A Prophylactic Approach to Child Psychiatry

Extract

It has long seemed apparent to workers in the child guidance field that many of their patients show evidence of longstanding emotional disturbance; either the symptoms now complained of have been present for many years, or there has been a history of symptoms earlier on which have disappeared only to be replaced by the existing ones. Some of these patients whose present condition may be almost intractable, might have been helped had they been treated at an earlier date, while recent work by Bowlby (1951) and others has emphasized how important are security and satisfactory emotional relationships in the early years for the establishment of a stable personality. Thus it appears that any prophylactic approach, aimed at reducing the incidence of emotional disturbance in older children, and it is hoped ultimately in adults, may need to be made very early in life.

Little has been published, apart from accounts of individual patients, of work on any series of very young children who were psychiatrically disturbed, particularly from a prophylactic point of view. Joseph (1948) has described some of the patients she has seen in a child guidance clinic attached to a child welfare centre, and Gillespie (1954) has compared the symptomatology of a series of pre-school children treated at Infant Welfare Centres with the preschool histories of older children treated in a child guidance clinic. She points out that the type of problem dealt with in the under-fives was seen in a high proportion of the earlier histories of those who needed treatment at a later age. The importance of early treatment for parents in the prevention of serious disturbance in the children has been emphasized by Fries (1946) by Jacobs (1949) and on a community scale by Caplan (1951). His experience in Infant Welfare Centres in Israel over a number of years has led him to concentrate on the treatment of cases where abnormal symptoms were not yet manifest, but where pathogenic relationships of the parents to the child were such that he felt that emotional difficulties in the child might later develop. In this country such a prophylactic approach is relatively unexplored, although the possibility of preventing mental ill health in children is one which has interested public health authorities for some time.