Child Psychiatry
Book Reviews
- Author:
Leo Kanner, M.D.,
Asst. Prof, of Psychiatry, The John Hopkins University, Baltimore. Balliere, Tindall and Cox. 27/-.
This is the first complete text book on Child Psj’chiatry we have read. As Dr Parkes, a children’s physician, says in his introduction ” no other book is quite like it.” The book is obviously based upon an extensive experience, and the wealth of case illustrations is a most commendable feature. Unfortunately, while the author is to be congratulated that his book is not overburdened with theory, one feels that this feature is bought at the expense of superficiality in approach and explanation.
It would be as well, however, to describe the book before making any further comment.
The book ia large, but not uncomfortably so. There are 43 chapters, and in all over 500 pages, not including two prefaces, one by Dr Adolf Meyer, and the other by Dr Parkes already mentioned. The contents are logically arranged in two parts. The first part is divided into three sections on the Basic Principles, Examination and Diagnosis, and the Principles and Aims of Treatment. The second part deals with particular difficulties, and is also divided into three sections. These are personality difficulties forming essential features or sequels of physical illness, personality difficulties expressing themselves in the form of involuntary partdysfunctions and personality difficulties expressing themselves clearly as whole-dysfunctions of the individual. There are many useful references throughout.
There are three tendencies throughout the book which we would single out for discussionThe book might be described as an apotheosis of common sense, a feature to which Dr Parkes gives praise in his introduction, and probably related to this is the author’s very evident aversion to psycho-analysis which he does not understand, and a tendency to over value the use cf classification and descriptive names, which is implicit throughout the work. This may be in the psychiatric tradition, but we have long ag? recognised it as a smoke screen behind which to conceal a lack of deeper insight.
Psychiatrists often find psycho-analytic interpretations monotonous, and others think the same about those relying upon common sense. That, however, is not the question. It is rather whether we are going to include in our conception of behaviour the existence of mind as a dynamic principle, and if in so doing, we are deepening our knowledge and insight.
To take an example from the book. In the chapter on the environmental factor (page 93) under the heading of the parent child relationship, we find the following summary of disturbances which is later amplified.
Parental over-solicitude, over-indulgence, and overProtection.
Parental indifference and neglect. Parental hostility and rejection. Excessive parental ambitions for the child. Loading excessive responsibilities on the child. There is no hint that each, any, or all, of these conditions can be considered as the result of Anxiety and guilt in the parent, and no curiosity as to the origin of this except in external conditions. Yet it is only when we understand the Anxiety and guilt factor on the part of the parent that we can deal with it effectively, so that it does not require to be displaced, or covered up, as when someone else accepts the authority for their actions, or is constantly reassuring. To take a simple illustration, one often comes across the case of a mother whose attentions to the child are dominated by a fear that it will be abnormal. In these cases one can often demonstrate the origin of the fear in guilt associated ^ith masturbation.
The evident aversion to, and misunderstandlng of, psycho-analysis, is to be found in many places.
On page 7, the author says: ” Thus, the teachings of infantile sexuality and the Oedipus complex are not derived from the study of children, but wilfully bestowed upon them a Priori.” On page 75 he discusses the Freudian view of infantile sexuality, but completely hisses the point?one is tempted to say wilfully ^-by applying the blind eye to the telescope. Nowadays it should not need to be stated that Jt is not the mere hedonistic connection between certain infantile activities and adult sexuality ^hich is responsible for the conception, but the tact that mature sexuality is actually identified ^ith these earlier forms and suffers from convicts arising in them. The same misunderstandlng is found on page 399 when he is discussing Masturbation. He says ” a less prejudiced view ^’ill hesitate to draw analogies between the masturbation of later years, aiming definitely at ?rgasm, or, at least, at erection, and the playful ^differentiated handling of parts of the body by the infant.”
It is interesting to note in passing, that sexuality only appears in the book as a problem and there is no indication that it can ever be ^ normal phenomena.
Positive evidence of the superficiality in approach is to be found in the description of the cases and the place given to treatment. The cases tend to be of a lurid and obvious kind, giving one no idea of the subtleity of behaviour, but this may be in the interests of clarity, and more important is the diffuseness of the diagnostic instrument.
Thus in the case of Bernard H. which is described on page 94, and again on page 115, the parental neurosis is first described in terms of parental snobbishness and misapplied social standards, but later the child is said to be suffering from ” an obese, untruthful, moody, selfrighteous mother.’’ Docs this really tell us anything about the inner workings of that mind? Although the book is large, only 20 pages are devoted to treatment generally, although the treatment of particular difficulties is discussed in the appropriate places. In chapter 13, we find acute sensible hints on how to avoid elementary errors of approach, but it is disappointing to find in the succeeding chapter on Work with the Child that this can be summed up as the explanation of the treatment plan, the dispelling of incorrect ideas as to the source of the symptoms, and a warning against surprise and deception methods. The meagreness of the chapter would be the only criticism but for the usual non-understanding reference to transference as used in psycho-analytic treatment. In the next chapter on Work with the Family there is again the same rationalistic explanation. There is a vague reference on page 127 to the provision of guidance by trained and untrained people if the parent’s state or level is unsatisfactory. But how?
It may be thought that these criticisms are rather unnecessary, but they are important when we come to treatment. In Chapter 17 which is devoted to particular therapeutic aids, we find that the use of a Star Chart is favoured in the treatment of enuresis, temper tantrums, and food fads, and this is to be kept secretly by the parent if the child is untruthful. What more certain re-inforcement of the sense of guilt can be imagined? Then with regard to the larger issue of mental hygiene, surely this will depend upon the accuracy of our knowledge. On page 399 and ff. sexual difficulties are related to domestic unhappiness, but why children should react in this way is by no means clear.
In conclusion one can return to some of the valuable contributions in the book, noting especially the insistence on the necessity of treating the patient rather than the condition the qualities of the psychological approach, and the type of diagnosis. W. Paterson Brown, M.B., Ch.B.
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