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A PSYCHOLOGY OF

Growth

by BERT I. BEVERLY, M.D.

Rush Assistant Professor of Pediatrics

College of Medicine, University of Illinois

Instructor in Psychology, School of

Nursing, Presbyterian Hospital,

Chicago, Illinois

McGRAW-HILL BOOlCHS^4PANY, INC.

^ftf""*"' *****

New York and London
1947

A PSYCHOLOGY OF GROWTH

COPYRICHT, 1947, BY THE

MCGRAW-HILL BOOK COMPANY, INC.

PRINTED IN THE UNITED STATES OF AMERICA

All rights reserved. This booh, or parts
thereof, may not be reproduced in any form
without permission of the publishers.

FIRST EDITION

TO MT WIFE

Preface

E COURSE in psychology that has been developed
during the past fifteen years for the instruction of
students at the Presbyterian Hospital School of Nursing,
Chicago, Illinois, is the immediate source of most of the
material for this book. The purpose of the course has
been to give nurses the understanding of themselves and
their patients that is essential to a mastery of the art of
nursing.

Many clues to adult behavior lie far back in childhood.
Every presonality is a composite of the attributes with
which the individual came into the world and the atti-
tudes and habits of response that he has developed through
the years. His problems usually have their origins in his
early life. In order to understand him, therefore, it is
necessary to study mental growth and development from
infancy through childhood and adolescence. Such a
a course of study not only gives the nurse an insight into
the causes of her patients' behavior but, by helping her to
trace the origin and development of her own personality
characteristics, makes her better able to understand her-
self and to adjust to her environment.

This is a matter of great importance and no little
difficulty. Many students enter nursing school imme-
ditely after high school, when they are still in the
adolescent period of growth and have to make many per-
sonal adjustments to society in general. At this already

vii

Preface

complicated stage of their development, they accept the
additional handicap of leaving home, many of them for
the first time, and trying to stand on their own feet, meet
new situations, and solve problems without the accustomed
support of their families. When students nurses enter the
hospital they find themselves plunged into a system that
is both unfamiliar and complicated. Standards are high,
accuracy and precision are essential. Because patients
are uncomfortable and frightened, their personality diffi-
culties are exaggerated and they are usually more exacting
than the persons with whom the nurses have been ac-
customed to deal. The students' relations with one an-
other also are complicated by the diversity of their social,
religious, and political background and by the inequality
of their intellectual capacities, manual dexterity, and emo-
tional maturity.

Although student nurses generally exhibit a remark-
able ability to adjust themselves to trying circumstances,
it is not reasonable to suppose that any of them can be
wholly exempt from personal difficulties. Some are aided
by self-confidence, self-reliance, and a feeling of security,
while others suffer the handicaps of insecurity, a sense of
inferiority, and irrational fears. The school of nursing
should be equipped to help them all solve their problems
and make their adjustments, both as a means of maintain-
ing their own mental and physical health and to aid them
in acquiring skill in caring for their patients and making
them comfortable. For this reason, schools of nursing now
provide in their curriculums a course in psychology. The
most thorough of these courses include not only lectures

viii

Preface

and full class discussion, but also private consultations
with the teachers concerning those personal problems that
a student may not wish to discuss in class.

While taking full responsibility for the statements in
this book, the author is indebted to many colleagues
and writers for their ideas and has given credit wherever
possible. The most stimulating and most frequently
quoted ideas are those of Dr. Franz Alexander, Dr. Arnold
Gesell, Dr. Ralph Hamill, Dr. Karl Menninger, Prof.
Hughes Mearns, and Dr. Carleton Washburn. The au-
thor is indebted to Mrs. Carrie Belle McNeil, Presbyterian
Hospital, Chicago, for invaluable aid and cooperation in
working with student nurses and is especially indebted
to Ruth G. Bergman for editorial assistance and to Doris
Thompson for research assistance.

BERT I. BEVERLY.

Chicago, 111.,
October, 1948.

Contents

Preface xi

Foreword by Lucile Petry xiii

1. The Foundation of Mental Health 1

2. The Two-Year-Old 20

3. Adjusting to Environment 31

4. Intelligence 41

5. Mental Deficiency 64

6. The School Child 79

7. Fears 92

8. Causes of Behavior Problems 108

9. Behavior Problems 119

10. Preadolescence 147

11. Adolescence 158

12. Juvenile Delinquents 186

13. Adults 199

List of Visual Aids 225"

Index 233

A chapter summary is given on
the fast page of each chapter.

Foreword

nr*HE PUBLICATION of such a book as "The Psychology
of Growth" and its use by students of nursing con-
stitute recognition of an important human relationship,
that between nurse and patient.

For the nurse it is essential that she have scientific and
humane understanding of the patient so that her care will
stimulate his continuing development to maximum
capacity for living. She must understand what makes
the patient into the person she finds. This understanding
increases her usefulness as a member of the health team
whose goal for the patient is preventive, therapeutic, or
most commonly both.

From other sources the student of nursing has learned
that at birth the infant possesses a pattern for physical
development. From this book she learns, in addition,
that he possesses a pattern for the development of mental
and emotional health. She learns the characteristics of
an environment which educe optimum development of
the individual. Two primary attributes of this environ-
ment described at length by Dr. Beverly, are "security"
and "standards appropriate to the age and characteristics
of the individual."

