Category Archives: Public debate

About Looking After Children in Hospital – 1953

20 Sunday Apr 2014

Posted by in 1950s, Bowlby and Attachment Theory, Children in Hospital, Conferences and Lectures, Newspaper reportage, Public debate

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In my previous post I noted that Hungarian born and trained psychoanalyst Dr Andrew Peto was a speaker at Sydney’s twelve day Pacific Seminar on Mental Health in Childhood  in August 1953. Sponsored by the World Health Organisation with sixty delegates – medical practitioners, teachers, psychiatrists, psychologists and social workers -.from sixteen  west Pacific and South East Asian countries it was a talkfest on child psychology not seen before. The director of the seminar was Dr. F. W. Clements lecturer in child health at the School of Public Health and Tropical Medicine at the Universality of Sydney and  formerly chief of the Nutrition Section of W.H.O.  The purpose of the seminar was to  consider those forces in the child’s home and communal life that could help or hinder him in his growth towards a mature personality’. Curiously this international Congress was scarcely reported even though delegates were considering the leading research of the day. Melbourne’s Argus newspaper provided a brief overview of the conference under the heading: Experts have some cute ideas of how They’d Bring Up Mother” concluding that at the very least, professionals were better informed.The Sydney Morning Herald relegated the matter to the Women’s Pages with a major article on women doctors from South East Asia. In a thinly veiled attack upon these highly qualified professional women, the Herald wondered why they were not at home tending their children and carrying out household tasks.  Only one of the major Australian women’s magazine, the Australian Women’s Weekly contributed a well thought out item about a topic  covered during the conference about the needs of  children in hospital. As you will see the author, Veronica West, drew upon newly published Attachment research by John Bowlby and James Robertson.   West carefully negotiated some contentious issues between doctors and reformers.Thanks to the National Library of Australia’s website TROVE, we are able to read these articles easily. West wrote:

Are Australian hospitals mending the bodies of sick children while blindly subjecting their minds to emotional stress more damaging in many cases than the disease or condition from which they are suffering? Must the price of the child’s health be submission to an inflexible hospital routine which catapults him from the security of home to a world in which his two paramount fears are realised – desertion by his parents, injury at the hands of strangers? Is Australia to lag behind progressive English and American hospitals which encourage the presence of mothers at the bedside of their sick children? Many medical and hospital representatives who attended the Seminar on Mental Health in Childhood at Sydney University last August are asking themselves these questions.A few enlightened paediatricians (child specialists) and doctors have long been trying to introduce overseas reforms in Australia. The safeguarding of children from unnecessary, frightening experience and training the nursing staff in basic concepts of child psychology are other steps, being taken abroad.First to throw down an official challenge to the old hospital visiting system is the Royal Children’s Hospital, Melbourne. It now proudly announces the success of a scheme which makes hospital routine fit in with new daily visiting hours for mothers.

This article was set in motion by the distress of a friend who spent two weeks in an intermediate ward of a city hospital. She said she couldn’t forget the despairing cries of “Mummy, Mummy, where are you?” which she heard from a nearby children’s ward throughout the night. She was astounded to hear that mothers were only allowed to visit the children once a week. When my friend spoke to the night sister about the distress of the children, her anxiety for them was dismissed as maternal sentiment.

“Nonsense!” said the sister, “a sedative soon puts them to sleep. The kiddies are always like this for a couple of days after visiting days. We dread visiting days. They do more harm than good.” My friend was told that except for a few problem cases the children were perfectly happy with the nurses during the week. “They are quiet and good, and settled in, but as soon as mother comes they stage terrific tantrums.” When she told me the story my friend said that if her own child went to hospital and was as mentally distressed as some of the children she had seen and heard, she would insist, through her doctor, on reasonable access to her little girl. Was my friend being over maternal and foolish, or was she instinctively right? Í set about finding out.

West attended the Seminar on Childhood Mental Health in Sydney in August 1953. She wrote,

The Seminar on Mental Health in Childhood revealed something of the general impact of hospital experience on the child of pre-school age. Subjects discussed included depriving the child of the comfort of his mother’s presence, his fear of pain, the isolation and aimlessness of his existence, the uncertainty of ever getting home again, and the inner turmoil and emotional drive to which frail bodies were subjected.With two-year-olds or three year-olds, especially, it was pointed out, the immediate reaction was a period of agitated despair, during which the child screamed, refused food, and only exhaustion brought sleep. After i a few days he became the quiet, good, allegedly settled-in child-in reality the apathetic, frozen-emotion child who had reached a serious stage of mental sickness...Sir Ronald Mackeith, of Guy’s Hospital, London, told of reforms which remove the risk of hospital damage to the child’s personality. One of the simplest was the opening of wards to mothers, who fed, bathed, and generally assisted the staff in the care of their own child on their visits. The Royal Children’s Hospital, Melbourne, I discovered, had been experimenting with daily visiting for the smaller children over the past two years, had found this a success, and had introduced regular daily visiting for all children four months ago. The Medical Director, Dr. Vernon Collins, said that he regards the ideal as “free visiting where the parents may come to the hospital at any time.” He believes that this is essential to build up good relation ship between the mother and the nursing staff and to get the best care for the child.

