Ari and Zac

Chapter 11: The Transcript (Segment 4)

HOST: I see. How young are we talking about?

VG: We tend to diagnose selective mutism in children as young as three, and it often resolves or at least improves with treatment during the elementary school years.

HOST: So a case of a 17-year-old who was mute since the age of three and showed no improvement with treatment?

VG: That would be a remarkably intractable case of the disorder.

HOST: Have you ever seen a case that severe in your own clinical practice?

VG: Occasionally, in cases with unusual underlying factors—a history of trauma or abuse, for example. But most cases of selective mutism crop up in otherwise healthy children who come from a loving and supportive home life.

HOST: And most cases tend to improve with treatment?

VG: There may still be residual difficulty speaking to strangers or vocalizing in front of a large group of peers, and that can interfere with classroom participation at school, but we would expect to see gradual gains over time. The child may feel comfortable speaking in a whisper to members of their immediate family first, followed by one-on-one interactions with trusted adults or peers. There is usually a stepwise progression from there, with many cases resolving fully over time.

HOST: And if you didn't see any such improvement?

VG: That would be a very unusual case.

HOST: A case that defies the bounds of medical or scientific explanation, would you say?

VG: I don't know if I'd go that far. In that case, I would look for something deeper going on beyond anxiety. But again, let me reiterate, I never met Ariel Callahan, and I'm not in a position to form an opinion on her specific case.

HOST: Of course, and I wouldn't ask you to speculate. Switching gears for just a moment, Dr. Guzman, are you familiar with the Hans Christian Andersen fairytale, The Little Mermaid?

VG: Very familiar indeed. I have three children of my own, and that was one of their favorite stories growing up.

HOST: I'm going to play a short clip for you and the viewers at home. For those of you who may be unfamiliar, this scene is from an early movie adaptation of The Little Mermaid, where the mermaid character turns into a human girl, but she isn't capable of speaking out loud. Let's watch, shall we?

[Video clip plays]

HOST: Dr. Guzman, you've seen that clip before?

VG: Not that precise version, but I've seen the Disney version.

HOST: So tell us, hypothetically speaking, if the mermaid character from the movie walked into your clinic with those symptoms, how would diagnose her? Selective mutism?

VG: Hypothetically speaking?

HOST: Right.

VG: That's an interesting question. Remind me, is the Little Mermaid character ever able to speak out loud under any circumstances?

HOST: No, not while she's a human with two legs.

VG: So that would generally rule out a diagnosis of selective mutism. In that case, I would run a battery of physical and neurological tests to try to isolate the underlying cause of her condition. From the scene you showed, it looks like her expressive language is intact. She's able to form the shape of words with her mouth, but she can't vocalize them. The most likely culprit in that case would be some sort of chronic laryngitis—

HOST: But assuming you looked at her larynx, and everything else, and all the tests came back perfectly healthy.

VG: That would be a very unusual case.

HOST: How would you diagnose the patient at that point?

VG: I honestly don't know. I would probe more deeply into the patient's history and try to form a hypothesis.

HOST: And what if you found no logical hypothesis? What if the patient insisted to you that she had no voice because she was a mermaid, trapped under the spell of an evil sea witch?

VG: [laughing] And she truly believed that?

HOST: Yes.

VG: Well, then I suppose I would have to look at that as a paranoid delusion—a sign of a more severe psychiatric syndrome. We'd start looking at various forms of psychosis at that point. Schizophrenia, bipolar disorder...

HOST: But under no circumstances would you consider the possibility that she might simply be right? That her story might not be a paranoid delusion after all?

VG: Are you asking if I would diagnose her as a mermaid?

HOST: Would you?

VG: No, of course not.

HOST: Even if every other sign indicated that she might in fact be telling you the truth?

VG: Listen, I'm a scientist. A rationalist. I don't believe in fairy tales. Mermaids don't exist.