A Colony for Maladjusted Children
- Author:
WELLISCH, M.D., D.P.M.
Medical Director, Crayford Child Guidance Clinic, Woodside Road, Bexley Heath, Kent. Introduction
The authorities in charge of Mental Health Services are becoming increasingly aware of the very great importance of the establishment of more and better Residential Homes for maladjusted children. These Homes are not only necessary for the segregation of children from their home surroundings and the diagnosis of difficulties by close and constant observation, but they offer, above all, unique opportunities for an intense treatment such as cannot be provided by other means. If adequately equipped and directed they can be the most powerful means of combating psychological illness in children and therefore deserve the greatest possible consideration.
In spite of many defects, the existing type of Homes render very valuable services, and it is only to be desired that there should be more of them available. Useful as they are, it must, however, be pointed out that the Homes as they exist at present are only a first step towards the type which will be necessary in order to solve the immense problems which lie ahead in the future.
Most of the existing Residential Homes are situated mainly in one large building?previously a large dwelling house such as a mansion, rectory, etc. This principle has great economic advantages. It means, however, that the children lead there a life of an ” institutional ” character, which often has an unfavourable influence on certain children who miss the atmosphere of real home life. The close and continued living together with many other disturbed children is also not good. Furthermore, the stay of children in these Homes can usually only be a short-time provision which is often not sufficient to achieve a cure. The residential staff consists in most cases of a superintendent with his assistant helpers. These workers are generally lay persons. Their salaries are on the whole very low. They care and cater for the children’s well-being but are only rarely qualified to give actual psychotherapy. The visiting psychiatrists and psychotherapists are too few and cannot devote the time needed if greater numbers of children are to be deeply influenced.
Because of these reasons it is suggested that Residential Homes for maladjusted children should in future be established according to the following principles?they should be colonies, laid out as a village and should use the system of family care and certain economic measures which will be described later.
The Organization of the Colony
The problems of mental suffering of children and the prevention of mental illness in later adult life are assuming such dimensions that bold plans for treatment are needed. The idea of creating colonies for the long-term treatment of psychological disorders is not a new one. It was, for instance, considered by the Neuroses Sub-committee of the Royal Medico-Psychological Association. Its Honorary Secretary, Dr Aubrey Lewis, published a memorandum (1) on this subject in The Lancet of July 29th, 1944. Another article (2) in the same number of The Lancet referred to the memorandum. The colonies as suggested by the Lewis report were in the first place meant for adult neurotics but should also have provisions for the patient’s family. The patient’s children should, if maladjusted, receive psychiatric treatment. A move towards the direction of colonies are also the so-called ” Cottage Homes ” for maladjusted children which exist in some places. There the children are housed in cottages and a central kitchen provides for all. The management of these Homes follows the usual lines of other Residential Homes.
The Lay-out of a Health Village
The Colony should have the lay-out of a little village. ” Health Villages ” are already in existence for the treatment of various diseases, for instance of epilepsy at Chalfont in Buckinghamshire or Lingfield in Surrey and in the treatment of tuberculosis at Papworth in Cambridgeshire. The idea of accommodating patients in a ” Hospital Village ” has been advocated by the Medical Faculty of Leeds general Infirmary (3). This Health Village should consist of a hospital and possess its own Workshops, school, cinema, farm, etc. The Colony for Maladjusted Children should e such a Health Village. The difficulties in establishing one at present are great. The idea, however, is not a medical Utopia. The time come, and let us hope soon, when its realization will become possible. In the meanllrie smaller plans than the ideal one which will n?w be described could also fulfil the main Purpose.
The grounds of the Colony should be rela1Vely large in order to enable the patients to ftiove within a wide area without coming into c?ntact with the outside world. A village c?uld be specially designed for the colony, but Perhaps better still an existing small village c?uld be adjusted for the purpose.
.The village should have a village green where h,e main administrative and cultural buildings ot the colony would be situated such as a school, a meeting hall and a guest house for visitorS.
Around the village green should lie the fesidential district. The village should have ^ccupational centres and workshops, playing role in the economic life of the Colony. The ol?ny should also have a farm and playgrounds. Possible, an area of the Colony should be uncultivated country.
, A separate area should be covered by a small ospital. It should possess an admission and In nervation ward, a treatment centre for the odily treatment of psychiatric illnesses, an institute f?r physical therapy, sick wards and a laboratory.
The System of Family Care
The Colony should be based on family units s the natural social cells of a healthy community life. It should use the system of family care.
