Attachment Theory, Childhood trauma, children, Children in Hospital, John Bowlby, Medical Profession, World Health Organisation
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
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