A Survey of Child Psychiatry
Edited on behalf of the Child Guidance Council :Author: R. G. Gordon, M.D., D.Sc., F.R.C.P.Ed. Contributed by Contemporary British Authorities. (Pp. 278; 2 tables. 10/6 net). London: Oxford University Press, 1939.
To attempt in two hundred and sixtyeight pages, as this book does, a survey of Child Psychiatry by twenty-one different contemporary British authorities, is no mean task. The Child Guidance Council, by whom the book is sponsored, felt that, after ten years’ practical experience, the time had come to collect and publish the knowledge possessed by British experts for the purpose of demonstrating the extent to which Child Psychiatry had become a living subject in this country. That they have fulfilled their intention there can be no doubt. Although it is only to be expected that some contributors should find it possible to express themselves more clearly, aptly and interestingly than others, the book as a whole is alive with positive, constructive views and recommendations, while not lacking in the breadth of opinion necessary in the approach to a relatively new science.
The book is divided into four sections. The first part deals with problems related to physical illness, and includes excellent chapters on epidemic encephalitis, juvenile rheumatism, epilepsy, and certain biochemical and metabolic disturbances. An example of the close collaboration between physician and psychologist which the book exemplifies is revealed in the chapter on rheumatism where the differential diagnosis between latent chorea and ” finding life difficult” together with its significance in relation to the welfare of the child is discussed. In the chapter on epilepsy, the contributor, while including reference (with diagrams) to electro-encephalography as a means of diagnosis, gives a good description of the epileptic personality and propounds the interesting theory as to how far the epileptic personality is the result of the attitude of the community (as exemplified by the ” no epileptics ” clause in the regulations for admission to every convalescent hospital in the country) towards the epileptic, rather than a concomitant of the disorder itself. This is followed up by admirable advice to parents and others regarding the management of epileptic children. The last chapter in this section, while reviewing present day knowledge on the subject, reveals that there is still a large field for research into the biochemical changes which are associated with mental disorders in childhood. Whereas a considerable amount of space is, quite rightly, devoted to conditions such as epilepsy and rheumatism, one looked in vain for any reference to asthmatic states, and allergic disorders as a whole receive but pas.sing reference. In view of the increased knowledge that is being obtained relating to the psychological aspects of these disorders, and the extent to which they are being referred to psychiatrists for investigation, the omission is perhaps unfortunate. The second section deals with problems related to mental illness and covers the field of psychosis, hysteria, anxiety states, obsessional and compulsive states, family neurosis, the unstable mental defective and backwardness. An excellent survey is presented of the comparatively rare condition of psychosis in children, with a detailed discussion on the differential diagnosis between organic cerebral disease, mental deficiency and mental disorder. The chapter on hysteria stresses a fact that cannot be over-emphasised, namely the importance of psychoneurosis being diagnosed not only on the fact of negative organic findings, but on the positive signs of emotional disorder. In the chapter on anxiety states, classification plays an over prominent part at the expense of a constructive account of these disorders and their management. The chapter on the family neurosis, however, provides a masterly survey of Freudian psychology clearly and precisely expressed in simple, everyday terminology. It is illustrated by well chosen and deftly described cases which seem, as is not always the case, to belong to the text in that one obtains from each a constructive idea of the purpose for which they were selected. It is not easy in a volume compiled by twenty-one co-writers to avoid overlapping on the one hand, or important omissions on the ether. Of the former there is very little, and, for the most part, where it occurs it only serves to present significant opinions or recommendations in a more vivid form or from a slightly different angle. Perhaps the most obvious omission is a chapter showing the relationship between Child Guidance and the problem of mental deficiency. It is stated by the Editor on page 137 that, as the book is intended to deal with those conditions met with in Child Guidance work, mental deficiency as such is not included in the subjects discussed. In view of this, the chapter on conduct disorder in mental defectives based upon experience of the residential care of grossly unstable defectives of all ages, inmates of the Rampton State Institution for such, appears to be wholly out of place and out of keeping with the rest of the book. Apart from mental deficiency resultant upon organic brain disease or injury, instability of conduct would be expected to occur with similar frequency in the mentally deficient as in those of other grades of intellectual development, and this the writer admits when he states that the great majority of the mental defectives in England and Wales is at large and presumably living respectable, more or less independent, lives. The writer goes on to argue that serious conduct disorder is seen much more frequently in highgrade feebleminded defectives than in imbeciles and idiots, and bases this assumption on the fact that the proportion of feebleminded to imbecile and idiot admissions to the State Institution is more than four to one. In the Report of the Mental Deficiency Committee, 1929, compiled by Dr E. O. Lewis, it is recorded with regard to the different grades of defect that the incidence varies inversely with the degree of defect, i.e., in every 100 aments, there were approximately 5 idiots, 20 imbeciles and 75 feebleminded. From these figures it will be seen that the proportion of admissions of different grades to the Rampton State Institution approximates fairly closely to that of mental deficients as a whole. In so far as cases of mental deficiency are presented for examination in psychiatric practice, a chapter dealing with the methods of diagnosis and the facilities provided by the various authorities and social organisations for their treatment or disposal according to the degree of their stability or instability, would have filled a real gap in a book which purports to cover the field of Child Psychiatry. Particularly is this so in view of the recommendations for increased use of voluntary residential supervision for such patients contained in the Report of the Feversham Committee, 1939. The chapter which follows contains an interesting and helpful account of what can be a very dull subject, namely the medical aspects of backwardness.
The third section covers the sociological aspects of Child Psychiatry from the point of view of the family, the school, social maladjustment generally and juvenile delinquency. A brilliant exposition of the subject is provided under the title of maladjustments in the school. Not only are the ideas and recommendations which it contains charmingly presented and delightfully expressed, but they relate to vitally important matters in present-day school regime and are recorded by one who clearly knows his subject from the inside. The problem of juvenile delinquency with its manifold contributory factors L not easy to condense into a single chapter but is well done. There can, however, be no excuse for confusion regarding the use of the terms ” moral defective ” and ” dullness ” as here presented. When the writer turns to the question of the preparation of medical reports for Magistrates or Probation Officers, however, he is clearly speaking from wide experience and his remarks are most valuable.
The final section is devoted to what are referred to as special syndromes such as enuresis, stammering, sleep disorder, tics, tricks, and habits, and sexual difficulties.
The chapters on enuresis and stammering are excellent, although the omission of references relating to the authors quoted in the text, so admirably carried out in the rest of the book, is unfortunate. The account of sleep disorders makes disappointing reading. It is followed by a good description of habit movements, although the views expressed regarding the nature and treatment of nail biting are not acceptable.
There follows an excellent and practical account of sexual difficulties in childhood, while the book closes with a comprehensive and masterly survey of the history, development and application of child guidance methods. It is perhaps unfortunate that so excellent a volume should have been launched at a time when the attention of those for whom it was written has of necessity been directed towards dealing with mass emergency situations rather than with the problems of the individual child, for the Editor’s wish that the book should “promote an interest in mental health in its beginnings and so encourage a more vigorous attempt to prevent mental illness ” has been amply fulfilled. M. B. H.
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