In the care of children, both as mother substitute and
as mother adviser, the nurse has a rich opportunity to
assure the provision of this security and the appropriate-
ness of these standards. In the care of the adolescent or

xiii

Foreword

adult she deepens her understanding of the patient's be-
havior when she learns the extent of the security given
him as a child and his reactions toward the standards held
for him or developed by him. Her care of all patients is
enhanced by her recognition of the two-way relationship
between physiological reactions and intense emotions,
rational or irrational. Knowing the psychological effect
upon the individual of feelings of optimum security, of
exaggerated dependence, or of rejection, the nurse comes
to understand the degree of maturity of the patient. The
concept of the "neurotic" a word sometimes improperly
used by the nurse is brought into truer focus. She
becomes less liable to errors in judgment and in handling
of patients, and she will learn to ease the ''inevitable
tension that lead to mental and emotional distortions."
The role of anxiety and of illogical prejudices in the de-
velopment of her patient's personality sometimes explains
his behavior to her and enables her to give him more
effective care.

In addition, the student who uses this book will find
fundamentals which will guide her in understanding her
own behavior. She is given concepts worthy of thorough
study as applicable to herself. The instructor who en-
courages self-directed learning in her students will provide
opportunity for free consideration and manipulation of
these concepts by each member of the class. She will
stimulate the student's search among the sources listed
as references.

Achieving insight into her own reactions will improve
the nurse's relationships with her patients, their families,

xiv

Foreword

her coworkers, and her friends. The development of an
objective attitude toward behavior her own and that of
others will make her a more effective agent for the pro-
motion of positive health through caring for patients,
through health education, and through assumption of
effective citizenship activities.

LUCILE PETRY.

Chapter One

The Foundation of Mental Health

Lifers patterns are largely determined by ancestry.
The vitality, temperament, and potentialities for growth
are already present at birth and cannot be changed. Growth
takes place according to a definite sequence. The baby
acts in the way he feels and immediately begins to form
habits of response to his environment. Given security and
standards appropriate to his age and individual character-
istics, he responds with optimum growth. The feeding
schedule is determined by the rhythm of the individual baby.
He is given as much food and affection as he wants. He
takes responsibility for toilet habits when he is ready.

THE infants now lying in their cribs will one day de-
termine the course of civilization. They will inherit
the reins of government, the control of industry, the power
within the atom. What use they will make of this tremen-
dous heritage, for good or evil, will depend, in large meas-
ure, on the way in which we bring them up and help them
to develop their latent abilities.

We cannot go into the nurseries and say unequivocally
that this infant is a potential Lincoln, that one an Edison,
and the other a good average citizen. We can, however,
assess certain physical, mental, and emotional traits that

- 1

A Psychology of Growth

should guide us in our approach to each child and help us
to care for him in a way that will bring out the best that is
in him, insure mental health, and permit him to become a
competent, well-adjusted, happy member of society. Con-
versely, experience tells us that in twenty-five years many
of the newborn babies who are now normal and healthy
will be suffering from that mental ill-health which is a
deterrent to individual success and a drain on social prog-
ress. What can we do about this situation?

It is obvious that during a child's infancy his parents
(mothers directly and fathers indirectly) are the masters of
his fate; but he never entirely throws off the yoke of their
influence and for that reason it is essential that they be wise
masters. In this incalculably important task they should
be able to get valuable help from nurses and physicians,
since these are the only professional groups that are in fre-
quent consultation with parents during the children's most
formative years. Because of the responsibility that thus
rests on professional advisers, it is necessary for them to
know what things are essential for mental health and how
it can be preserved.

At the outset, they will recognize that a baby's poten-
tialities for development are born, not made. Fortunately,
since nature is wiser and more consistent than parents, there
is no physical or psychological alchemy by which anyone
can change an infant's innate racial or individual character-
istics. That is a natural law that man has recognized and
accepted submissively in its application to every living thing
except children. No farmer expects a pear tree to bear
apples; no cattleman hopes that his herds will produce wool.
For the same reason, no parent should plan to transform

The Foundation of Mental Health

his stolid, down-to-earth child into a poet, or one who may
be color blind into a painter.

The agriculturist, to be sure, has this advantage over the
parent: his sapling looks like a pear tree; his calves are
unquestionably going to be cattle. To the parent most
babies appear much alike. He cannot tell by looking at
his newborn child whether he has on his hands a dancer
or a mathematician, a singer or a scientist, or any one of a
hundred beings that fathers and mothers want their children
to be or to avoid becoming. Clues to this mystery are
scattered through the family history, but for the complete
solution the parent must wait and watch and permit the
gradual unfolding of the child's personality. It is a fascinat-
ing process and can be made to yield the most satisfying
returns if the parent will be patient and will not expect his
young pear tree to appear some day wearing apple blossoms.

Just as the farmer knows that he cannot change nature,
he realizes that the only way he can improve her handiwork
is by collaborating with her. If he enriches the soil and
provides water and protection from parasites, he may expect
his tree to grow and flourish within the limits set by nature.
He will not, however, demand that its sap should rise before
spring or that it should bear fruit the first summer. Parents
who are equally realistic will not try to force their child to
walk before he is ready or to talk at the same age at which
his brother talked or to play the violin because the next-
door neighbor's child shows musical talent. They will
recognize that their baby is what he is, that his pattern of
development is predetermined, that they cannot change
nature but, if they abet her by enriching the soil, by pro-
viding nourishment and protection, they may help the child

- 3

A Psychology of Growth

to achieve that sought-after miracle of growth and perfec-
tion which can be obtained in no other way.

Life, then, is a growth process beginning with a two-cell
organism and continuing at least to senility. The greatest
progress that has been made in the understanding of human
behavior has resulted from observations of this process.
Observations by pediatricians, educators, psychologists, and
psychiatrists have contributed to our understanding of hu-
man behavior and of the factors that promote mental health
and of the causes of mental ill-health. One means of
understanding all human behavior, therefore, is to seek it
through a consideration of the phenomena of growth.

