The Tooth Fairy and the Anti-Truth Fairy
Key Takeaways
- Childhood rituals exemplify Winnicott’s interplay of playing and reality, paralleling Coleridge’s “willing suspension of disbelief” that enables meaning-making beyond quotidian logic.
- Husserl’s epoché and Jaspers’ phenomenology inform psychiatric stance: bracket assumptions to apprehend lived experience, akin to managing transference–countertransference in psychodynamic work.
Preparing children for vicissitudes and losses and for the mystery, magic, and poetry of life.
SECOND THOUGHTS
Two events happened recently in the life of our little girl.
Anita is 6 years old and in Grade One. Her permanent teeth are coming in, so we have regular visits from the tooth fairy, who is now more generous than when I was a child. The going rate was 25 cents in my childhood while Anita now rakes in 2 to 5 dollars per tooth! Anita recently woke up very early to come to show us the reward that the tooth fairy had left her. We share a nostalgic pleasure in this rite of passage. This childhood ritual enfolds 2 opposing elements. On one hand, her new permanent teeth arriving are a normal and welcome sign of her growth. On the other hand, celebrating it with the gifts of the tooth fairy are part of the magic of childhood. We could call these opposing forces reality and fantasy. Or, in the words of Donald Winnicott, MD, the great English child psychoanalyst, “playing and reality.”1
For those of us who have already traversed these rites of passage and become parents, the capacity to revisit our own childhood with nostalgic amusement and perhaps even joy in these childhood and family rituals requires the “willing suspension of disbelief” to see the magic and the poetry of life. Another Englishman, Samuel Taylor Coleridge, coined this memorable phrase in his Biographia Literaria, published in 1817,2 to describe the processes that are possible when we suspend judgement and put aside the implacable logic of everyday life. Neither poetry nor fiction and by extension none of the arts would be possible without this capacity. Coleridge’s notion already had roots in Roman poetry and rhetoric and no doubt has parallels in many classical civilizations. Now, Coleridge’s explanation of the conditions for poetic reason also has its critics, notably in Plato who mistrusted poetry as a kind of pretense representing nonreality. We acquire this capacity in childhood and if we are lucky, with creative nourishment and a dash of irony, we can preserve and grow this perspective throughout our lives.
There are other ways to construe this and even within English letters, there were other attempts to understand our response to imaginative works, such as J.R.R. Tolkien’s notion of “secondary belief.”This is close to Italian semiologist and novelist Umberto Eco’s arguments about the nature of fiction in his Six Walks in the Fictional Woods.3 Literary critic and novelist George Steiner talked about “counterfactuals”—our human capacity to imagine things that are not in order to get beyond the things that are.4
The reader will ask, what has this to do with psychiatry? Wait. One more turn of the wheel. In philosophy, Edmund Husserl introduced phenomenology which was an attempt to see things as they are rather than as we construe them. In order to do that, Husserl called for the “phenomenological reduction” in the jargon of philosophy and named this apparatus or conceptual tool the epoché. We can define it as the “bracketing” or “putting in parentheses” or “suspending judgement” of our perceptions of the world. A medical student in Heidelberg who spent most of his time in the library reading philosophy made Husserl’s phenomenology relevant for psychiatry and changed our field. By introducing phenomenology into psychiatry, Karl Jaspers, MD, became one of the founders of modern Western psychiatry.5-7
Sigmund Freud, MD, who was no fan of philosophy and had the same teacher of philosophy—Franz Brentano—as Husserl, introduced the notion of transference and countertransference.8 And we know that Otto Kernberg, MD, has founded his psychoanalytical psychotherapy based on this capacity to understand others empathically by suspending our personal prejudices in the shape of countertransference.9
That is a lot of squeeze out of a visit from the tooth fairy, the reader will say. It is. And yet, it is at the heart of the whole enterprise of what we do in psychiatry, accounting for human experience. What is at stake is nothing less than representation—how we map out the territory of life, the world, and our place in it. Now, must our maps always be true to the territory? Does representation have to reflect reality?
The Death of a Child
And what was the other event, the reader is wondering?
