My book, Delivered Unto Lions, is set in a children’s psychiatric unit in the 1970s. The consultant psychiatrist Dora Black has written a ‘brief history’ of the mental health care model reflected in my book. She identifies a 1920s ‘child guidance clinic’ in Boston, Massachusetts, as the originator of the ‘scientific’ approach to ‘deviant’ children. It is, of course, very telling that children with mental health problems were described as ‘deviant’ (or even ‘delinquent’), and this may well account for the persistent impression held by child patients (right up until the 1970s and later) that they were being punished.
‘Child guidance’ came to the UK in 1927 with the founding of a clinic in the East End of London. The honorary director of this clinic was Emanuel Miller, who had trained in Boston, thus reinforcing in Britain the assumptions maintained in that first ever clinic in the US.
Soon there were other children’s psychiatric clinics established in the UK capital: The London Child Guidance Centre in 1928 and the Tavistock Clinic in 1933. By the late 1940s, there was child psychiatric service provision (of one kind or another) in most regions of Britain. Some of this provision was of the residential in-patient variety. A quick look at a British parliamentary Hansard transcript for 29 November 1961 reveals a handful of residential institutions for ‘psychotic or severely maladjusted’ children, including Gwynfa (Colwyn Bay), High Wick (North West London), West Stowell (Oxfordshire), and Merrifield (Somerset – the direct inspiration for Delivered Unto Lions).
It was by the end of the 1960s that the background scenario to Delivered Unto Lions was fully in place. Child psychiatrists were being employed in the UK by the National Health Service (NHS) and were based in child guidance clinics alongside social workers, educational psychologists and ‘remedial’ teachers. Many of these clinics represented joint provision by the NHS and the local education authority.
Dora Black describes how many of the children’s psychiatric services were based in isolated locations, thus separating child psychiatrists from most of their clinical and academic colleagues. Black sees this separation – along with heavy workload – as a block to progress and development; child psychiatrists were left unable to engage in very much research, and in any case, they were largely bereft of the necessary collegiality to support such research. This, therefore, left most children’s mental health disorders misunderstood and improperly treated.
One of the things I find particularly interesting is the use of language in reference to emotionally or mentally disturbed children. The early labels from the ‘child guidance’ movement included terms such as ‘deviant’ and ‘delinquent’. As time moved on the labels changed, but a notion of moral judgement remained; it was as though children were being punished for being unwell.
In my own experience as a child patient I saw some evidence of an attempt by authority figures to change the language of judgement. At the Merrifield Children’s Unit of the 1970s (and in the fictional unit of my novel), it was not uncommon for a child to be subjected to a ‘consequence of his (or her) actions’. Children were not ‘punished’, but they had to endure ‘consequences’. This language must surely have been intended to give the impression that unpleasant penalties (confinement, sedation, etc.) for distressed behaviour were ‘natural’, rather than the result of draconian decisions by institutional staff.
I would hope that since the 1990s, when residential children’s units began to give way to ‘care in the community’, that the closed environment of children’s mental health professionals was finally thrown open to admit some fresh air and new ideas. But the fear emerges that, where ‘care in the community’ is seen as inadequate, the new children’s residential units (such as Orchard Lodge, successor to Merrifield) will withdraw into that same invisible world, isolated from scrutiny and alternative sources of insight.
____________
Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu
For more information visit www.davidaustin.eu
I heartily agree with your comments,David. This judgement by the child psychologists, backed up by the psychiatrists, was deemed to be a correct analysis because it was diagnosed by those trained professionals. If a doctor said it was so, then it was so. Elsewhere you have written about it being impossible to know what goes on in a person's mind. If a person has Chickenpox, it is easily diagnosed by the outward symptoms of the characteristic rash - if the illness is within the state of a person's mind causing that person emotional distress, how can its invisible symptoms be guessed at in order to make a diagnosis? The behaviour of children with emotional distress can be irrational - the behaviour of any of us can be that at times for surely there is no one who has not experienced an overload of stress on occassions. 'Temper tantrums and tears' are common in toddlers as they give vent to their feelings of frustration and this spat of unreasonable conduct is accepted as being just that - an anticipated part of an infant's development. If an older child displayed such tendencies in the era your book 'Delivered Unto Lions' was set, they could be subjected to such health checks as to label them juvenile delinquents. There is not much indication that anyone from the diagnostic team was saying "This child needs help in the form of kindness and understanding." Although we can read of a few instances of compassion shown to Daniel in your book, kindness was not a prevailing feature in that childrens' unit. Punishment (otherwise named: 'a consequence of actions') was. I too, hope that things have improved with modern NHS charters and attitudes......but I share the concerns you express in your last sentence.
ReplyDelete