ABSTRACT
The paediatric consultant asked the author to see Paul when he was three years old because the boy’s constipation had not responded to various drug treatments. When he first saw Paul, the paediatrician prescribed a programme of laxatives and diet, besides giving Mrs P detailed instructions as to how to help her son achieve a regular rhythm of emptying his bowels. At one level of dosage, the drugs were producing “a powerful evacuation”, with such mess that the mother felt this was unfair on Paul. Paul had achieved his developmental milestones quite normally and by the age of eighteen months was dry and clean. Some time after that, Paul began to show a reluctance to empty his bowels and Mrs P turned to health visitors and doctors in search of effective advice. Mrs P was focusing on the overt behaviour and emphasising the mechanical aspect of Paul’s play.
