Book Review

Taming the Troublesome Child: American families, child guidance, and the limits of psychiatric authority

N Engl J Med 2000; 342:361-362February 3, 2000

Article

Taming the Troublesome Child: American families, child guidance, and the limits of psychiatric authority
By Kathleen W. Jones. 310 pp. Cambridge, Mass., Harvard University Press, 1999. $47.50. ISBN: 0-674-86811-0

Whom should parents turn to when a son or daughter exhausts their child-rearing capabilities, leaving them at their wits' end? In Taming the Troublesome Child, Kathleen W. Jones, a historian at Virginia Polytechnic Institute and State University, provides an eloquent, erudite account of how, during the first half of this century, psychologists, psychiatrists, and social workers banded together as a child-guidance team to claim sole authority in understanding the causes of and cures for problematic behavior.

Jones's story begins with Progressive Era reformers such as Jane Addams, who “believed in the righteousness of middle-class family values” and set out to impart these to working-class and immigrant families who, because they had not been Americanized, were, in their view, producing feebleminded and delinquent children. These “child savers” were “environmentalists.” Much like their counterparts in public health, they saw troublesome behavior as stemming largely from the impoverished conditions in which children were being raised. However, environmentalism was gradually replaced by emotional determinism, in which children's behavioral problems were seen as rooted in unmet emotional needs.

Jones illustrates this transition to psychodynamic ascendancy using the medical records of the Judge Baker Foundation (later renamed the Judge Baker Guidance Center), which was established in Boston in 1917. The Baker, as it is known locally, was originally a branch of the juvenile court but later served many troublesome children who were brought in by parents. The protagonist in Jones's narrative of this ideological shift is Dr. William Healy, the clinic's first director and the author of its major research study, The Individual Delinquent: A Textbook of Diagnosis and Prognosis for All Concerned in Understanding Offenders, published in 1915 (Glen Ridge, N.J.: Patterson Smith Reprint, 1969).

In his book, Healy presented 20 general categories of “causative factors” for delinquency, including ones that were “developmental, physical, environmental, and psychological.” Most often, Healy determined that a case could be explained only by a combination of several of these causes. To arrive at this position, Healy had to eschew previously popular hereditarian explanations, as well as those linking delinquency to feeblemindedness or other “mental defects.” His scientific approach left him no other alternative. Healy observed that delinquent patients at the Baker did not necessarily have subnormal IQs on the tests that had become a standard part of the clinic's evaluation “ritual.” And because the ideology of the clinic had been popularized by proponents of child guidance (“child guiders”), the clinic's patients were increasingly from “good” middle-class families, not the poor served by the child savers.

Even though they were published more than 80 years ago, the diagrams from The Individual Delinquent, in which Healy showed the “web of causation,” could easily be mistaken for contemporary illustrations, with a few modifications of terminology such as changing “broken-up home” to “female-headed household.” But rather than laud Healy as a visionary, Jones casts him as a kind of villain who “helped sound the death knell of Progressive environmentalism and community intervention,” paving the way for detrimental “mother-blaming” theories (blaming the mother for the child's problems) because of his focus on the individual patient and a “shallow environmentalism” that ignored the importance of class distinctions.

Jones's account is colored by her apparent belief that proper treatments for mental health problems are environmental, but her criticisms are most often oblique and veiled. She comes close to a direct ideological statement when she writes: “At a point in American history, in the midst of the country's worst economic catastrophe, child guidance provided a way to care for all children without any economic restructuring.” Similarly, Jones seems unable to sanction the use of emotional determinism to remove the blame for troublesome behavior from the shoulders of children. In describing Healy's testimony for the defense at the murder trial of Nathan Leopold, Jr., and Richard Loeb, she writes that “the abnormal and abominable behavior of Leopold and Loeb was tamed and made normal through the analyses of expert witnesses.”

In describing the clinic's treatment of 11-year-old Adam, whom Jones describes as a hellion because he had started a fire, stolen money, “and generally made his stepmother's life miserable,” she downplays the fact that Adam had never known his biologic father, that his biologic mother had died, and that his remarried stepfather and new stepmother wanted to “put him away.” Instead, she writes that “security and parentage were a long way from the fire setting, stealing and upsetting behavior Adam's parents had seen as their son's problems. In fact the problem ceased to be Adam's at all as the clinic explored his parents' failure to meet his emotional needs and examined ways to change the parents.”

There are other lacunae. Despite the fact that 90 percent of the children treated in the clinic were boys, Jones tends to illustrate her writing with renderings of girls who were troublesome because they chafed against the narrowness of early-20th-century sex roles. The human element of clinical practice is also missing. Jones writes extensively about how children were “always involuntary participants” at the clinic and how clinicians used deception to sustain treatment, but there is scant mention of caring, connection, or cure.

A great deal of harm has been caused by mother-blaming, especially by the notions of “schizophrenogenic” mothers and “refrigerated” mothers (cold and distant mothers thought to cause autism), and by misguided psychoanalytic treatment such as attempts to “cure” male homosexuality. It is commendable that Jones investigates the events that predated these appalling practices. Her account is well written, informative, interesting, and intelligent. It is also incomplete. Jones finds herself in the position of a psychiatrist who misdiagnoses a patient's disorder because she has not taken a thorough history.

Daniel J. Kindlon, Ph.D.
Harvard Medical School, Boston, MA 02115