Quoting this as an example, I interviewed leading paediatricians, medical men, child psychologists, hospital medical superintendents, matrons and sisters. I found the paediatriciains and doctors awake to recent research and already trying to apply the new methods to their patients, but still uncertain ol how general reforms could be carried out. Their reactions were surprisingly mixed, with individual but not collective antagonism to the new methods. Some had not heard of  visiting – hour reforms, and wary of the threat to hospital routine, were reluctant to hear of, or discuss, the subject. Others equally ill-informed listened kindly, but remained unshaken in their conviction that present methods were best. As an official spokesman put it, they were “sitting pat and waiting.”

West seems unimpressed by that response. She continued:  Here is the statement of the official spokesman of that hospital-the Royal Alexandra Hospital for Children, Sydney, which has 485 beds and treated 11,777 in-patients last year…

“Just say we are interested in the entire subject and an studying all the material available, but we prefer to wait and see. There will be no immediate alteration in the Sunday visiting day for the children.”

Here, too, are some of the opinions expressed at interviews: First, a talk with a hospital matron with many years’ experience in children’s wards. “I think the reforms will have to come,” she said. “The seminar undoubtedly opened the eyes of some of us who have long prided ourselves on the physical care of children in our charge. The most efficiently run ward in Sydney is not worth the constant reproach of the screams of the frenzied child, or the misery and listless apathy of the quiet child, star ing blankly, hour after hour at hospital walls.”

The most outspoken of the pediatricians who recently returned from England and who had instituted more liberal visiting hours in his hospital outside London said this: “Christmas is coming, and we will again have Press photographs of happy children and gaily decorated ward:and once again people will murmur warmly, ‘The hospitals are wonderful going to so much trouble for the children!’ “What the enlightened child expert would like is a little of this Christmas sentiment from hospitals and doctors spread over twelve months in our children’s wards.“When I was a medical resident I agreed with the general opinion that the weekly visiting day for mothers, with its aftermath of temperatures up and chaos in the wards, was an unnecessary evil. “Experience brought wisdom. In the London hospital I arranged for the mothers to visit the children daily, dropping in and out for brief visits on the way to town or after shopping.”The mothers sometimes fed the children, tidied beds washed them, and were of real assistance to the nursing staff. Reassured by the seemingly casual visits of the mothers the children were happy and contented, and were discharged mentally and physically well. “Certainly some cried when their mothers left, just as children here in our private ward« who enjoy the. privileges of more frequent visiting do. But a little weeping at temporary parting is one of our natural human emotions. It bears no relation to the violent reactions, or, worse, the disturbingly quiet ones, of the visit-starved public-ward child. Of course, we must have hospitals for sick children, and any physical pain inflicted is negligible to the suffering it spares the child, but too often both doctors and parents undertake to put a child into hospital without giving sufficient thought to the matter”.

The Doctor continued: “Some parents fall down on ‘he job of preparing the child for what lies ahead. They, in mistaken kindness, tell him fairy stories or refer to his approaching period in hospital as a ‘party.’ “What happens when the child arrives for the ‘party’?

“Generally he is whisked away from his harassed mother at the admission office, and, stripped of his favorite teddy bear or chewing rug, he is jet propelled into his new world. For the next six days until visiting day he is walled up in a world of white, forsaken bv his parents, helpless against the towering, white-clad, masked strangers who periodically select him for injury. It is not the pain-most children can take pain better than adults-it is the terror of what it is all about that breaks the child. While the comfort of the sympathetic nurse is often refused by the child in his des- pair, the reprimands and threats of the thoughtless, ill tempered nurse aggravate the situation. “Some of our hospitals allow the mother to accompany the child to his bed, get him used to the nurse, as well as letting him keep his cherished toys.

“In others where haste and ordered routine is the rule the opposite is the case. In many of these hospitals it is still the current practice on chaotic tonsillectomy morning to line up about a dozen young patients on a form out- side their ward or adjoining the theatre for upwards of an hour, and drag them off one by one.. for the operation.”