It is possible to approach the subject through the study
of one individual, taking into account only those things
which pertain specifically to him, or from the standpoint
that "every human being and his whole existence are a link
in the long chain of historical evolution, a part of the eternal
life stream. In this type of experience, existence is no
longer defined by the personal past, instead the impersonal
past creates for the individual experience a timeless back-
ground, a perspective of 'eternity' and 'immortality'." 1
From the latter point of view it appears that the infant, at
birth, is not a new but a very old individual. In Aldrich's
words, "each newborn is actually a living replica of the
individual that came into the light of day long before the
dawn of history." 2 His behavior reveals the unfolding of
patterns developed by the countless generations of his fore-
bears; he will pass them on to the generations to come.

Before birth, growth proceeds at an enormously rapid
rate. The two cells of the original organism separate and
differentiate and, at the same time, synthesize and coordi-

. 4 .

The Foundation of Mental Health

nate their functions. There is a division into cell groups,
which multiply and form organs. Each group of differ-
entiated and integrated organs forms a system and the
various systems make up an individual as a whole. In the
end, the two cells become six billion cells, each with meta-
bolic processes and established behavior within itself and in
relation to all the other cells of the body. There are, then,
cells, organs, and finally an individual behaving according
to a specific plan. In psychology, we are interested pri-
marily in the central nervous system, but we must remember
that each system influences all the others. A new field,
psychosomatic medicine, has to do with the effect of the
central nervous system on the other systems. Obviously,
the other systems often affect the central nervous system.

Growth takes place from within. We cannot add to a
child's stature by grafting flesh on his bones, nor can we
increase his mental capacity by trying to force knowledge
into his head. The process is much simpler than that. We
give him food and physical care and he responds with bodily
growth; we give him affection and supply his intellectual
needs and he responds with mental growth. If we with-
hold this nourishment we may stunt his frame and distort
his mind; otherwise, we cannot change his characteristics.

Each individual is endowed with growth energy and is
motivated by inherent drives. He has a lifetime storage
battery that stimulates growth and the unfolding life pat-
terns. This force, which may be called aggression or
vitality, is normally constructive and capable of producing
optimum growth.

His rate of growth also is established and we can alter it
only in an unfavorable way; that is, we may retard it, but

A Psychology of Growth

we cannot appreciably hasten it. Growth takes place in an
orderly manner, according to a specific pattern. Every
muscle is formed by a regular process and in a precise
sequence. Behavior traits grow like an automobile on an
assembly line. Nature is the master designer; if we try
to change her plans, the result is a faulty product; it is only
by helping her to carry out her plans to perfection that we
can be said to take the best possible care of the infant and
the growing child. We can, however, supply the kind of
care that he needs in order to attain the best possible health
and develop his native, irrevocable powers to a maximum
degree. This care begins at birth and its continuance dur-
ing the child's first few years is extremely important, since
infancy is the period when he forms the emotional patterns
that will serve him throughout life.

A baby is born with a mechanism for response to his
environment. He reacts in terms of feeling; that is, he acts
in the way he feels. Feelings are the conscious mani-
festations of emotions, which, in turn, represent instincts or
life energy, the basic drives motivating all life processes.
Under certain conditions an individual feels frightened;
under others, resentful. When his emotional needs are
met, he feels satisfied and responds with confidence and
complacence.

Satisfaction of his specific needs also permits a child to
achieve maximum growth. For bodily growth he requires
adequate food and physical care; for mental growth he
needs security and an opportunity to do things appropriate
to his age and ability. Security is a feeling that is given
to a child from birth by parents particularly by a mother
who wanted him in the first place and now accept him as

6 -

The Foundation of Mental Health

he is. It is a feeling of confidence and trust and all-
rightness, which grows deeper and stronger and more sus-
taining as parents manifest their willingness to permit him
to develop in accordance with his individual pattern and
with those standards which conform to his own capacity
and level of growth. Coupled with these attitudes, the
child must always have the satisfaction of doing those things
of which he is capable without being retarded or pushed to
reach some artificial standard or to fit some preconceived
idea on the part of the parents. When these basic needs are
fulfilled, the child can adjust himself to his environment,
can develop the self-confidence that he needs to form habits
of responsibility, and can grow up to be a reliant and reliable
individual.

All behavior is expressed in terms of habit. Thus the
infant, from birth, forms the habit of responding to his
environment with satisfaction and complacence on the one
hand, and with fear and resentment on the other. The
former pattern, if it becomes dominant, leads to mental
health, the latter to mental ill-health. However, there
are justifiable fears and resentments, emotional responses
that represent the instinct of self-preservation and are
therefore vital to the individual's existence. The child
who reaches maximum growth, which means mental health,
is able to experience the self-confidence that will allow him
to meet situations in an intelligent manner. This goal is
not always reached, but it should be our aim in rearing
children.

