Child Psychiatry
- Author:
Leo Kanner, M.D., Associate
Professor of Psychiatry, Associate Professor of Paediatrics, and Director, Children’s Psychiatry Service, The John Hopkins University, Baltimore, Md. Oxford. Second Edition. Blackwell Scientific Publications. 752 pp. 45s.
Students of child guidance, of whatever professional discipline, are usually told that there is at present no satisfactory comprehensive text-book on Child Psychiatry. At first sight this enlarged second edition by a leading member of the PsychoBiological School will rouse great expectations, for it is excellently produced, well indexed and wide in its scope. But while the reader in search of other people’s contributions will find much to excite his gratitude, he will only experience frustration in the search for the real reasons why children suffer from psychological difficulties.
Psycho-biologists make a powerful plea for the consideration of the whole child, not just the symptom or the environment. However, in this book the co-operative approach is not helped by the unfriendly, sometimes even offensive references to others, notably school teachers ; while psychiatric social workers suffer an almost total eclipse. Even more disruptive to continuity of thought is a classification based on epiphenomena, mainly on symptoms.
The author disposes of psycho-analysis* by the effective device of bald statement of some of the more controversial contributions of that School, given in inadequate context and without explanation. A notable victim of the ensuing massacre is the concept that the child includes a living, growing constellation of forces, the nature of which need further study. One result of this may be illustrated by an extract (p. 460) from a discussion on ‘ Problems of Eating Behaviour ” :
‘’ The suggestion that the mother ‘ ignore ‘ the child’s refusals, represents good logical reasoning but forgets the frequent underlying emotional inability to ignore. It also tends to forget the child’s determination to carry the struggle through to continued victory… .”
The soundness of the first sentence contrasts with the almost startling irresponsibility of the second. What is this determination to gain victory : for what ; over what ? Is it in effect, determination to starve to gain victory over that powerful instinctive force on which the continuation of life depends ? Or is it just a go-slow strike to spite Mama ? If so why should a child spite his Mama and what happens to them both when he does ? These are deep matters and worthy of consideration ; in fact further progress in understanding maladjusted children is dependent on more study of them.
. The consequence of this avoidance of deeper issues ls the limitation of the book to an examination (in great detail) of the more superficial environmental mfluences, to an erudite examination of heredity and to the critical evaluation of other work ; ah valuable but not satisfying by themselves. In the circumstances, treatment becomes largely a Matter of prevention and of manipulation of the environment ; both advocated by rather didactic methods. ” Intensive psycho-therapy ” is Mentioned at intervals, but beyond references to ‘ working out aggressionno explanation is offered of the method or what the term means. Indeed, from the’ underlying psycho-pathology employed it is quite impossible to guess. A distaste for psycho-analytical modes of thought, however rationalized in massive proof of the ubiquity of the connection between body, mind and environment, does not fill the need for a spirit of curiosity into psychological origins ; which, unfortunately, this volume sadly lacks. K.S.
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