By E. MILLER, M.A., M.R.C.S., D.P.M., Hon. Psychopathologist to the West End Hospital for Nervous Diseases, Hon. Medical Director of the Child Guidance Clinic of the Jewish Health

Organisation. There

are a

variety

of

problems

which have

come to

the front in Child

Mental Hygiene. We may divide such problems roughly into public and private. This is an exceedingly arbitrary classification because, taking a long

view,

we must

realise that

even

those disorders of childhood which affect

child and parents alone may, if left untreated, develop in such a way as to have direct social repercussions. For example, the minor psychoneurotic disorders ?f

children,

and such behaviour disorders

as

do

not come to

public

notice

^ay become each in their way matters of wider importance. The neurotic child may be difficult to place when the time comes to put him to work, and further, when maturity is reached, his repeated illnesses, nervous debility and the like may cause, as it has been suggested by most eloquent statistics, great industrial wastage

as

well

as

individual

unhappiness.

As far

as

behaviour

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disorders

concerned, industry too stands to suffer from repeated absenteeism, insubordination, and minor delinquency. Innumerable cases can be quoted are

of delinquents who in adult life would never have reached the Courts if their disorders in childhood had been made the basis of psychological enquiry. For the purpose of this article, I intend dealing with the problems of juvenile delinquency as they present themselves?

(a) Directly to the Child Guidance Clinic, (b) Through the Children's Courts. It is

of considerable importance to decide what behaviour disorders be regarded as sufficiently well defined and serious to merit investigation. Before a disorder is a behaviour disorder as such, it must impress the mind of an observer as being sufficiently severe to interfere with the social life in which the child is found. Now it must be obvious that opinion as to the gravity of a behaviour disorder will vary according to the person who makes the complaint. A mother may bring a child to the doctor because he is loath to go to school in the morning, is sick before breakfast in consequence. She the sickness alone as calling for investigation. The skill of the may regard and the psychiatrist pediatrician will discover that there are other troubles in addition to the morning sickness. One discovers that the child is a food fad, that he is solitary and makes few friends, and is at loggerheads with other members of the family. His intelligence may prove to be somewhat in question, and the mother may think the child dull and slow to learn. The school reports, however, are good. He is average in his lessons, amenable to discipline, and his sociability has never been in question. The teacher resents that one of her normal children should be subjected to an investigation, and she fears that anything in the nature of a psychological quest will render the child morbidly introspective. Better leave alone. On the other hand, the parents may have no complaint to make of the child in the first instance, but the teacher complains that the child is a fidget, that he cannot sit still in class, that his attention wanders, that he is interfering with the ordered life of the class and that his record in his lessons is poor. Psychological testing shows the child to be normal but that his achievements are scattered, that he seems rebellious in the tests and only gives satisfactory answers when the subject matter interests him, or when, being caught up in the tests, he forgets himself and does well. Now it is the parents' turn to resent the investigation. Why is George picked out from a whole class ? His behaviour is good and they him as bright. A careful scrutiny of the child's history reveals no sicknesses to account for the poor school behaviour, and that the developmental history is a good one. On the other hand, tactful social enquiries reveal the state of the family milieu. The boy is the last of a family?there is a considerable gap between him and the next in years. The mother has become tired of child' bearing and weary of family management. Mother and father too are on edge a matter

