Trying to keep his voice calm, Step interrupted. "What I'm interested in today, Dr. Weeks, is not a final statement, but an explanation of what you know so far, or what you suspect so far. DeAnne and I have to decide now, not two months from now, whether to continue treatment."

"I'd be happy to work out a payment schedule with you," said Dr. Weeks. "But I can hardly discuss an ongoing process, especially when you are not the patient."

"The patient is eight years old," said Step. "And if I were a fellow psychiatrist, you would have no trouble at all talking with me about what you think the diagnosis might turn out to be."

"But you are not a psychiatrist, Step."

"I have a Ph.D., Dr. Weeks. It's in history, which isn't an exact science like psychiatry, I know, but it does mean that I'm an educated human being, and I think that if you try to explain to me what's wrong with Stevie, I'll understand you." Thinking of what was going on at the hospital with Zap, he added, "For instance, you must have some idea of what his condition isn't. Things you've eliminated."

"It would be much more helpful to the whole process, Step, if you and your wife came in for some sessions with me yourselves. In fact, I suspect that your insistence on hurrying the diagnostic procedure may suggest possible sources for Stevie's abnormal reaction to stress."

I should have expected this, thought Step. The very fact that I want to hold her accountable is proof of my disorder. Well, he was not going to let Weeks establish a doctor-patient relationship with him. "Fine," he said.

"If you explain to us what you think the problem might be and why our coming in for sessions might be helpful, then we might well agree that our joining in the therapeutic process might be the indicated course of action."

"Step," she said, "you seem to feel some hostility toward psychotherapists, along with an apparent fascination that has caused you to learn some aspects of psychological jargon. I wouldn't be surprised if you have unconsciously communicated this hostility to Stevie."

"Dr. Weeks, my efforts to find out what's going on between you and Stevie did not cause his problems."

"I wasn't implying anything of the kind," said Dr. Weeks. "Why do you think you felt a need to defend yourself just now?"

"Dr. Weeks, I think you misunderstand our relationship. I'm here as Stevie's parent. If I had brought him to a pediatrician with a bad cough, I'd have a right to expect the pediatrician to tell me what he thought might be causing the cough and what he intended to do about it, and he wouldn't give me any crap about how I couldn't possibly understand the ramifications of pulmonary function and, by the way, have I been short of breath myself lately? Stevie's been with you for two months, and apparently all you've observed about him is that he's morose and has imaginary friends, which is strikingly similar to what we already knew when we brought him here. I hope you'll understand that I'm not trying to interfere with Stevie's treatment. I simply have a responsibility to know what that treatment consists of and what it's designed to accomplish."

"Let me tell you why I'm reluctant to discuss this with you, Mr. Fletcher. Given the importance of parents in a child's life, it is inevitable that Stevie's parents are involved in the source of his problems. This idea is obviously threatening to you, and I fear that you may withdraw Stevie from treatment in order to protect your own ego. This might cause the boy great harm."

Step recognized that she was attempting to manipulate him into backing off- any objection he raised to her diagnosis could be dismissed as ego protection. But he held his temper and said none of the vicious retorts that came to mind. "Dr. Weeks," he said, "DeAnne and I knew from the start that solving Stevie's problems would almost certainly mean us changing our lives somehow. We're willing to do whatever it takes to help our son, and I'm not afraid to find out flaws in my own parenting. But I can promise you that if you don't tell me what you've learned about his condition, then we certainly will withdraw Stevie from your care."

She regarded him for a while, her expression aloof and uninvolved. She must have spent hours in front of mirrors during graduate school, Step thought, practicing that detached, I'mabove- emotional-engagement-with-mere-humans-and-their-pettyproblems look.

"All right, Mr. Fletcher," she said, "I will tell you what possibilities I am currently considering as diagnoses for your son's condition. First, we may be seeing a simple factitious disorder. Second, we may-

"Factitious disorder?" asked Step.

"Factitious means the opposite of what it sounds like, Mr. Fletcher-"

"I'm aware of the meaning of factitious," said Step. "It's the meaning of the phrase factitious disorder that I'd like you to explain."

"In layman's terms, it means that Stevie might be lying about these imaginary friends because he knows it upsets you and he's hungry for the attention that ensues."

Step stifled his desire to say Stevie doesn't lie, he has never lied, he tells the truth even when it causes him to be embarrassed, even when he's sure that he'll be punished for it. If Stevie says that he's playing with imaginary friends, then that's because he really thinks he's playing with these friends, and it's not some damned cockamamy factitious disorder. Instead, he merely said, "And your second hypothesis?"

"It is possible that this is a mere adjustment disorder with depressed mood and withdrawal."

"And what would that mean?" asked Step.

"That he was seriously disturbed by your move to North Carolina. That he felt dislocated from his friends, from a familiar and safe setting, and instead found himself plunged against his will into a terrifying environment where he is incapable of making sense of what is going on and feels himself unable to protect himself from others. In that case, these imaginary friends would be a hallucinatory effort on the part of his unconscious to re-create the safe environment of the past, while his depression would be a sign that in fact the hallucinations are not successful in masking his unhappiness. He does not quite believe the falsely happy reality that his unconscious mind has created for him."

Step kept himself from saying, That's precisely what DeAnne and I thought before we ever brought him to you. "What do we do about it?" he asked.

"That was a hypothesis," she answered, "not a diagnosis, and therefore we will do nothing about it."

"But if it turned out to be the true diagnosis, what would be the right course of action?"

"We are getting into dangerous territory, here," said Dr. Weeks. "Highly speculative."

"I understand that, and I'm not proposing that you do anything improper. I just want to have some idea of what the treatment might consist of if this turns out to be the diagnosis."

"Well," she said, "we might begin by having you contact the parents of some of his former friends back in Indiana, to get them to write to him or telephone. However, that may not be effective because at his age children are not very adept at making meaningful emotional contact through indirect media like the telephone or letters."

"And?" asked Step.

He meant for her to propose other possible treatments that might be used if Stevie's condition really was adjustment disorder with depressed mood and withdrawal. But she took it as a request for the third hypothesis.

"The third possible diagnosis, and the one that I think is most likely, is also the one that will be most difficult for you to hear impartially, and therefore I ask you to keep an open mind as best you can."

Step nodded, even though it was clear that she didn't think him capable of it.

"I think we can best account for Stevie's behavior if we view it, not as a new condition brought on by the move to North Carolina, but rather as an exacerbation of a preexisting condition of some severity, one which remained unobserved because it had gone on so long that you thought it a part of Stevie's underlying character."