The infant is a selfish little animal, concerned only with
his own growth needs. He is controlled by those primitive
drives which are primarily concerned with self-propagation

. 7

A Psychology of Growth

and self-preservation. At the same time, he is confronted
by a complex and complicated society which, in his adult
life, will demand the curbing and sublimation of a part of
his impulses to conform to the high standards of civilization.
This would create a critical situation if it were not that
adaptability is one of the salient characteristics of the human
organism. This adaptability, however, is part and parcel
of the growth process; it is slow and continuous, and twenty
or twenty-five years is a short period in which to achieve it.
In early infancy, the child is passive in his demands, that
is, when his needs are not supplied he cries; but as he learns
to use his body, and as his intelligence grows and his emo-
tions mature, he tries to gain satisfaction by more active
efforts. Since he is growing and using his constantly
increasing abilities, he becomes more aggressive in his
attempts to satisfy his inner cravings, and in this he is
successful, provided that his environment does not present
too many obstacles. If too much is expected of him he
becomes frightened and resentful and his aggressiveness may
become partly destructive instead of being the constructive
element that is necessary for success. Then, because his
conscience causes him to feel a sense of guilt, his destructive-
ness may be partially turned against himself and he will do
things that harm rather than help him in his efforts.
Menninger says, "If we can imagine a parent sufficiently
skillful to replace each satisfaction of which the child is
deprived by another satisfaction that the child could accept
as approximately equivalent, without disloyalty to the
requirements of reality, we should expect to see in the prog-
eny of such a parent an ideal person, not one without
aggression but one without a sense of being thwarted in the
8

The Foundation of Mental Health

adventures of life, and without hate for anything except
those things which should be hated and fought against in
defense of his own ideals and best interests." 3

At first thought, these fundamentals seem to be too
simple; yet they are the principles'around which the human
race has developed during the countless centuries it has been
in existence. It is only since society has become more com-
plex and the individual has therefore encountered greater
difficulty in adjusting to its standards that parents have
tried different methods of rearing children and that mental
ill-health has increased. If we go back to the beginning of
history, we find that self-preservation and the protection of
the family were the sole business of the father; the mother
cared for^the child, keeping him close in infancy, providing
him with food, water, and warmth and permitting him to
set his own pace for performing new acts and learning new
skills. Even though society has undergone marked changes
since our ancestors lived in caves and tents, babies have
remained very much the same. We find that the young
baby who was born yesterday is unhappy unless he is close
to his mother for a considerable part of the time and receives
the same care that the primitive woman bestowed on her
child thousands of years ago. Changes in the rules for
rearing children, therefore, reside in the details rather than
in the fundamentals and are not necessitated by alterations
in the human race but only by the increasing intricacy of
civilization, which makes it necessary for us to use greater
care in rearing children so that they can "take it."

With these general statements in mind, let us now go into
the hospital and observe a group of babies. Most of them
are sleeping, but their sleep is not quiet or continuous.

A Psychology of Growth

Their breathing is rapid, then slow and shallow. For a
short time they lie still, apparently sleeping deeply; then
they partly waken, tense their muscles, pull up their arms
and legs, wince, and go back to sleep. These actions are
performed by their bodies as a whole; there are no move-
ments of individual muscle groups. Their crude move-
ments are indexes of the immaturity of the babies. Their
nervous systems are still in the process of development; their
nerve pathways are not complete and the nerve sheaths are
not fully formed.

From time to time, different babies will cry. It may be
because they are hungry, in pain, too warm or too cold, or
wrapped too tightly. A sense of falling or a loud noise
startles them and causes them to cry. A nurse picks up
one of the wailing babies and in a moment or two he is
quiet. Studies by Dr. C. Anderson Aldrich and his associ-
ates 4 at the Mayo Clinic indicate that the amount of crying
is inversely proportionate to the number of nurses on duty;
when the babies are picked up more frequently, they cry
less. They cry when they are separated from their mothers
for too long a time.

A baby is equipped at birth with several important re-
flexes. As soon as he is born, he automatically begins to
breathe. Nor does anyone have to teach him how to nurse.
When his cheek is placed against the mother's breast, he
reaches for the nipple and sucks. X-ray films have demon-
strated that babies sometimes suck their thumbs or fingers
before birth. The reflex response to pain is well known.
In every normal baby the Moro, or startle, reflex is also
present. It is produced by a loud noise or a sense of falling,
which causes the infant to become rigid, thrust his arms
forward in an arc, make clutching motions with his fingers,

The Foundation of Mental Health

and utter a despairing cry. In the distant past this reflex
was related to self-preservation and still expresses protest
against minor insults. It is absent in cases of birth injury
or irritation of the brain from other causes.

These are elements that are common to all babies, but
as we observe the occupants of the nursery one by one on the
examining table we find certain marked differences, notably
in size, build, and behavior. This one, who is diminutive
in stature, has small parents and will probably follow the
family pattern. The next infant is relatively tall and large-
boned. He may become a big man, like his football-
playing father. Scientific investigations of growth indicate
that children are likely to follow these patterns, notwith-
standing nutritional advantages or disadvantages.

Similarly, we can ascertain some of the ^mental poten-
tialities of these very young persons before us. The nurse
tells us that this one tried to nurse, the day he was born.
In so doing, he passed his first intelligence test and gives us
reason to believe that he is normal mentally. By smiling
before he leaves the hospital, or within the next few weeks,
he strengthens our confidence in his intelligence. The next
baby whom we examine causes us grave concern, because
he is two or three days old and has not yet tried to suck.
For that reason we must consider the possibility of a brain
injury or lack of brain development. The intelligence or
lack of intelligence of these two babies will continue through-
out their lives. At this early stage of their development, we
cannot say that some of the babies in the nursery are
endowed with musical ability and that others will show
mechanical aptitude; but even such characteristics may be
tentatively deduced on the basis of family histories.

