Psychiatric Examination of the School Child
- Author:
Muriel Barton Hall, M.D. Edward Arnold & Co.
London. 15s. net.
When a book with such a title includes a detailed technique of psychiatric examination, a systematic description of the clinical field and a section on the writing of psychiatric reports, in spite of the Author’s disavowal, it can scarcely be regarded as other than a textbook of diagnostic psychiatry. The stated intention of the book is to portray general principles of assistance to medical practitioners, especially school medical officers, in clinical examination and it is hoped that educationists and others may be interested.
The approach is physically determined and readers interested in dynamic psychology will find that, far from elucidating general principles, the psychological level of the book is superficial and unenquiring.
The classification employed is based almost exclusively on symptoms, but readers may feel that the time has passed when child psychiatry can afford to be content with merejy symptomatic divisions. Within this classification, temperamental states are included with nervous habits (so-called) such as thumb sucking, enuresis, tics, and sleeping and feeding disorders; whereas inadequacy, anxiety and attention-getting behaviour are grouped under a separate heading together with behaviour disorders (so-called), such as lying and stealing. A separate chapter is given to juvenile delinquency and yet another to ” the psycho-neuroses Repeated references to the difficulty of distinguishing between the divisions are scarcely surprising in the circumstances and no attempt is made to relate classification to pathology.
The weakness in classification is most apparent in the chapter on Psychopathic States because, coming towards the end, most of the thunder has been stolen by the earlier chapters and there is little left to contribute to the student’s understanding of psychopathy. Here, as elsewhere, the experienced reader may feel that he is being led through a territory where much is observed, little understood and nothing explained.
The book is marred by a lack of scientific curiosity; for example, it is remarked that except for certain constitutional handicaps, symptoms tend to be less severe in young children than in older ones. This surely depends on the criteria of severity and many will consider this observation to be quite remarkably untrue. Whereas stag hunting begets more public protests than fox hunting, the rat is chased and slaughtered with universal approval and it may be that the size of the animal has something to do with it. Or again, nail biting is described in terms of metabolic anomalies, habit formation and frustration, with the symptom as a means of relieving nervous tension. The nai’ve speculation follows that the intelligent child may find time to analyse his thoughts and feelings while biting his nails. A similar unenquiring attitude is found in two tall stories illustrating the importance of paying attention to early history. A self-willed (sic) boy defied his mother deliberately before a tramcar full of people when he was nine months old; and a dishonest maiden at the age of twenty-two months took a penny from her mother ” by stealth and on submission to a third degree examination passed it surreptitiously from hand to hand to avoid detection. These stories are given as fact and not as illustrations of the need to distinguish between history and parental interpretation. Again, laziness is dealt with as a phenomenon in its own right, rather than as a symptom arising out of the interaction of strong dynamic forces.
The many references to discipline, self control, wilfulness and so on are more moralistic than scientific. Modern readers of psychological literature demand a critical attitude to these phenomena, an analysis of their component forces in their conscious and unconscious significance to the individual and to the community. Without this critical attitude, psychiatry has little to offer except systematization to the understanding of behaviour problems, not already contained in religious and ethical systems.
The examining doctor is advised to withhold blame, blunt remarks and harsh comment ” no matter how justified they may appear when talking to the parents; and to resist the temptation to demean the parents or to reveal their ignorance. Undoubtedly this advice is fundamental to the psychiatric attitude, but if necessary, it is a sad commentary on the present state of medical education and manners. However, such temptations are less inimical to psychiatry than the state of mind in which ?these ideas are consciously formulated, and both are far less dangerous than the unconscious judgement which betrays its presence in the use of such terms as ” spoiling “, ” self-discipline ” and ” uncontrollable Let us seek an enquiring attitude in psychiatric practice and leave moral evaluations to our off-duty hours and to the clergy and lawyers. K.S.
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