Now, we get to crunch time. During our March winter break—and it is significant to note that it is still winter in March in Quebec—we heard of the death a 6-year-old boy in a sledding accident.10 Separately, both my wife and I noted the incident mentally, privately, and tried to put aside our reactions—how fragile life is, what grief the family must be feeling—and we suspended the rest. And yet on Friday night at the end of March break, before school was to restart on the following Monday morning, we learned that the boy who died was a student in Anita’s school. We were distraught and worried about the impact on our daughter. During the weekend, we found out that the boy who died was in Anita’s Grade One class and that his sister is in Grade Two at the same school.
We consulted Anita’s class photo. There was his image, right beside our daughter. The school assured us that they would have a team in place to break the news to the children and be available for consultation. The lessons of trauma have been integrated everywhere it seems.
We spent the weekend worrying about the deceased child’s family and the impact of his death on the children of the school, his class, and naturally, our own daughter. I called my wife from the children’s psychiatric hospital where I work as she was entering the house with Anita after school on Monday afternoon. Anita was upbeat and happy.
My wife Leticia confirmed that Anita had been told about her classmate’s death and appeared well. We talked about it that evening and revealed our secret fears when we had heard the news item of the child’s death—a parent’s worst anxiety for their children. Partly relieved, still concerned, we decided to let our daughter express herself spontaneously with as little interference from us as possible. As a graduate of the
On the evening of the second day of school after the March break and this terrible accident, I asked Anita how she felt about it. She was untroubled. Another girl in her class told her that the boy was happy in heaven, where there were rollercoasters and unicorns. Her mother and I exchanged looks and left it at that.
Leticia is a psychologist who worked with young children in Brazil. We heard Anita’s words through the prism of our understanding of children’s reasoning about life and death. Perhaps for different reasons, neither of us would have told our daughter such things about life after death. We were both raised in the Catholic Church and know that this is not the Christian vision of the meaning of death or the hopeful promise of life in the hereafter. However, I remain troubled by this visit from the anti-truth fairy to our daughter.
Like the visits from the tooth fairy, this visit wrapped up 2 very different messages in 1. On one hand, it was a way of acknowledging death. On the other hand, that acknowledgement was simultaneously undermined by offering an untruth. What exists—if anything—after death is a matter of faith and personal conviction. Yet, psychologically and philosophically, talking about heaven as a children’s theme park with rollercoasters and unicorns is a lie. Like euphemisms about death like “passed away,” now often simply reduced to “passed” or the “passing” of someone, as if it is a kind of journey, this neither prepares a child for the vicissitudes and losses of life nor for the mystery, the magic, and the poetry we may experience therein.
When I was an undergraduate in psychology at McGill, I heard Austrian-American psychologist Bruno Bettelheim talk at the McGill Sex Symposium in 1974. When queried as to when to talk to children about sex, he replied, quoting the Song of Songs from the Bible:
I charge you, O daughters of Jerusalem, That ye stir not up, nor awake my love, until he please.
– Song of Songs, 8:4, King James Version
His wise reply has stayed with me more than 50 years later. His message then and later in The Uses of Enchantment13 was simple: respect a child’s pace and rhythm for dealing with life’s adversity, complexity, and mysteries. European folk tales, the source material for our fairy tales, combine social history and fantasy in dealing with social preoccupations such as high levels of maternal mortality which meant that many children had stepmother substitutes, as in the story of Cinderella. Folk tales and fairy tales confront children with the full panoply of playing with reality: ogres, monsters, dangerous animals, betrayal, violence, and loss—all with a pinch of fantasy and love. My own childhood in Italy was filled with folk tales retold by my maternal grandmother and great-grandmother. When I read them as an adult in Italo Calvino’s collection, Italian Folk Tales,14 including a dozen from my native Abruzzo in central Italy, I was struck by their fidelity, practically word for word, to the oral tradition. Those folktales prepared me as much as anything for life’s vicissitudes and its mysteries. Later, they were bolstered by the tragic farces of Nobelist in Literature Luigi Pirandello, Eugène Ionesco’s Theatre of the Absurd, and another Nobelist, Dario Fo, whose tragicomic plays satirized Italian politics and reminded us to laugh at ourselves rather than succumbing to nihilism and despair.
