C. L. C. Burns
(Physician to Tavistock Square Clinic) We are increasingly conscious in our day of the large number of persons who are maladjusted in themselves and to society.
We realise that such persons should not be allowed to drift towards the extreme of maladjustment, which is insanity, without great efforts being made to prevent, when possible, this dissolution.
We realise, too, that the situations which tend to bring this about, in so as they are not causes inherent in the organism, are to be sought in the environment of earliest childhood, and we have extended the concept of mental hygiene backwards?from the treatment of the adult ” lunatic ” to the ner- vous baby in the cradle and beyond. Indeed, if we broaden the concept, we come up against the whole structure of human life and society and to a dis- cussion of the end for which mankind exists, not to mention the extremely Maladjusted condition of the society in which we exist. Such a flight into philosophy is, however, not the purpose of these remarks, which will be con- cerned with more individual problems.
In dealing with the maladjusted child or adult it is fairly clear what type ?f organisation is required in the way of associations, clinics and special hos- pitals. We may claim also to have a fairly extensive knowledge as to the factors which help to bring about the maladjustment. These are but the dry bones of the subject, and to make them a living force we need the less tangible yet equally essential qualities which reside in human personality. Of these, little can be said which is clear-cut and not open to the suspicion of mere word- spinning; it can only be hoped that the random remarks that follow may be at least provocative of thought on the subject.
Words, no less than humans, are often maladjusted and misused, espec- ially those about which we can say that ” anyhow, we know what we mean.” Examples of such words are ” character ” and ” personality.” We say that a person has character, or has such-and-such character, that his character can be reformed, and so forth, thereby implying that character is something which is added to, and wrought upon, the person. Behind and beyond character, therefore, lies the kernel of that person’s being?what we may term personality. The formation of character may develop and enrich a personality or, as in the case of the neurotic, may overlay it with certain traits and aberrations which yet do not necessarily imply a fundamental poverty of the person. It is on this distinction between character and personality that we base all attempts at mental or moral salvation. We postulate potentialities which we have to unfold and reveal, and our power to do this depends largely on the degree to which we believe these potentialities to exist in everyone; we must always act as if people were better than they appear to be?those who are not will be the necessary exceptions to a rule!
We are concerned, therefore, with the influence of one personality over another. Now, when people say that A is influenced by the personality of B, it really means that B has had the knack or gift of releasing the personality of A, and not that a kind of magnetic and mysterious something has emanated forth. There has been an interchange of positive feelings?of sympathy, under- standing, belief?between one person and another, and ultimately it is this kind of transference which decides the issue: whether we are dealing with the frightened or rebellious child, the introverted adolescent, or the vociferously extraverted parent.
Adler has said that we must take upon ourselves the role of being mothers to our patients, but we must correct this by a certain attitude which we may call detachment. This means that we must not allow ourselves to be disturbed by fear of failure or expectation of success, that we must beware of allowing our own feelings of superiority or the reverse, of self-esteem or unworthiness, to play any part in the therapeutic process; that though confident we must be equable; strong yet yielding.
We must also know how to wait patiently, because we cannot foretell the moment of success or failure. We may feel, if over-anxious, that we are making no impression, yet, it may be years after, the incubation period of what we have sought to do comes to an end and the results appear. Often we may seem to be doing nothing more than being friendly and interested?yet some- thing gets done.
Mere detachment, of course, is not enough, and to achieve that ” some- thing ” we must be able to some extent to enter into the minds and feelings of the people we are dealing with. It is easier to do this if one is gifted with a fairly vivid imagination and able to look at the world through the eyes of the other; it is also helpful to remember that one is not so very different from the others, and should emulate the publican rather than the pharisee.
The method of external approach is also important and Homer Lane gives the example of a policeman, who is trained not to rush into a disturbed crowd waving his arms, but to slip in quietly, appearing to be one of them, then gradually, understanding the emotion of the crowd, become its brain and so control it. This may be observed, too, in a person who knows how to deal with children : an unobtrusive sympathy tinged with a sense of humour might best describe the attitude which wins their friendship?we all know the bad boy’s grin.
Having postulated of our worker a tactful firmness towards parents and humorous sympathy towards children what else is required of him or her? That he or she should be able to act in turn as buffer, bridge, and lightning conductor. A buffer is needed by the neurotic, for a time, between him and the cold hard world, a bridge over which to lead the delinquent or rebel back to normal social relationship, and a lightning conductor to lead off the emotions and repressions which exist in varying degrees of dynamic intensity in the maladjusted. To be equipped for these tasks requires knowledge no less than personality and we might now discuss a few points with regard to maladjustment, and indicate the field of the work, before concluding this random analysis of the worker.