Family care of psychological disturbances ready plays a considerable role in mental Raiment. It is widely used in schemes for yarding out maladjusted children in suitable J10mes- An interesting pamphlet on family Care of the Mentally 111 ” (4) was Published by the New York State Committee n Mental Hygiene. The most important optical example of family care is the colony Gheel in Belgium (5, 6). In this town mental j^hents live and dwell with families which take re of them.
A feature of the Colony for Maladjusted Children should be the presence of a considerable number of foster parents in the Health Village. Each foster family should take on only a small number of children, usually not more than four. The foster parents may have children of their own, and the number of maladjusted children whom they should take on would be in accordance with the number of their own children.
To be a foster parent should be a permanent job. A suggestion how this could be accomplished will be made in the next paragraph.
Economic Problems
The economic problems of such a Colony would be great but not insuperable. The already mentioned Lewis Report contained the suggestion that a colony of (adult) neurotics should be a self-supporting ” Occupational Colony It should offer training and remunerative work. The report suggested that in accordance with Section 15 of the Disabled Persons Employment Act, 1944 (7), the Minister may contribute towards expenses incurred by companies or local authorities which provide facilities for patients. This Act would in the case of a Colony for maladjusted children only apply to, perhaps, some of the older adolescent patients. The idea of an occupational selfsupporting community, however, can also be used for a children’s Colony if the following suggestions are considered.
Small industries should be created within the colony which should mainly be worked by the foster parents. This might not only help considerably to secure the economic existence of the Colony but would also solve the problem as to how the foster parents could find a satisfactory living. Healthy adult persons who are interested in the aim of the Colony but do not wish to be foster parents should also be allowed to work and live in the village. Some of the children’s parents who will be found to be in need of long-term psychological treatment should also live and work in the Colony.
As far as possible the Colony should produce its own foodstuffs, and again, the farm workers should be recruited from the foster parents or other healthy adults living in the village, or from the children’s own parents.
Treatment at the Colony
The Patients According to the purpose of the Colony, special age groups of children, or children of a certain grade of intelligence or suffering from a special kind of disturbance, will be accepted. Larger Colonies, however, could accept most, or all, categories of maladjusted children. They could, if required, be separated within the Colony in different groups of houses.
In addition to the children, some of their parents also should be admitted to the Colony if in need of treatment. In some cases the whole family of the patient should be allocated a house of their own in the village. This would have the unique advantage of observing and influencing them in their natural setting. In other cases it would be advisable to place the parents and their children in separate Homes. The Reception Centre and Plan of Treatment Every new patient should be admitted to the Reception Centre which would be part of the hospital. There, mental and physical examinations will be carried out. Then a plan of treatment will be worked out. The patient will be either placed into a suitable foster home or transferred to a hospital ward for bodily treatment.
I Psychotherapy Analytical Psychotherapy should be available to all patients who need it. It would be given by analysts who should preferably live in the Colony.
” Situational Psychotherapy.” The Colony would in addition to analytical treatment, also use the various situations as they arise during the patient’s everyday life at the village, for the therapeutic aim. In the same way as education has to be more than classroom teaching, art more than exhibitions in galleries, and religion has to extend beyond the ritual of the Church service, so psychotherapy has to go beyond the boundaries of the consulting room. It has to extend to the practice of life and has to use all aspects of life as far as it is possible to do so for the purpose of treatment. In this respect the assistance of the foster parents would be of great help.
Minor Psychotherapy. The therapeutic role of the foster parents in the Colony would be considerable. The fact that a great number of foster parents would be concentrated there would give them an opportunity of special training. They would be carefully selected, and courses and continuous instruction would be given to them by the Colony’s professional staff. In this way the foster parents could become, in time, lay-therapists entrusted with many important tasks of minor psychotherapy. Indeed, a new group of mental nurses could be formed in this way which could be affiliated to the official organization of Mental Nurses, as ” Professional Foster Parents for Maladjusted Children They would, as was mentioned before, also be employed by the Colony in its workshops and farms.
Educational Treatment
The bigger Colonies should possess a school building. The teaching staff should be residential. Remedial teaching should be provided by experts in this branch of the work.