Now, I understand that at 6 years old, my daughter and her classmates are not ready to deal with the finality of death and what Avital Ronell, my brilliant philosophy professor and friend at New York University, calls Finitude’s Score.15 I am curious about and want to respect how Anita will deal with this knowledge as it unfolds. What she does not need—and I reject as a parent, a child specialist, and social philosopher—are any more visits from the anti-truth fairy.
Concluding Thoughts
In passing, I wish the reader to note that I do not use the words “development “or “tragedy” and only invoke the word “trauma” gingerly. That is right, I am a child psychiatrist who does not talk about
Resources
For guidance in dealing with children facing grief, I recommend this online resource:
“Helping Children Cope With Grief.” Child Mind Institute.
This advice is especially valuable in orienting our work with kids in these situations from their online guide:
Do not use euphemisms. Avoid phrases like “passed away,” “gone,” “we lost him.” Kids tend to be very literal, and this kind of fuzzy language leaves them anxious, scared and often confused. Or conversely, it may lead them to believe the deceased will come back and that death is not permanent.
Dr Di Nicola is a child psychiatrist, family psychotherapist, and philosopher in Montreal, Quebec, Canada, where he is professor of psychiatry & addictology at the University of Montreal. He is also clinical professor of psychiatry & behavioral health at The George Washington University and past president of the World Association of Social Psychiatry (WASP). Dr Di Nicola has received numerous national and international awards, honorary professorships, and fellowships. Of note, Dr Di Nicola was elected a Fellow of the Canadian Academy of Health Sciences (FCAHS), given the Distinguished Service Award of the American Psychiatric Association (APA), and is a Fellow of the American College of Psychiatrists (FACPsych) and Fellow of the Royal Society of Canada (FRSC). His work straddles psychiatry and psychotherapy on one side and philosophy and poetry on the other. Dr Di Nicola’s publications include: A Stranger in the Family: Culture, Families and Therapy (WW Norton, 1997), Letters to a Young Therapist (Atropos Press, 2011), and Psychiatry in Crisis: At the Crossroads of Social Sciences, the Humanities, and Neuroscience (with D. Stoyanov; Springer Nature, 2021). Dr. Di Nicola is Trustee-at-Large elect of the American Psychiatric Association.
References
1. Winnicott DW. Playing and Reality. Tavistock Publications; 1971.
2. Coleridge ST. Biographia Literaria. Leask N, ed. Dent; 1997. (Original 1817).
3. Eco U. Six Walks in the Fictional Woods. Harvard University Press; 1994.
4. Steiner G. Our homeland, the text. Salmagundi. 2015:188-189.
5. Jaspers K.
6. Jaspers K. General Psychopathology. Hoenig J, Hamilton MW, trans. Manchester University Press; 1963.
7. Di Nicola V, Stoyanov DS. Psychiatry in Crisis: At the Crossroads of Social Science, the Humanities, and Neuroscience. Springer Nature; 2021.
8. Gyemant M. Contrasting two ways of making psychology: Brentano and Freud. Axiomathes. 2017;27:491-501.
9. Kernberg OF. Severe Personality Disorders: Psychotherapeutic Strategies. Yale University Press; 1984.
10. Boy, 6, dies after sledding accident in off-island Montreal suburb. CBC News. March 2, 2026. Accessed March 19, 2026.
11. Mollica RF. Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World. Harcourt, International; 2006.
12. Di Nicola V. Borders and belonging, culture and community: from adversity to diversity in transcultural child and family psychiatry. J Am Acad Child Adolesc Psychiatry. 2018;57(10):S116.
13. Bettelheim B. The Uses of Enchantment: The Meaning and Importance of Fairy Tales. Alfred A. Knopf; 1976.
14. Calvino I. Italian Folktales: Selected and Retold by Italo Calvino. Martin G, trans. Harvest/Harcourt; 1980.
15. Ronell A. Finitude's Score: Essays for the End of the Millennium. University of Nebraska Press; 1994.
16. Miller A. Tragedy and the common man. New York Times. February 27, 1949. Accessed March 19, 2026.
17. Felitti VJ, Anda RF. The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: implications for health care. In: Lanius RA, Vermette E, Pain C, eds. The Impact of Early Trauma on Health and Disease: The Hidden Epidemic. Cambridge University Press; 2010:77-87.
