Shirah Vollmer MD

The Musings of Dr. Vollmer

History of Child Psychiatry

Posted by Dr. Vollmer on September 25, 2013

It turns out the field is less than one hundred years old. Who knew? James McCracken MD, chief of child psychiatry at UCLA, gave a wonderful presentation of how child psychiatry, a field in its infancy, has evolved, largely through the prowess of some key researchers, many of whom, cut their chops at, what was then called, the UCLA Neuropsychiatric Institute, and now called the Semel Institute. Given that I trained in the 80’s, I have lived through over a quarter of that history. Dr. McCracken reminded us, painfully, that historically speaking, autism was thought to be secondary to “refrigerator parents” and not to the bad wiring, which we have now come to understand. The ugly history that child psychiatrists “blamed parents” for what is most likely, to be a brain disease, is particularly painful. Parents of disabled children struggle with disappointment, guilt and the life-long worry that these children may never be able to be independent. The idea that child psychiatrists exacerbated these negative feelings by wrongly telling the parents that it was their emotional limitations that caused their child not to have friends. Like with any historical exploration, I, as a child psychiatrist in 2013, must accept that my fore-fathers (there were few women in the field at the time), had theories which hurt families. The lesson to be learned, as psychoanalysts  like to promote, is that uncertainty should be tolerated and so not-knowing should create a position of humility in the physician, rather than the certainty of a harmful theory. In essence, we are moving to a greater biological understanding of mental illness in children, but our movement is slow, and the field still depends on a great deal of subjectivity in the physician. I wonder what the next hundred years will bring.

6 Responses to “History of Child Psychiatry”

  1. Ashana M said

    The funny thing about science is that it’s usually wrong, but it’s the best we can do at the time. Blaming parents for a neurological disorder is certainly damaging, but it’s probably better than exorcism.

    • Jon said

      Napoleon Bonaparte is quoted as having said, “[Medicine is] a collection of uncertain prescriptions the results of which, taken collectively, are more fatal than useful to mankind.” This is also intertwined with his statement, “Doctors will have more lives to answer for in the next world than even we generals.” That stated, there has been progress in the last 200 years. There continues to be progress in the last 30 years. Thus, I agree with Ashana that a damaging and incorrect blame of parents for a neurological disorder is not nearly as bad as exorcism.

      • Ashana M said

        I can see why he would have said it then. It was probably true at the time. And a lot of psychiatry has done more harm than good in the last 100 years as well. I have my doubts about our ability to understand our own minds: it seems to be the area our cognitive limitations make it most difficult to see accurately. But I suppose when we can do better, we will.

        • Dear Jon and Ashana,
          I think the problem with psychiatry is that they claimed certainty when there was none! As long as we maintain a place of humility, we will continue to strive to make meaning out of difficult situations. Sitting with uncertainty is the challenge we pose to our patients, but it is also the challenge we should pose to ourselves. I do not think this irony is lost on anyone. Thanks.

          • Ashana M said

            I think that’s exactly spot on. Unfortunately, I think psychiatry and psychology generally still tends to assume there is more certainty than exists. I suspect a desire for certainty is a part of what attracts people to the field–rather than the inherent uncertainty most scientists presume in other fields. And I think it’s holding back innovation–because it is so hard for us to conceive of our minds in new ways or see it from new angles, which is what leads to new approaches and cures.

  2. Shelly said

    Ashana, I don’t think blaming the parent for a neurological disorder is better than exorcism: exorcism probably blames an outside force beyond the control of the parents for the child’s behaviors whereas the alternative simply blames the parents. Even today, I have in-laws who insist there is nothing wrong with my child and that his five separate diagnoses are all figments of my imagination. My child is recognizes as mentally ill from the State–and it’s still “my fault.”

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