A woman pediatrician had this to say: “‘Certainly periods in hospital do not affect all children, temporarily or permanently. This is also true of epidemics, yet we would not deliberately expose children to such a risk, I believe a system of staggered daily visiting hours would be best, with full co- operation between the doctor in charge and the sister. Of course, some mothers because of domestic duties or because they live a long way from the hospital would not be able to make the daily visit.”

And what of the position in hospitals or wards where the children may stay months or even years? Two doctors stressed the need for closer contact between mothers and children in such hospitals.

“I commend any doctor or parent about to confine a child to one of these hospitals to study Bowlby’s report to the World Health Organisation***,” one of them said. “As he and the famous Sir James Spence point out, these hospitals, despite the various activities, occupations, and entertainments arranged for the children, overlook one important factor -the depriving of the child of his mother. Perhaps Australia cannot immediately emulate these reforms, but some of the broken mother-child relationship can be repaired by extending visiting hours.

Finally I saw child psychologist Miss Zoe Benjamin. Clinging to mother, temper tantrums, bed-wetting, hostility towards the mother, and kindergarten activities are all typical symptoms of hospital experience,” said Miss Benjamin. Handled sympathetically by parents, these usually disappear, but can lead to serious results. The experts quoted agreed that the most urgently needed reform was an increase in visiting hours in children’s hospitals, which must be championed by an enlightened medical profession generally.

I for one was surprised to find this article published as long ago as 1953. I remember attending lectures at Melbourne’s Royal Children’s Hospital during the 1980s when Isabel Menzies Lyth from the Tavistock Clinic spoke about the needs of children in hospital. Here she advocated what one 1953 Australian Matron also promoted: that the ward be divided into smaller units with children allocated to a ‘team’ of carers during their admission? It seemed, upon listening to Mezies lyth that her recommendations and their implementations were far more recent. It is to be wondered about why such a large newspaper as the Sydney Morning Herald failed to report upon this and other matters arising from this international conference. Was there some sort of external pressure upon its editorial team not to do so? It would be interesting to look into this a little more.

*** “Child Care and the Growth of Love”-Penguin edition summary of the John Bowlby report to the World Health Organisation

References:

Child Care Is Their Subject. (1953, August 20). The Sydney Morning Herald (NSW : 1842 – 1954), p. 5 Section: Women’s Section. Retrieved April 20, 2014, from http://nla.gov.au/nla.news-article18383141

Sick children need parents at their bedside. (1953, November 25). The Australian Women’s Weekly (1933 – 1982), p. 20. Retrieved April 20, 2014, from http://nla.gov.au/nla.news-article41447234

 

 

 

 

 

Popular Psychoanalysis 1 – Bill McRae, ‘The Psychology of Nervousness’

22 Saturday Sep 2012

Posted by in 1940s, Bill McRae, Lay analysis, lectures, pioneers, psychoanalysis in lay terms, Public debate, public education, the psychoanalytic process

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William A McRae, The Psychology of Nervousness: The Mind In Conflict, OUP, 1942.

In The Psychology of Nervousness McRae sets out to write ‘the story of our inner judge and jury whose task it is to mete out punishment when we fail to live up to our ideals’.   It was part of McRae’s intention to take psychoanalysis out of the doctor’s consulting room, away from a small and elite ‘avant garde‘. Ordinary people he inferred needed to know about the complexities of the mind the unconscious.  McRae wanted to show people that understanding the motives that led to certain behaviours could and would help alleviate emotional suffering. He wanted people to rethink notions of behaviour as an outcome of ‘moral’ lessons beaten into them in childhood. The book addresses the complex matter of destructive anxiety; how envy, rage and jealousy amongst other things may undermine one’s relationship to self and another.   It is one of the first of its kind in Australia, one of McRae’s three plain language introductions to psychoanalytic theory and treatment published between 1941 and 1945.

McRae does not pretend to be a theorist. He is an educator. He drew on the work of Freud and Alfred Adler and used illustrations from his clinical practice in Perth to develop his points. His ‘patients’ were people like his readers, parents, couples, working men and women, adolescents and children. Some were returned soldiers suffering from war trauma.  All behaviour has meaning, he stated. It was a matter of searching for its motives and to accept that much was unconscious. ‘Just as nine-tenths of an iceberg is beneath the surface of the ocean, so an equally large part of our minds functions beneath the level of everyday consciousness’. Behaviour is not an outcome of moral success or failure, he argued but an expression of the instinctive forces within the self mediated by parental figures from infancy. This recognition, helped along by psychological research was ‘gradually teaching men to appreciate how the instinctive forces in the mind, functioning through his feelings, determine his behaviour to a large extent’. It is also a glimpse into notions of  respectability, good behaviour and the emotional effort required to conform to the Australian society at that time.

