There are books that promise a lot
and deliver little, books that seem not to promise a great deal but are
immensely rewarding, and everything in between. Taming the Troublesome Child
sounds like one of those hundreds of books aimed at giving parents advice on
how to cope with their obstreperous offspring. However, the sub-title, American
Families, Child Guidance, and the Limits of Psychiatric Authority, gives an
indication of the real subject matter. This is one of those wonderfully
understated books which make a genuine contribution to our understanding of the
relationship between authorities representing social versus medical factors in
our analysis of the aetiological factors involved in childhood disorders. As such, it deserves a place on the
library shelves of all colleges and universities which run courses on the
history of medicine.

The author, who is Associate
Professor of History at Virginia Polytechnic Institute and State University,
has used a great deal of primary source material, most especially the case
files from the Judge Baker Guidance Center in Boston, covering roughly half a
century. Her main thesis is simple: whoever wins the battle to wield the most
authority has the power to define the problem and dictate the solutions. The
problem is juvenile delinquency and the combatants trying to monopolise authority are mainly the
psychiatrists, psychologists and social workers. Caught in the crossfire, so to speak, are the
juveniles themselves and their parents. The author sets this problem in a wider
historical context covering the period from the 1880s to the 1980s. Massively
important issues are raised along the way: the nature versus nurture
controversy; labelling; biological versus social interpretations of
delinquency; the nature and meaning of intelligence; biological versus social
causation of mental illness; and many more.

Jones sets the scene towards the end of the nineteenth century when
juvenile delinquency or sociopathy was already a serious problem in many of the
U.S.A.’s large cities and boys could be sent to penal institutions as a result
of petty misdemeanours and girls could be removed from their homes and
institutionalised for showing too much interest in the opposite sex. She then
charts the setting up of a professional child guidance scheme with
psychiatrist/physician, psychologist and social worker sharing the work. The
development of this scheme is then traced and along with it the rise of
specialisms such as paediatry and child psychiatry. She is particularly good at
revealing the slow rise of the blame culture whereby society, unable to face up
to let alone do anything about the appalling social and economic conditions in
which so many children grew up, had to place the blame on the children
themselves or on their parents. The chapter entitled The Critique of
Motherhood is fascinating as is the account of Momism in the
following chapter. Her short account of how “Strecker held moms responsible for
everything from alcoholism and homosexuality to public-spirited ‘movements’ and
fascism” (p.211) is riveting. Dads didn’t escape entirely but the poor mums got
the brunt of the attack.

The constant medical specialisation together with the continual raising
of new biological issues and the extending of psychodynamic theories undermined
but did not quite destroy the socio-structural concerns which the child
guidance movement thought sufficiently important to lead them to view their job
holistically. For example, Jones deals with the landmark report of the Joint
Commission on Mental Health of Children issued in 1970 and its castigation of
the social conditions in which many children were raised. However, she notes
that its recommendations failed to endorse broad social changes and that it
merely piously hoped that in time these conditions would improve.

The last part of the book is quite shocking. The author mentions the
figures produced in 1988 which showed that twenty percent of American children
were sufficiently seriously psychologically disturbed as to need treatment and
that these twenty percent were merely the worst with many other children being
not far behind. Just as Peter Breggin uses the figures of millions of children
diagnosed as having ADHD to plead with the medical community to rethink its
aetiological analysis of mental disorder, so too does Jones use the 1988
statistics to beg us to look closely at the situation. She suggests that a
closer look will reveal that the growth in psychiatric authority has restricted
our vision. Concentrating ever more exclusively on the psychological flaws of
children and their parents has coloured our views so much that we are wary of
socio-structural explanations. The state finds this quite convenient because it
enables the agencies to redirect the funding to other projects. In short “it
leads us to examine only the individual schoolyard shooter instead of the
culture in which he lives.” (p.228) These surely are wise sentiments and the
author ends by asking for child guidance to go back to its roots when social
and individual factors were all taken into account and when practitioners had a
social conscience. As the author says, quoting from Hillary Rodham Clinton, “it
takes a village” to raise a child. (p.217)

This is a fine book and is to be recommended to anyone interested in the
upbringing of children and it will be of particular interest to those
interested in the history of medicine and the role of psychiatry in defining
what is abnormal and its causes.

© 2003 Kevin M. Purday               

Kevin M. Purday teaches at
Worthing Sixth Form College, in the UK, and is currently a distance-learning
student on the Philosophy & Ethics of Mental Health course in the
Philosophy Dept. at the University of Warwick.

Categories: Ethics, ChildhoodDisorders, Psychology