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ADHD: Attention Deficit Hyperactivity Disorder
Childhood Mental Disorders and Illnesses

by Kathleen W. Jones
Harvard University Press, 1999
Review by Kevin M. Purday on Mar 25th 2003

Taming the Troublesome Child

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.