PEDIATRICS Vol. 2 No. 4 October 1948, pp. 405-409
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PSYCHOTHERAPEUTIC ASPECTS OF PEDIATRIC PRACTICE

HILDE BRUCH M.D.1 and DONOVAN J. MCCUNE M.D.2

1 The Department of Psychiatry, College of Physicians and Surgeons, Columbia University.
2 The Department of Pediatrics, College of Physicians and Surgeons, Columbia University.

THE profound importance of emotional influences for the healthy or abnormal development of children is now generally recognized. Knowledge of this fact is so widespread, indeed, that one can scarcely open a medical journal or popular magazine without being confronted with it. This cartoon illustrates the fate of maldevelopment. It shows father, mother, sister and brother—all of them at once—under psychoanalytic treatment. The caption explains that a neurosis has its basis in conflicts within the family group. One might well raise the question: "Why did things go wrong to such an extent? Couldn't their pediatrician have advised them so that at least the children would have remained well?" This is a troublesome question from the point of view of both the psychiatrist and the pediatrician.

Psychiatrists have been very articulate in talking about the need for better emotional care but frequently the pediatrician has been left in a state of doubt and frustration. There has been too much emphasis on psychiatric methods from the psychiatrist's point of view and too little attention has been paid to the psychotherapeutic possibilities that are inherent in the practice of pediatrics.

The conventional and most fascinating way of demonstrating the importance of psychologic factors is the extensive case history which tells in detail all the vicissitudes of a child's emotional development and how the psycho-dynamics of his inner life are related to the many complaints and symptoms which had been resistant to traditional medical treatment.

The usefulness of such accounts for the pediatrician is their demonstration of what psychiatry can do and what patients might benefit from psychiatric treatment. Yet this treatment is time consuming and it requires special training and experience and it cannot be part of the practice of pediatrics.

Submitted on May 25, 1948




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