Isabelle moves her eyes from the edge of the rug to the dark panels of the hardwood floor beneath it, which themselves end at the wall just beyond the rug’s edge or else disappear beneath the thick wooden door of the office into which this new doctor has led her mother. She can imagine her mother sitting there, her purse at her feet and her back straight, the doctor far off across the desk between them. She imagines the knuckles of her mother’s hands white as she balls them into fists or else grabs at the arms of her chair; she imagines the sound of her mother’s grinding teeth. She imagines the psychiatrist’s diplomas on the walls, the photographs of his children on his desk, the ink blotter, the paperweight, the wall of books on childhood trauma and emotional disorders, the same titles she sees in every doctor’s office. To think of it all makes her tired.

She is right in what she imagines; the desk between the doctor and Ruth is wide, there are the wall of books, the diplomas, and the paperweight. Ruth is sitting up straight in her chair, her purse at her feet, anxious as she waits for this new doctor finally to speak, to say something beyond the formalities. Ruth watches his eyes move quickly back and forth across each page as he thumbs through an open folder on his desk. Finally he clears his throat. “An interesting case, your daughter,” he says. “I’ve read through her file,” he says. “I’ve read through it quite carefully, and it’s an interesting case.”

“Interesting?” Ruth repeats. “Meaning?”

“Well,” the doctor says, setting the folder back on the desk, “it’s been nine months of silence, is that correct?”

“Yes,” Ruth says.

“The symptoms and clinical observations aren’t at all consistent with a diagnosis of autism. There is nothing clinically wrong.”

“Correct.”

“And she’s seen, what, five, six other psychiatrists?”

“Four.”

“And none of them have been of any help to Isabelle.”

“She’s very stubborn,” Ruth says. “She has a will of steel.”

“Ah,” the doctor says. “First and foremost it is paramount not to blame the patient in situations like these. It is not because she is stubborn that none have had success with her; it is not because she does not want to speak.”

Ruth looks at this man, this Dr. Steingold. “Then what? Why? If she wanted to speak, then why wouldn’t she speak? I don’t think she wants to speak.”

“I’ve seen cases like this before,” Dr. Steingold says, pushing back from his desk. “Not necessarily cases of silence, but withholding of other sorts—some children will not, say, make a bowel movement; others will not eat.”

He looks at Ruth. She nods. “Yes,” she says, urging him on.

“Habits that seem derived of stubbornness yet that are really beyond the patient’s control.”

“And so what do you do?”