Different degrees and types of emotional response also

A Psychology of Growth

appear while we have these babies on the examining table.
We can test their reactions by extending their legs and
holding them firmly. One infant is not greatly concerned;
one cries mildly when he is held too long; a third protests
more vigorously, but stops as soon as he is released; while
another becomes tense, cries violently and continues to wail
after he is released. Each infant will behave in the same
manner when his face is turned away from the mother's
breast after he has been nursing only a few minutes. These
responses to unpleasant situations are constant for each
infant and may continue throughout life. (Sufficient ob-
servations for proving this idea have not yet been made.)
The last-mentioned infant, for example, will react violently
whenever he is displeased. This reaction must be accepted;
it cannot be changed. It may be designated as the tem-
perament of the individual.

Thus we see that each baby at birth has a well-developed
and functioning mechanism by means of which he responds
in terms of feeling to his environment. When his physical
and emotional needs are satisfied, he is quiet; otherwise, he
is restless and cries.

Provided that we satisfy the baby's essential needs pre-
viously described, we shall see his growth patterns slowly
unfold and shall have the pleasure of observing how his
abilities increase and adapt themselves to a more complex
environment. But the parents are entitled to some specific
information, in order that they may know what to expect of
their child. They need to learn his characteristics and the
program that they should follow. Because of the close
relationship between physiological functions and emotional
satisfactions, it is important to adjust feeding and other

The Foundation of Mental Health

health schedules to the emotional needs of each individual
infant. We should consider the child as a whole, so that
both the physical and the mental aspects of his growth
will receive attention.

The emotional outlets of the baby are confined largely to
feeding, fondling, elimination, and warmth. It is impor-
tant, therefore, that these satisfactions, which have physical,
physiological, and emotional aspects, should receive careful
consideration, from both a physical and a mental stand-
point.

FEEDING

In regard to feeding we should keep in mind a few im-
portant facts. First of all, a baby is given more security
from breast feeding than from any other source. It pro-
vides an intimate relationship between the mother and the
child and is reassuring to the infant, who at birth was sud-
denly separated from the mother's being. If a mother is
not able to nurse her baby, she should take him in bed with
her and hold him in her arms while giving him the bottle.
During the time that they are in the hospital, therefore,
every baby on a bottle should be carried to his mother
("banana wagons" are out) at each feeding time. At all
ages, children should be offered food never be fed. From
birth forward all well, normal children eat a sufficient
amount of food to maintain health and promote growth.
Only the child himself can determine the quantity of food
he desires or needs. When the stomach is empty, painful
contractions, together with sensations that come from body
needs for food, stimulate hunger. When the stomach is
filled with an amount of food that satisfies these physio-

- 13

A Psychology of Growth

logical needs, hunger disappears. In addition to acquiring
food, however, sucking provides an emotional satisfaction.
That is the reason why all babies suck their thumbs and they
should be allowed to do so. As their emotional needs are
met in other ways, they give up thumb sucking with the
bottle (at the age of from one to two years), returning to
the habit only when they are tired or angry, and then only
for short periods. *

The feeding interval depends upon the baby himself.
Each baby comes into the world with a fairly regular sleep-
ing and waking schedule (rhythm) of his own. He usually
sleeps about three, three and a half, or four hours at a time,
or perhaps three hours for the daytime naps and four for
those at night. From careful observations, Gesell 5 found
that babies awaken less often during the night than during
the day. At the end of each interval, the baby wakes up
and cries. If he is fed, fondled, and made comfortable, he
soon goes back to sleep. Especially during the first few
weeks of life, it is important to adapt the feeding schedule
to this individual waking rhythm, regardless of the irregu-
larity of the program. Such a schedule is never regular,
because the rhythm cannot conform to a time schedule and
at A best can only approximate a three-, three-and-a-half-, or
four-hour program.

A four-hour baby (that is, one who eats at intervals rang-
ing from three and a half to four and a half hours) who is
permitted to determine his own feeding schedule will usually
give up the night feeding during the first four or five weeks.
In other words, he will not wake up, and the mother may
omit the feeding. The three-hour infant will be likely to
continue on his original schedule for several weeks. When

The Foundation of Mental Health

the mother reports that he does not seem hungry, the doctor
will know that he is probably ready for a four-hour schedule,
and at six to ten months of age it will likely be discovered
that the time has come for a three-meals-a-day schedule.

Infants readily learn to take food from a teaspoon if it is
offered to them before they are five months old. At six
or seven months, when they like to put things in their
mouths, they may be offered milk from a cup each day.
If they are not hurried, they will learn to prefer the cup to
the bottle and, in most cases, will give up the latter when
they are between the ages of ten and twenty-four months.
Most children from thirteen to fifteen months of age have a
desire to feed themselves and can master the art in a few
months.

At fifteen months, then, we may find a child on a three-
meal schedule, feeding himself (with, perhaps, a little help
and an abundance of patience on the part of the adult in
charge), and eating a sufficient amount of food for health
and gain. He may have given up the bottle or will soon do
so. He has developed these important health habits with-
out restriction or force, but as a result of having had an
original food schedule that conformed with his own rhythm
and was adjusted from time to time as his growth needs
changed. This fact may be considered as an illustration of
progressive education.

AFFECTION

Parents want to know how much affection they should
show their babies. This is an important question and
deserves a specific answer. (1) We should emphasize the
fact that security, of which affection is a part, should be

15 .

A Psychology of Growth

given the baby continuously by the mother or by one
mother substitute, that is, the infant should be cared for
by the same person day after day, and not by one and then
another. (2) The quality of the affection is more im-
portant than the quantity. The best kind of affection is
given by a mother who needs the baby as badly as he needs
her. It is not given from a sense of duty and is not forced,
as in the case of a mother who is unduly fatigued, but is
bestowed spontaneously and without anxiety. (3) The
amount of affection is inversely proportional to the age of
the infant. During the first weeks of life the infant should
be close to his mother, much more so than when he is older.
In general, a child should receive as much loving attention
as he wants, but should not be used as an emotional outlet
by parents and other adults. Fondling, up to, but not
beyond the point of fatigue at each feeding period, is usually
sufficient.

