The editor of the new quarterly, The Nervous Child, devotes this double issue to a symposium on the still highly contested question of schizophrenia in childhood.
In her introductory remarks the coeditor, Lauretta Bender, points to the fact that the diagnosis of schizophrenia in childhood, which hitherto had been made by exclusion of any other diagnostic possibility, finally can be decided upon by positive criteria. The schizophrenic process in children reveals a characteristic pathology in every field of integrative functioning of the central nervous system. The disturbance should be conceived as a focal disturbance in patterns of behavior reflected through all levels of integration. Dr. Bender
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stresses that dementia præcox does not occur as a narrowing of the brain functioning but 'often as a dramatic emergence of, for example, artistic, philosophic or linguistic preoccupations'.
Under the heading of Biography of a Schizophrenic Child, Charles Bradley gives an interesting case history of a little girl who showed conspicuous seclusiveness at a very early age and an increasingly bizarre behavior; when she retired more and more into a world of fantasy, hospitalization became necessary. The prognosis, in spite of favorable hereditary and environmental background, is considered poor, due to the progressive personality deterioration.
The next chapter on Therapy contains a paper on Treatment of Schizophrenia in Childhood by Frances Cottington and another one by Jack Rapoport, Therapeutic Process in a Case of ChildhoodSchizophrenia. Cottington describes an intensive program for treating schizophrenic children. It has been inaugurated in Bellevue Hospital with the aim 'of bringing the schizophrenic child closer to reality', to 'minimize the pathological process', to 'alleviate the patient's anxiety' and to 'promote personalitydevelopment as far as possible'. About twenty children were treated with a combination of direct therapeutic procedures and an alteration of the environment. Shock therapy was utilized 'as an adjunct to socialization' and to psychotherapy. The author admits, however, that cases who showed symptoms after the age of ten and who received metrazol at about the onset of puberty showed little improvement. However, one patient, a nine-year-old boy, became more accessible to contact after metrazol treatment so that the working through of some of his cannibalistic and other murderous fantasies became possible. Thereupon his fear of aggression appeared and became more realistically related to punishment actually received by the parents.
For the psychoanalyst the most challenging part of the symposium is Rapoport's report on the therapeutic process in the case of an eleven-year-old schizophrenic boy who, after having been erroneously institutionalized as mentally defective, was diagnosed and treated as a schizophrenic. The most alarming symptom was the patient's absolute refusal to eat.
Rapoport used Melanie Klein's psychoanalytic technique and found the oral-sadistic mechanisms described by her. Most of the patient's 'object' conceptions were improperly fused symbols for food and people, e.g., egg-pajamas equalled father, coffee-shirt was interchangeable with mother, crackers stood for his little sister. These objects were literally interchangeable. Rapoport explains that the overwhelming (oral-sadistic) anxiety in this patient, created by early aggression and rejection on the part of the mother, 'knocked out the most basic kind of introjection: eating'. A therapeutic effect was reached through access to toys in a controlled environment, through understanding and 'interpretation' of the play production which led to new and higher differentiated patterns of play. Transference to the doctor, to the 'society' of the ward, and particularly to a nurse who allowed the boy to have 'the experience of an exceedingly kind mother … have been instrumental in helping the patient'.
A really fascinating and thorough piece of research is Tramer's Diary of a Psychotic Child, which was condensed and translated by Drs. Hilde Bruch and Frances Cottington from the original paper published in the Swiss
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Zeitschrift für Kinderpsychiatrie in 1934 and 1935. This is a diary written by the mother of a boy, who after a short period of normal development and a somewhat precocious motor and speech progress, showed signs of disturbances; his development slowed down generally and he even regressed to previous states of motility and speech. He showed a very marked disparity between dependency on, and emotional reaction to, the mother.
Louise Despert makes an excellent contribution in Prophylactic Aspects of Schizophrenia in Childhood, which certainly deserves careful study by all workers interested in the problem. She carefully reviews the pertinent literature and then summarizes her experiences with twenty-nine schizophrenic children, admitted from 1930 to 1937 to the New York State Psychiatric Institute. An impressive psychiatric study of the symptoms and the prognostic criteria, all of which are in full accordance with psychoanalytic points of view, is included.
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Mahler, M.S. (1944). Schizophrenia in Childhood. Psychoanal. Q., 13:131-133