sent home a note.
Although he had been an excellent student, the letters and
syllables seemed hopelessly mixed and he began to fail in
reading. Every type of remediation was ineffective. David's
parents were frustrated, angry, and concerned.
Finally, David was brought for psychiatric treatment.
During the first months of therapy, he played listlessly and
remained aloof. He filled a pail with sand and dumped it
again and again. He worried that his hands were soiled, and
often visited the bathroom. In the third month, he smiled
spontaneously and began to use a variety of playthings-
puppets, paints, Play-Doh, and dart guns. Now he enjoyed
our sessions "a lot." One day we talked about how babies
were born. David was silent and picked at his ear. Suddenly
he asked if babies would die from "dirty things." Even with
my reassurance he refused to elaborate-instead he struck
the long-nosed alligator puppet again and again against the
sink.
In the next session David was sullen and distrustful.
Once more he poured the sand from one vessel to the next.
Silently I modeled a large red Play-Doh penis on a baby doll.
He stared at it intently for several moments. Abruptly, he
flew at the doll and smashed the penis with his fist. "I know
what that is!" he screamed. In the weeks that followed, more
organs were constructed and demolished. I asked if he ever
wanted to do that to himself. There followed a torrent of
words interspersed with tears.
His penis was "dirty, rotten,
evil, and it stinks." This was because he had played with
himself even though he knew it was bad. He said, "If you did
that God would hate you and kick you out of your house."
David's parents were astonished.They had never punished
David or told him that sex was evil. Fortunately, they understood,
and reassured David that he was not bad and would not
be sent away. His father gave him permission to masturbate
by relating his own early pleasures and concerns. David again
read fluently and remembered to take pencils to class.
Because David had little positive information or experience,
he grossly misinterpreted events. Ashamed and miserable,
he attempted to deny all erotic feelings, engaging only
in clean respectable activities. This was all too much for
David, and so he became symptomatic. If David had had
reassurance, encouragement, and permission to engage in
sex play, therapy would have been unnecessary.