A comfortable rocking chair is an essential adjunct to the
nursery. When that is supplied, the nurse or the mother
can rock the baby during and after his feeding. He knows
how much fondling he wants and will soon communicate
his wishes to the person holding him so that she will know
when he has had enough and is ready to go back to his bed.
If she misinterprets the signals and the baby cries for more
attention, she should hold him for a longer period. In
order to make the baby feel secure, affection should be given
largely by one individual, preferably his mother; he cannot
be passed around for the pleasure of the friends and rela-
tives. The mother need not be disturbed about the possi-
bility of spoiling the baby by following this method. Spoil-
ing is a different matter, which we will discuss later.

The Foundation of Mental Health

TOILET TRAINING

Toilet training should start as soon as the infant is ready
for it. That time comes when he is old enough to under-
stand the use of the toilet, generally at the age of twelve to
fifteen months, if his emotional growth has reached the point
where he enjoys this accomplishment and wishes to take on
the responsibility for it. The mother or the nurse should
then place him on a comfortable toilet (preferably, a small
chair with a comfortable footrest) at the time of day when
he usually has a bowel movement. She may massage his
abdomen lightly. If she praises him for a new accomplish-
ment and treats his failure with unconcern, he will soon get
so much more satisfaction from using the toilet than from
soiling his diaper, that he will take the responsibility for
this habit. When he fails to do so, it is because he is not
ready or the efforts to hurry him have been too great. ^U

Most children train themselves for bowel movements dur-
ing the day, at the age of twelve to eighteen months, and
remain dry at twelve to eighteen months. They usually
discontinue bed wetting when they are between eighteen
and thirty-six months of age. It is important to remember
that children accept these responsibilities when they are
ready, when they want to, and not before. If the child is
allowed to take responsibility (toilet training, for example)
when he is ready (grown sufficiently), the function will not
assume undue importance in his mind. If the training is
started too early and too vigorously, it will assume pro-
portionately greater importance in the individual's mind
throughout life.

A Psychology of Growth

RELATIONSHIP TO OTHERS

During the first few months, an infant will not actively
rebel when he is held by someone other than his mother,
unless the situation is too strange and he is held awkwardly
and uncomfortably. He will apparently accept mother
substitutes contentedly if there are not too many. At about
the age of six months, however, his mind is sufficiently
developed so that he can distinguish between individuals.
When this occurs, he nearly always cries at the approach of
unfamiliar persons. He begins to show real anxiety when
he is separated from his mother. This is well illustrated
by his wails when he is taken to a physician's office for
routine examination. The nurse and the physician can
modify this behavior by the manner in which they handle
the baby. Just as his protests will be violent if he is held
in such a way that he cannot jnove, so they will decrease
if he is permitted to sit on his mother's lap or if she or the
nurse holds h'm during the examination. From these
observations it becomes evident that the baby does not cry
solely as a result of the inoculations he receives in the doctor's
office, but also because of his natural feeling of insecurity
when strangers approach, and especially if they take him
from his mother.

A mother, to be sure, cannot remain with her baby con-
stantly, but when she is obliged to be away from him it is
best to have her place taken by the same individual every
time. The baby feels more^secure^when he is cared for by
his mother and, in her absence, by the one substitute. It
follows that parents who employ a nurse for their baby
should be extremely careful to find one who has the cmo-

The Foundation of Mental Health

tional attributes of a good mother, as already described, and
should keep her throughout the child's infancy. Like-
wise, when it is necessary to place the infant or small child
in the hospital, he should have the same nurse during his
entire stay and that nurse should be one who really wants
to care for children and likes this particular patient.

The resistance to outsiders reaches a maximum when the
child is between the ages of eighteen and twenty-four
months. After that it gradually decreases. At the time
the child is thirty to thirty-six months of age, he should be
ready to accept strangers and cooperate with them. If
he does not give this cooperation, it is probable that there
is something wrong with his program.

REFERENCES

1. DEUTSCH, HELENE, M.D., "The Psychology of Women, 5 '

Vol. II, p. 1, Grune and Stratton, 1945.

2. ALDRICH, C. ANDERSON, M.D., Ancient Processes in a

Scientific Age, American Journal of Diseases of Children,
[vol. 64, pp. 7-14, October, 1942.

3. MENNINGER, KARL A., "Love against Hate," Harcourt,

Brace and Company, Inc., New York, 1942.

4. ALDRICH, C. ANDERSON, M.D., CHICH SUNG, M.D.,

D.P.H., and CATHERINE KNOP, M.D., The Crying of
Newly Born Babies, Journal of Pediatrics, vol. 26, p. 85,
August, 1945.

5. GESELL, ARNOLD, M. D.,"The Embryology of Behavior,"

p. 144, Harper & Brothers, New York, 1945.

Chapter -__._ Two

The Two- Year-Old

Growth patterns are fairly well established. The child
now learns to speak in sentences, walks, plays; he is happy
and has acquired the self-confidence that results from doing
things. Retention of his normal mental qualities is most
important in any disciplinary program. A child of this
age cannot reason, in the adult sense.