ought

to

regard

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with one another. The children witness the scenes. The older members have taken advantage of their own maturity to leave home and seek happiness elsewhere. The lad feels insecure; he is obtaining little love and receives few lessons in social orderliness. He becomes a law to himself and seeks in school life to attract attention to himself and actively to irritate his teacher into a feeling of frustration. What is to weigh with the investigator in deciding whose estimate of disordered conduct is to be taken as a standard of severity? Are we to accept the familial standard of disorder and discrepant behaviour, or the teacher's? In America, extensive researches were carried out on the problem, and it was discovered that there was a wide divergence between teachers' and psychiatrists' estimates. Whereas the teachers stressed social obliquities?such as sexual offences, insubordination, and rebelliousness, interfering with other children, rowdiness, etc.?the psychiatrists, habituated to seeking for subtler manifestations of mental disorder, stressed the retiring nature of the child, sullenness, loneliness, and proneness to minor vague disorders which lie outside the scope of medical physical treatment. In proportion as the teacher is concerned with the disciplined life of the school and the ways and means of imparting knowto ledge groups rather than to individual children, she must pick out the " attacking type who frustrate her purposes. Unless the retiring type is unusually sullen and non-co-operative, the child may pass unnoticed as a somewhat unobtrusive and acquiescent type. His dullness may be regarded as due to intellectual poverty, rather than to emotional inability to face up to the work in hand?an emotional disposition which may be fraught with great dangers for the future mental health of the child and its power to find a place in the industrial life. Ambitious parents with an eagerness to see their child succeed and to excel, will notice this retiring disposition, or they may on the other hand, blinded by too much solicitude, regard the quiet child as a perfect little angel who wouldn't hurt a fly and naturally doesn't wish to associate with the nasty little boys in the same street or school. The opportunities of a Child Guidance Clinic are in the direction of discovering the many sides of a child problem which may exist in any particular case. From a survey of two hundred cases, including a variety of child disorders from minor neurotic disorders, noticed alone by the doctor, to delinquencies brought before the Court, it has been found that three factors may stand out in the of such disorders, such factors existing alone or "

together. These

production

are :

(1)

Conflicts in the mind of the child arising out of parents and secondarily to brothers and sisters.

(2)

Scholastic difficulties.

(3)

Social

abnormalities,

as

regards adjustment

to a

relationship

particular

to

the

milieu.

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the first, it has been noticed time and time again that a child the direction of ill health, psycho-neurosis formation, and behavmay iour disorder as a result of conflict between itself and the family. Such conflicts may not appear to the parents at all, nor are they obvious to the child, in the same way as adults with nervous disorders of a functional type are not conscious of the emotional conflicts which underlie their troubles until they are able to see the way in which their mental life has developed from childhood onwards. Sometimes the conflict is fairly superficial. It may lie in errors of nurture which are to be placed to the debit account of the parents alone; on the other hand, it may be due (not so much to nurture as to unconscious attitudes which parents adopt towards their children, that is to say, although the parents may not themselves be manifestly neurotic, they may possess certain character anomalies which make them difficult parents. In such wise, arises grudging attitudes towards children which are sensed in an immediate way by the child with its acute perceptions of difference of mood. The child on its side may respond emotionally to such attitudes and yet be quite unable to put such emotional responses into words unless a close and sympathetic enquiry is made, nor is it easy to get adults to realise their own parental shortcomings. How often does a father attribute the child's disorders to inheritance on the mother's side and vice versa. And how often too will a child protestingly state that it is entirely the fault of its parents that it is driven to do this or that. Enquiry into history may show that in the latter case the parents are not to blame but that the child itself has such a temperament as cannot fit in with either the coldness or the excessive warmth expressed in parental attitudes. The attitude of children to one another may be a function of the treatment the parents mete out to their children in accordance with position in family, and in addition, children may take up an attitude towards one another irrespective of parental attitude. For example, there may be educational rivalry, rivalry due to the fact that an older brother has already entered adult life and appears to move about with a freedom and self-assurance which a younger member envies; a youngest child may feel itself in a family of adults, to whom it feels it does not belong, and in consequence develops a feeling of isolation which gets its recompense in fancies of excessive self-estimation, in rebellion, in wandering from home, and sometimes in delinquency which gives oblique satisfaction, or which may be an act of revenge knowing that its misdeeds will call the attention of the parents to it at any cost. As

regards

react in

Scholastic difficulties may be brought to the Clinic by the teachers, or be discovered when mental tests are carried out. Such discoveries may may explain a flight into neurosis in order to compensate for shortcomings at school, and in some cases truancy and delinquency may result from the child's inability to face lessons which it fails to understand through native lack of endowment or through bad methods of teaching. Such bad methods of teaching, however, must sometimes be put down not to the shortcomings of the teacher but to the fact that the method may not fit a particular child.