Although McRae does not cite group theory as such he was firmly of the opinion that the individual is shaped by the group. As the child grows from infancy to adulthood instinctive forces are tamed, primitive forces, civilised..

Today, a person who is afraid dares not try to run away in many instances, simply because he fears more the rebuke of his friends who may call him a coward. Often he cannot give way to his burning resentment, for society may not countenance the form of revenge which he contemplates. Likewise when he craves to express the hunger of the reproductive forces within himself, he must learn control, for the rules of society are more powerful than the instinctive urges of the individual.

Social Darwinist ideas underpin the text: McRae describes how humans banded into clans, groups, communities, society to combat nature and thus enable the development of the civilised mind.

Just as a small child has to learn the art of co-operating with others in the home, so primitive man had to gradually educate himself to work with the group. Just as the child is completely selfish, and instinctively brushes aside the wishes of others, so primitive man, in the childhood of the race, acted in the same way. Through discipline and punishment, the child learns to obey the voice of its parents; primitive man, through the laws of the group, was forced to heed the rule of the majority. The power of thinking, however, came to his rescue.

The ability to think separates [humans] from the jungle past. Even so, he continues,  destructive forces – desires to rape, kill and go to war – may break their bonds in some individuals and social groups. ‘Man will not realise that at heart he is still a cave man’. It is a struggle for all of us.

The first chapter, ‘Guilt Feelings and the Need For Punishment’ takes us into the heart of the matter – and a fundamental precept of psychodynamic therapy.  It is hard to convey the understanding, yet so simple when it is understood, McRae says, ‘that the character of the individual is formed in the first few years of life,and that ever afterwards his behaviour is dictated and directed by this underlying style or pattern’.

McRae is particularly interested in Adler’s theory of the Inferiority Complex. For him it seems, the inferiority complex explains much.It is formed in the early interactions between parent and child – a point reiterated throughout his book. In a typical passage McRae writes

The style or pattern of life, formed in the first five or six years of a child’s life is extremely important, because this style of life is an unconscious one in later years. If a feeling of inferiority has resulted from the training the child has received during these years, that feeling will be embedded in the unconscious in later life, and the child will be heir to all those psychological ills that plague sufferers from Inferiority Complexes. Allied with the feelings of inferiority are usually feelings of fear and guilt, also unconscious – a fear of the world, which the owner has never been allowed to face with a feeling of courage or adequacy, and a feeling of guilt that is, perhaps, the natural enough consequence of a lack of love for strict parents, or the envy of others more fortunate.  

Repressed feelings of fear and guilt…are potent factors in self destruction, he continued. ‘Inferiority Complexes, with their attendant unconscious fears and guilt, are also self destructive’. A chapter on dreams summarises Freud’s theory of the unconscious – about wishes, desires fantasies and symbolization before proceeding to look at unconscious processes in marriage as couple navigate the birth of children, parenthood and the cycle of life.

McRae, however, seems to have all the answers – his version of psychoanalytic theory and dream interpretation is somewhat reductive – along the lines of ‘this means this and that is equal to that. Even if he is trying to get his readers to think afresh about behavior and experience, beyond conscious apprehension.

In analytical work I find that many women feel that the change of life has robbed them of the very essence of womanhood, for few of them are well enough adjusted to realise that their period of usefulness is by no means over when they are no longer able to bear children. Psychologically, this accounts for many of the difficulties which many women experience when the change of life looms ahead of them, for these conflicts set up sorts of nervous reactions. Such women unconsciously resent the passage of time, and often nervous anxieties produce sleeplessness, which may be related to a fear of growing old and dying. This explains what adolescent daughters often find their mothers so trying, for their young charm and freshness intensify the mother’s jealousy, which is unconscious, but finds apparently legitimate reasons to express itself. 

Reception of The Psychology of Nervousness was  lukewarm. It was noted in the press across Australia  particularly in Western Australia. It was  warmly recommended to readers by the editor of the ‘problem page’ in Perth’s Daily News. The editors of the Morning Bulletin in Rockhampton, far north Queensland was somewhat more direct.  The Psychology of Nervousness was ‘the least convincing’ of McRae’s three books on everyday psychology, they wrote.