If required, children should be sent to schools in the neighbourhood. The teachers of these schools should be associates of the Colony. It was formerly said that education has to be more than classroom teaching. It should be 1 given inconspicuously throughout the child’s everyday life. Physical training, art, music, drama, and above all religious education should play an essential part in the character educationPhysical Treatment
The physical side of the problems of maladjusted children should receive full attention. Physiotherapy. As was pointed out in another article (8), maladjusted children frequently benefit from a simultaneous bodily treatment. The agents of physiotherapy, the use of mechanical force, warmth and its carrier water, light and electricity, are particularly suitable as a bodily approach. Lack of energy, listlessness, depression, faulty bodily mechanics, vascular instability, various psychosomatic and neurological disorders are examples of the many indications for physiotherapy in maladjusted children. The physical training grounds of the Colony should be used for this purpose. The Hospital of the Colony should be equipped with afl Institute for Physical Therapy with rooms for mechano-, hydro- and light treatment. The Institute could also serve outpatients of the neighbourhood of the Colony.
Psychosomatic Treatment. Special consideration should be given to the treatment of psychosomatic disorders both with psychotherapy and paediatric measures. Asthma, some skin diseases, epilepsies, or colitis may be mentioned as examples of the more common psychosomatic disorders of maladjusted children. The paediatric side of the treatment should be carried out with the help of the hospital.
Physical Treatment of Psychotic Tendencies of children should be given at the hospital.
An Appeal
The realization of a Colony for Maladjusted Children on the suggested principles will depend in the first place on the interest of persons in these ideas, and on their idealism and collaboration.
Workers of many professions will be needed: psychiatrists, psychologists, social workers, nurses, teachers, artists, clergymen, economists, etc.
Will those who are interested in these plans, please communicate with the writer ?
REFERENCES
Colonies for Neurotics. The Lancet, 29.6.1944.
A Place for the Mentally 111. The Lancet, 29.6.1944.
A Hospital Village. The Lancet, 8.12.1945.
(4) Crutcher, Helen B. (1948) An American Experience of Family Care. Mental Health, Vol. viii, No. 1. (5) Henderson, D. K., and Gillespie, R. D. (1944). Textbook of Psychiatry. Sixth Edition. Oxford University Press. (6) Rademaeker, A. (1948). The Colony of Gheel. Mental Health, Vol. viii, No. 1. (7) The Disabled Persons (Employment) Act, 1944, Section 15. (8) Wellisch, E. (1949). Occupational- and PhysioTherapy as Adjuncts to Child Guidance. Mental Health, Vol. ix, No. 2. (9) Crichton-Miller, H. (1937). The Frontiers of Psychotherapy. British Journal of Medical Psychology, Vol. xvi, Parts 3 and 4.
It is our responsibility to see that the current blaze of popular enthusiasm over the problems of mental illness does not blind psychiatrists to the more prosaic problems of mental deficiency, many of which are fundamental to a comprehensive understanding of human behaviour. Leslie R. Angus, M.D.
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Social Treatment
Family Life. It is within the life of the family ^’here the foundations of our character are laid. ^ careful study should be made of the individual needs of each child as regards his family life and the type of foster home which would be best Suited to meet these needs. The influencing the children within the family life of the *?ster parents would be of great importance. Community Life. By taking part in the c?nimunity life of the Colony the social sense behaviour of the child would be developed, ^he natural setting of the village with its school, Meeting house, playgrounds, etc., would give “Opportunities for a social life as it is led in the outside world, and as neither a Residential -4ome for maladjusted children of the usual %le with one main building nor an ordinary bearding school can provide.
Zone of Collaboration.’’’’ Although a certain amount of isolation of the children within Colony would be needed, especially in the lnitial stages of treatment, complete isolation ^’?uld not be desirable. The ultimate therapeutic aim should consist in teaching the patient 0 face and master the outside world. This c?uld be greatly facilitated by gaining the sympathy and collaboration of the population wing around the Colony. Such a ” zone of Elaboration ” would be a therapeutic buffer area between the Colony and the outside world. tare the Colony should own houses and Premises which would serve as outposts and flaying centres.
Group Morale. The most important aspect the social treatment and of the treatment at Colony as a whole should be the development ?* group morale.
Can psychotherapists be objective about their Patients’ morale ? Every psychotherapist, as eyery man, is bound to have a moral attitude towards the problems of psychological suffering and healing, whatever his scientific creed may be and whatever his attitude towards morale and religion is. Therefore H. Crichton-Miller wrote (9) that it is impossible to attain an objectivity upon matters of moral opinion during psychotherapy. As this is so, the question arises on which moral code psychotherapy should be based. I believe that it should be based on the love of our neighbour as it is taught in the Bible.