A neuropsychiatric theory is supported by evidence that certain brain lesions in laboratory animals have been associated with abnormal eating behaviors, and it is postulated that pica might be associated with certain patterns of brain disorder in humans.
Psychosocial theories surrounding pica have described an association with family stress.
Addiction or addictive behavior has also been suggested as one possible explanation for pica behavior in some patients.
Treatment: Education about nutrition. Psychological counseling. Behavioral interventions for children with developmental disabilities. Closer supervision of children during play. Child-proof homes and play environments.
Eric didn’t seem to have developmental difficulties, or an obsessive-compulsive disorder, the sandbox was regularly raked, there was no lead paint in the house, none, as far as she knew, in the dirt. He was the youngest member of a loving family, and chewed a children’s multivitamin every single day. What stress could he have?
That night, Joan showed Martin the pica entry and said, “I think our youngest son might be suffering from this.”
They had a heart-to-heart with Eric in the living room. Martin on the couch, Eric on the ottoman, Joan in the comfortable armchair some distance away. Triangles were the only thing she remembered from junior high geometry, and if a line were drawn from Martin to Eric, Eric to Joan, Joan to Martin, they were the three points of an obtuse triangle, and she, way out there, was the longest side, the point at the end of ninety degrees.
“Eric, do you feel compelled—is something making you eat dirt, sand, pebbles, leaves, twigs, sticks, stones, grass, and anything else that people don’t usually eat? Something inside that’s telling you to eat those things? Voices, or just a hunger you can’t explain to yourself?” Martin asked.
“No,” Eric said.
“No what?” Martin asked.
“I don’t hear voices and I eat real food when I’m hungry.” It wasn’t an explanation, but it was something.
“Will you stop eating dirt, sand, pebbles, leaves, twigs, sticks, stones, grass, and anything else you know doesn’t belong in your mouth?” Joan was impressed Martin could reel everything off twice in the same order, although surely he did the same thing, with medical terms, in the operating room.
“Yes,” Eric said. “It’s just for fun anyway.”
“Will you promise not to have that kind of fun anymore?” Martin asked.
“Yes. No more fun,” he said. “Can I go?”
Martin nodded and Eric ran from the room, his bare feet stomping on the hardwood floor. He had Martin’s loud walk.
“Pica crisis averted,” Martin said. “Next.”
And it was true, the crisis disappeared or never truly existed; still, it seemed strange to Joan that Eric would have eaten any of those things in the first place, and she wondered what went on his head.
10
A fair came to Rhome the first weekend of August, setting up in a huge field where the hay had been sickle-mowed, leaving behind a flat, golden carpet. The field was ten miles past the Mannings’ neighborhood, now called Peachtree by almost everyone. It was hot and sunny, the cloudless sky a rich blue. All of Rhome seemed to have turned out, as well as a good part of the populations of the towns on either side of it, for the fair was bustling when Joan and Martin and the boys arrived. White and beige tents dotted the landscape and booths had been set up and were doing a brisk business selling local produce, home-made jams and preserves, cheeses made from cows and goats and sheep from the nearby farms, wine bottled from Rappahannock County and Shenandoah Valley grapes. For the kids, there were Italian ices and sno-cones to lick, cotton candy to pull apart, and rides—a Ferris wheel, a merry-go-round, a small roller coaster, a riding ring where old horses were taking the youngest for slow rides, round and round. The aroma of barbecue was in the air.
Joan assessed the crowd, lighting upon the most interesting: young men turning white T-shirts into art, pinching the material tight and rubber-banding each section until they looked like porcupines being dipped into huge steaming vats of colored dyes; the young woman with a bird’s nest of purple hair sitting at a potter’s wheel, slamming down hunks of clay, her hands moving nearly as fast as the wheel, cups, vases, plates, bowls, trays, appearing like magic; the elderly man in a worn blue linen suit, a jaunty straw boater on his head, a smeared palette tight in his hand, painting a mammoth canvas of people on a beach staring out at an ocean where a sailboat bobbed in the distance, though he himself was standing in a mowed field; the handsome young man at an old-fashioned school desk, a manual typewriter in front of him, a stack of paper to the side. He had long pony-tailed hair and round wire glasses perched on the bridge of his nose, and his sign read: $5 GET YOUR OWN PERSONAL SHORT STORY. Joan absorbed these people and something clicked inside of her.
Daniel brought her back, tugging at her hand, saying, “I want to go exploring. I’ll take Eric with me, but I’ve got so much to see and you and Daddy are walking too slow.” He was a serious, responsible boy.
“He’ll pull you every which way,” Joan warned Daniel, wanting him to take Eric, thinking a good mother would let her older son run free, not obligate him to watch over his younger brother.
Martin touched her shoulder. “Let them go,” he said, and she wondered why he would think she wouldn’t.
Martin handed Daniel ten single dollar bills. “For whatever you guys want,” he said. “Meet us at five at the entrance, okay? There’s a lot of people here and it would be tough to have to search for you.”
Daniel held up his wrist, showed his father his watch, the birthday present he had chosen for himself last year. He was obsessed with time lately: how much time had elapsed between one event and another, how much time had gone by since the beginning of the world, since he had written his last Henry story, since he had given Joan a story to read, since he began reading the latest big book he was reading, how little time was left before he was late to a friend’s house, before he started fifth grade, before his tenth birthday in late December, before he was all grown up.