The general reader is rightly cautious about disagreeing with experienced opinion in such matters as this book deals with, but he will be hard put to find support from his own knowledge for many of the claims this writer makes. The manifestations of the unconscious mind seem altogether too wayward and remote, and while it may be granted that the unconscious mind, at times, works in anything but a logical way and is a latent influence exerting great effect on an individual’s life, the layman feels that psychologists tend to resort too frequently to the unconscious mind for explanation of certain types of human behaviour. The reason quite often may he a purely physiological one or at least a combination of body chemistry and mind. It may all amount to a question of first cause and that is a great field for argument.

Perhaps McRae’s analysis too reductive  for them.

The general reader falls into this line of thought when he reads that if a child is thrashed for stealing he thenceforward unconsciously looks for and feels the need of punishment whenever he commits theft again. Again: “There have been few “perfect crimes’ because the culprit usually leaves a clue which proves his undoing. He unconsciously desires punishment, so makes a little error in order to be detected.” This seems to endow people with an extraordinarily high ethical sense and to discount the force of self preservation.

Perhaps, the editors suggested, it was better to let things lie even if they were interested in McRae’s chapter on shell-shock and war neurosis and hysterical conversion symptoms.

One valuable advance in psychology has been the demonstration of how internal conflict can affect the organs of the body and produce disease. Mc Rae’s observations on the subject are highly interesting. We can understand that when a conflict is solved the Individual finds life more harmonious and that he gains in physical and mental health but conflicts seem to he part of the price of man’s existence and they must have had considerable influence on the progress of the world. How much do art and science owe to discords of mind?

McRae had faced such objections before. In his final chapter he stands by his position.

I do not require that it should completely satisfy the philosopher and the aesthete. I know that it works, that it heals the sick and comforts the weary, and that, because of this, must be right. If its concepts offend some, the answer that I give them is not an elaborate justification, but a simple indication of someone who has been cured, someone who has been made happier.

He then describes what is involved in an analysis… explaining the notion of the transference, free associations, dreaming and the negative transference – and matters concerning length of treatment, and the costs.

Sadly William McRae does not make the gallery of psychoanalytic pioneers, the subjects of the exhibition, Inner Worlds, held at the National Portrait Gallery in Canberra during 2011.  I wonder though, how many people struggling with their particular daemons and personal pains found something of relevance, and direction in his books? How many people sought treatment as a result?  A year later in 1943 Mcrae’s public lecture series on psychoanalysis for the University of Western Australia drew an enrolment of 297…

PSYCHO-ANALYSIS: A Doctor’s Warning – 1924

08 Saturday Sep 2012

Posted by in 1920s, Australian History, Conferences and Lectures, historical source material, Lay analysis, Medical circles, NSW, Press, Public debate, Sydney

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By the early 1920s public interest in psychoanalysis in Australia was broad, and certainly not restricted to medical circles. The president of the Victorian branch of the British Medical Association, Dr L.S. Latham used his retiring speech to warn that psychoanalysis should not be utilised indiscriminately. At the very least, he argued,  psychoanalysis should be practised ‘under skilled medical direction’. It is clear that there was sufficient interest for the editor of the Sydney Morning Herald  to publish Latham’s speech in the edition of 1 January 1924. Here is the text:

“The widespread and general interest in psycho-analysis is to be viewed with some concern. I am anxious not to indulge in cheap criticism, but it may be pointed out (what should be clear to anyone who has practised with any concentration psycho- logical method of introspection) that there are many pitfalls to be avoided in a logical tracing out of psychological associations. Follow a train of thought in your own mind and the associations are frequently most difficult to connect. The ideas would appear to be associated in time, but in little else.

Psycho-analysis affords by the “word association tests” a valuable means of examination of mind and determining the lines along which association tends to occur, but recognition of the occasional value of this method is consistent with the view that it should be but rarely applied, and that the Freudian symbolic interpretation of many phenomena thus observed need not be endorsed. The efforts of ancient philologists In derivations such as faba, fabaricus (fab-aricot-us) (h) aricot, and mus muris (mu-rat-us) rat, are ingenuous and simple in comparison with some of the psycho-analytic symbolisms.

Probably the whole profession makes use from time to time of suggestion, and many of our patients need above all things inspiration or, it may be, comfort, and these constitute a form of psycho-therapy.

It should be strongly emphasised that In cases of nervous disease psycho-analytic methods should not be employed by non-medical exponents alone, even though they may be expert psychologists, for it is necessary before application of such methods that the presence of organic disease liable to be aggravated by the employment of such methods be first excluded. Such conditions aro encephalitis and other inflam- matory states. Of course, the ideal method would be that persons suitable for this method of investigation should be handled by an expert psychologist in association with skilled medical direction”.