BY THE time that the baby has reached the age of two,
he has passed his most rapid and important period of
growth. Even though he evidences little desire to cooper-
ate with strangers and other children and requires frequent
praise from his nurses and parents, he has progressed far
enough physically, intellectually, emotionally, and socially
so that it is possible to determine his growth patterns and
assess his potentialities and abilities more accurately.
Physically, he has a well-defined structure; that is, he is
tall or short, small-boned or large, well coordinated^ or
clumsy, possessed of a sense of rhythm or devoid of it. He
has learned to sit up, stand, toddle, walk, run, and climb
stairs. Usually he speaks in sentences. According to the
Gesell scale, the average child of this age can build a tower
of six blocks, string beads with a needle, help dress and
undress himself. He is able to distinguish black from white,
but he does not discriminate between colors, even though
he may know the color names.
20

The Two-Tear-Old

All this behavior indicates that the child has gone through
a long sequence of growth processes. In the matter of
speech, for example, he started by making noises with his
lips, mouth, nose, and throat. Later, some of these sounds
began to take on meaning. At the age of three or four
months, when he was able to recognize individuals, he
evidenced happiness by laughing and cooing. As time went
on, his laughing and cooing became more expressive. In
course of further mental, physical, physiological, and emo-
tional growth, he learned to use certain sounds to form
words and thus, at the age of twelve months, said "mama"
and named some objects. As his speech developed, he sup-
pressed a large percentage of the sounds he had previously
used and finally, at the age of two, put words together to
form sentences. All his growth processes passed through
analogous stages, which varied in accordance with his
efforts and his innate capacities and were affected by the
amount of security that he received and the opportunities
that he was offered.

This two-year-old, further, has developed much self-
confidence and many habits of responsibility. He has, for
instance, taken full responsibility for food habits, feeding
himself, enjoying food, and always eating enough for health
if he is offered a proper diet. His bowel habits and diurnal
bladder control have been well established; he seldom has
an accident, except under stress of some unusual or dis-
turbing circumstance. Although he desires frequent ex-
pressions of approval, he plays by himself for short periods.
He has found that it is fun to make noise. His emotional
expression is spontaneous and without control. He is self-
centered, being absorbed in his own capabilities and sense of
usefulness.

A Psychology of Growth

At the age of two, the inborn temperament and individu-
ality of each child is plain and unmistakable. It is very
evident that one is alert, active, quick, and determined and
offers more resistance than another, who is quiet, slow, and
amenable to suggestion. One cries bitterly when disap-
pointed; another is less sensitive. In other words, we see in
action the same differences that we observed in the group
of newborn babies on the examining table. These patterns
are now more mature and unchangeable; they constitute
the differences that create individuality.

It is extremely important for parents and nurses to see
that a two-year-old has fun doing things in order that he
may acquire the confidence that is essential for further
growth and self-reliance. Discipline and restriction also
present pressing problems, since the two-year-old can walk
and is impelled by unbounded curiosity. Everyone has his
own ideas on the subject of discipline, and they are probably
a reflection of his own childhood. The question is not so
simple as it may appear to be, however, and is worthy of
careful consideration.

DISCIPLINE

As in the case of all forms of growth, the best discipline
comes from within and that kind is more helpful in later life
than any compulsion imposed by another individual. On
the contrary, exaggerated demands for obedience and im-
possibly high standards of behavior may markedly impair
a child's mental health. The problem of discipline usually
begins to trouble parents about the time when their baby
learns to walk and his curiosity and activity lead him to
investigate everything in the house, including his parents'

The Two-T ear-Old

treasures and such lethal weapons as matches, knives, and
electric fans. The amount of restriction that can properly
be placed upon a child depends not only on the nature of the
coercion but also on given qualities, such as the degree of
his vitality, the relative softness or hardness of his nature.
Here again we must recognize the innate aggressiveness
and degree of resistance that the child offers, especially to
relatively unimportant situations. The final test of dis-
cipline is whether it furthers or disturbs mental growth.

Disciplinary problems caused parents of a twenty-six-
month-old girl to take her to her doctor for examination and
consultation. The child, who had been cared for accord-
ing to the program previously described, was normal,
healthy, and responsive; but now she posed a new question.
The parents wanted to know how they could discipline her
without cowing her. Watching as she ran around his
office, the doctor saw that she was very active and full of
healthy curiosity. While she investigated everything in
sight, including objects that she could not have, she talked
to herself about her discoveries and was obviously happy.
Her long sentences indicated high intelligence. The parents
reported that she was always lively and gay to a degree that
had delighted them until recently, when she had broken
two cigarette boxes, overturned a lamp, and pulled a cloth
off the dining table, thereby shatttering some of her mother's
choice glassware.

Certainly she was not an easy creature to live with, but
the qualities that motivated her actions were more important
than the results. Her parents wisely recognized that,
though they did not like to have their property destroyed,
that was not so irreplaceable as the child's mental attri-

A Psychology of Growth

bates, which they might injure permanently by too stringent
efforts to safeguard the lamps and the tableware. What-
ever its immediate consequence, her conduct showed that
she was endowed with intelligence, alertness, curiosity,
aggressiveness, and a happy disposition. They recognized
that her aggressive destructiveness was accidental and not
motivated by resentment or anger. In other words, it was
not an aggressive destructiveness that should cause concern;
rather, the child's accidents were those that go with aggres-
sive constructiveness or trial-and-error learning. She was
making some mistakes, but these were not too serious and
she was learning from them. If she could retain her present
qualities she would grow into the kind of woman that her
parents wanted her to be. Recognition of this fact was
more essential than devising methods of forcing too much
obedience on the little girl, and the problem resolved itself
into a matter of preserving her good traits and a state of
mental health while preventing her from doing the very few
things that might have serious consequence.

There are various means of inducing individuals to act in
a given way: (1) force or fear, (2) praise, (3) example,
(4) interest, (5) habits of self-reliance.