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Social factors may be discovered in the course of investigation at a Child Guidance Clinic only when the family and the child is considered in relation to its social milieu. Not infrequently a child may suddenly develop either neurosis or delinquent behaviour on a change of environment; that is, removal from associations of early childhood to a strange milieu not necessarily unhealthy, or from a social milieu of good character to one of bad repute. Every individual tries to fit in with its immediate social environment. To prevent criticism or even ostracism by word or gesture, it will adopt the habits of a new social set for the sake of some measure of social harmony. Even delinquent environments have their esprit de corps, and an unstable child or a retarded child will rapidly, chameleon-wise, take on the colour of its surroundings. Cases come to one's notice where a boy has actually suffered if he has not joined a local gang, and he may even develop feelings of isolation and ill health where parents, with the best intention in the world, separate their children from what they regard as unhealthy companions. All these factors are discoverable by a team working together which can, by its multiple equipment, dig out every possible factor. When we turn to the Children's Court, we enter a realm of fixed social conventions embodied in legal enactments and punishments. The child who is brought to a Children's Court comes only because of a social offence or for such abnormal behaviour within the family as is described as unmanageableness or as being beyond control. The fact that being beyond control may bring a child to the Courts implies that the family is a social unit and that membership of it is only possible on the basis of conformity. We have learned to believe that social conformity too has its origin in family ideas, that authority is paternal. Roman law was characterised by this notion and the concept of Patria Potestas, or the power of the father, although a striking embodiment of Roman law, runs like a thread throughout human group development. All the reports about a child that appears before a Children's Court possess a social colouring and are judged in accordance with legal usages, and in this respect there is no essential difference between laws as applied to children and laws as applied to adults. The procedure is largely the same, and even very young children may take the oath if they wish to give evidence on their own behalf. In fact, where evidence is in doubt a child may elect to go to a higher Court. Anyone with only a superficial knowledge of human child psychology must he conscious of the shortcomings of this procedure. In the first place, it is very doubtful whether a child really understands the significance of the Law except that it is the authority and power of the father writ large and having a sanction, giving the power to punish and to segregate. Further, the natural tendency, particularly for unstable children, to fabricate, makes the taking of an oath almost absurd. The atmosphere of the Court, although it is devoid ?f the unction of adult Courts, is free of the uniform of the police and the severity of the judge, is undoubtedly a terrifying place, or if it inspires no terror it is completely misunderstood. Some benevolent magistrates, how-

6

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give to the atmosphere of a Children's Court a benign character which disarms many children, placates many parents and may do a considerable amount of good, but in the majority of such Courts the procedure is fixed, if not altogether relentless, and the burden of work in hand calls for more or less quick decisions which may prevent full investigation of a case. The probation officers themselves are almost invariably on the side of the child and some magistrates do come to every case with minds prepared to see the human side of every problem and to leave the law to do its work only when the case is one of glaring neglect on the part of the parents, or one of such deliberate delinquency for profit as cannot be put down to mental aberration. But when one who works in a Children's Court studies the immaturity of the child mind as regards a knowledge of its social obligations, the social difficulties it has to face, the family perversities and hardships which it daily suffers, one realises that every case, without exception, calls for a full individual and social analysis. If we turn back to consider the discoveries that are made in a Child Guidance Clinic, one is aware of the large number of behaviour disorders which might become delinquent, which might in years to come be the seeds of unalterable social obliquity and rebelliousness. These cases may be largely psychoneurotic or mildly behaviour problems, and in them the social perversity is apparently small. Study in the Child Guidance Clinic should not be concerned prima facece with the social disorders of children. It should be concerned with the whole gamut of emotional disturbances expressed in ill health, mental unhappiness of a private kind, and disorders of behaviour. From these arise mental disorders in later life, and from these mental disorders major and minor, much wastage to industry accrues, and also such disorders of personality which though passing as apparently normal, influence society in a variety of ways. It follows, therefore, that the Children's Court, although it must remain a legal institution, should be conducted largely on psychosociological lines. No Children's Court should be regarded as complete unless a psychiatrist and a socially trained probation officer is found working in close collaboration with the Magistrate whose role it should be to interpret the law but always to consider the underlying factors in individual psychology and in family disharmony which are responsible for each problem. While years and perhaps generations must elapse before the punitive character of the law is eliminated, it must surely be an ideal that the law, particularly with regard to children, should be changed at least on the administrative side in order that the latest discoveries of child psychology and social psychology should be utilised to the full. While law embodies our natural conservatism, our desire to cling to the old and apparently safe ways, we must realise that the Children's Court only sees one expression of child disorder, the social expression. The Clinic, on the other hand, has a wider perspective because it recruits its subjects from a wider field, and it is because of this that it is able to help in the interpretation of the cases that are brought before our magistrates. ever, do

Child Guidance and Juvenile Delinquency.

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