It is well to consider each situation that we meet with as a complete whole, which may be visualised as a circle containing within itself both the individual and his environment, for these form a unity which is as difficult to grasp in indissoluble terms, as is the unity of the physical and the mental. It is easy to pay lip-service to a ” holistic ” conception but less easy to act upon it- We have within this circle the individual human being, with his physical pattern, his inherited tendencies, and all that we vaguely call temperament: the emotional type which evolves from the physical. This, in the main, is given and unchangeable?the material which is to be moulded.
When we have allowed for the organic short-comings and temperamental peculiarities of our material, it remains to study the mould which gives it, or deprives it, of the character which it is in its nature to receive, that it may emerge as a personality of worth.
There is no doubt that in the unfolding of an individual personality, it is the family which plays the biggest part, and it is necessary that we should have an intimate knowledge of it. Within each family there are many inter- related parts, or variety of intercurrent forces, and the effects of these as they have been in the past, as well as in the present, are imprinted on the indiv- idual. We can get a certain amount of knowledge as to these forces and their effects from a comparative and numerical study of many cases; such, for ex- ample, as the influence of broken homes, place in the family, differences in age and sex, and so on. This we might call an anatomical knowledge, and we then proceed to the physiology of family relationships?the jealousies, affections, and understandings, or the reverse, which are found to be associated with certain reactions of the child. With this kind of knowledge we are, in some measure, equipped to study the individual family where our perspicacity in discovering situations is to be exercised.
An example of a possible state of affairs is that of a family where the mother is compensating to herself for the loss of her husband’s affection or his neglect of her, by using her child (generally a boy) as a shield of self-protection ?giving him, and expecting from him, the affection which she should have from her husband. Or again, where a battle of wills goes on with regard to the children’s upbringing, dictated perhaps more by a desire for dominance than by any real concern for the children’s welfare.
Situations such as these naturally call for great tact on the part of those who would elucidate them, but as often as not, they are already partially per- ceived by the parties concerned, as having something to do with the child’s troubles, and it only needs a little careful probing and suggestion to get it acknowledged.
Such clearances will often of themselves produce dramatic effects on a neurotic child.
Adjustment or change of the external environment is therefore an essen- tial part of our task, but it is not enough, for the individual personality remains the crux of our problem, and our efforts should be to adjust the individual to his environment rather than the reverse: but in saying this we are forgetting our ” whole,” for in a sense the individual contains or holds the environment within himself, and its adjustment must take place also within the field of his own ego. Whatever the central point, be it delinquency, neurosis, or intro- version, towards which we are finally directing our efforts, it is well to start at the periphery, so to speak, of our circle, and work inwards. By this I mean that we proceed from a knowledge of the external environment, the history, attainments, and interests, to the study of the individual and his particular problems; we do not, for example, as a rule embark straightway on a discussion of stealing money with a child who is brought for that trouble, although here there are many exceptions, for each child demands different treatment; in some cases the particular complaint is the very thing we should first mention, because the child expects it, and must not be kept on tenterhooks of any kind. The younger the child the more indirect is our approach both to elucidation and treatment; here we meet with the child’s conception of its own world, which is not our conception at all, and which is best enacted and worked through in the miniature world of a play-room. This, however, is away from our subject.
When we come to adolescence and beyond, the problem is harder, for the confidence which should help the unfolding mind to envisage new horizons is lacking or distorted, and there may be a turning inwards as a protection against a hostile world, or a face of rebellion set against it. Hence the re-establish- ment of that confidence, the forming of a link with society, and the discharge of pent-up emotions must be our task : buffer, bridge and lightning conductor once more.
What is demanded of us then is knowledge of the work, a power of see- ing the problem through the eyes of others and an attitude of detachment to temper our interest and enthusiasm. These qualities and attainments, how- ever, must hold subjectively as well as objectively, and this involves a good knowledge of ourselves, of our unconscious as well as conscious motives for 1 ? .
doing what we are doing. The work of social workers in this field often in- volves what has come to be known as sublimation: the conscious diversion into kindred channels of energies which do not find their normal outlet?for instance, the use of the maternal instinct on the more diffuse plane of social service. In this there is always the danger of compensation instead of sub- limation : we may be unaware or deny the existence of certain urges or feelings within us, whether of love or pride, and if disappointed of their fulfilment, derive satisfaction from other activities, though still unconscious of our real, selfish motives.
Good work may be done, it is true, even in a mist of self-delusion; but for this work in particular it is dangerous to be self-seeking or indulge in com- fortable feelings of beneficence.
When our task is no less than to be all things to all men we would seem to need not only knowledge, but also charity, peace, patience, benignity, and so on through all the possible gifts and virtues; but as human beings, have to remain satisfied with even a small allowance of each.
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