1 , Most children can be forced to do all manner of things,
though some of them rebel violently from birth. These
individuals develop serious behavior problems when parents
set impossible standards. Anyone who uses force in govern-
ing a child should know, that force is fear and that, whether
it is exerted in the form of corporal punishment or of nag-
ging, the results are the same. Since all behavior proceeds
from habit, the child who is frightened too many times will
habitually respond fearfully to every situation in life. Fear

The Two-Tear-Old

and resentment also go hand in hand. In consequence, too
frequent or too great use of force can only produce a fearful,
resentful type of adult. Resentments, as we shall later see,
lead to a sense of guilt as the child reaches maturity. Alto-
gether, force, resentments, and a sense of guilt are the
materials from which "nervous breakdowns" are made.

2. Praise, on the other hand, is a safe and effective
instrument safe because it docs not stimulate any harm-
ful responses, effective because it satisfies a fundamental
human craving. Every individual needs attention, and the
younger he is the more he requires. Children constantly
seek attention and cannot help doing so. Such behavior is
as natural as sleeping or playing. However, there are two
kinds of attention favorable, which is praise, and unfavor-
able, which is criticism. A child who is not receiving suf-
ficient favorable attention to indicate general approval and
whose emotional needs are not being satisfied will resort to
any action that will attract notice to himself, even though
he knows it will provoke censure. That being the case, the
wise parent will give his child attention in the form of praise,
realizing that this will make it unnecessary for him to court
unfavorable notice. This practice produces gratifying re-
sults, because the child will do more for the sake of approval
than for anything else in the world. There are different
kinds of restriction. If parents are angry and use a threaten-
ing tone or slap a child, he becomes frightened and feels that
his mother and father do not love him. If they use a gentle
tone and have a kind demeanor, they can convince the
youngster that he is a fine boy and that they are objecting
only to certain things that they cannot allow him to do.
Very often parents can substitute a permissible activity

A Psychology of Growth

that the child enjoys for the one that they must prohibit.
By praising him for the thing he is now doing well they can
partly offset the child's anger as the result of being thwarted.
It is strange that so many parents feel it is not wise to be kind
to their children.

3. A child learns by imitation, and his parents are the
models that he follows most closely. If parents decide how
they want their boys and girls to act when they are grown,
behave in that manner themselves, and do not talk about
it, they will have a good preview of their offspring's adults.

4. Children, like adults, do what interests them. If we
knew how to add interest to the things we want them to do,
discipline would be a simple matter. The difficulty is that
we know very little about making things interesting to the
small child. Parents (and nurses and schoolteachers) have
difficulty in placing themselves on the child's level of growth.

5. In considering discipline we should never forget,
furthermore, that we must regard all behavior in terms of
habit and that habits of responsibility based on self-reliance
are those which will be particularly valuable to the child
when he is grown. In childhood he gets satisfaction from
doing the things of which he is capable and for which he is
loved. A feeling of usefulness gives him confidence in him-
self and makes it possible for him to take on repsonsibilities.
He will develop self-reliance, therefore, when he has adult
approval and is permitted to do things up to the limit of his
capacity. A two-year-old is pleased when he is allowed to
assume full responsibility for food and toilet habits, for help
in dressing himself, and for play; and he gladly accepts the
new obligations. The resultant self-discipline is more valu-
able than any force that could possibly be applied from the
outside.

26 -

The Two-Tear-Old

So much for general suggestions to the parents who
wanted advice about their little daughter. Specifically
there were a number of plans for them to follow. They
might move breakable and dangerous objects out of her
reach; they might move her out of the way of danger; and
finally, they might, within certain limits, restrict her forc-
ibly. Putting fragile and expensive ornaments on a high
shelf for a time would eliminate breakage and solve one
problem of discipline. The father suggested that a lock,
which he could attach to the flour bin in ten minutes, might
save untold trouble. The use of a playroom or a playpen
would safeguard both youngster and house at times when
the parents were unable to watch her, as long as she per-
sisted in doing things that were genuinely destructive or
hazardous. This would probably cause the young lady
some displeasure but would do her no harm if the restrictions
were not carried to excess. At other times, when the child
did something that the parents could not tolerate, they
might stop her forcibly if they were unable to distract her.
A reasonable amount of restriction does a child no hp.rm if,
in imposing it, the parent does not lose his temper.

These suggestions conform very closely to the attitude
that the Chinese have held for centuries. They keep their
tempers when children become too troublesome, and punish
them only by removing them from the presence of the adult
members of the family. If a child's behavior is very ob-
jectionable, his elders sagely say, "His wisdom has not
opened yet."

One question in the minds of most American parents is
whether or not they should insist on prompt obedience.
The answer is that they may have a right to expect some
degree of it, provided that they are reasonable in their

A Psychology of Growth

demands on their children. Since parents are often un-
reasonable, however, and children seldom can carry out
more than 10 per cent of the orders they receive, it is not
safe to recommend exact and immediate compliance.
Parents usually do not make demands in terms of the growth
needs of their children, but in relationship to their own
personality make-up and difficulties. They may take out
on their children the resentments they developed in their
own childhood and inflict their own anxieties on the young-
sters, or they may be too tired and overworked to be reason-
able with them. The attitudes of parents will be discussed
in more detail later. Parents should not worry about dis-
obedience in any but very serious matters. The important
thing is to preserve the qualities that go to make up mental
health, rather than to inflict fears and resentments in an
effort to correct lapses, which are seldom of any consequence.

We cannot leave the question of obedience obtained by
force and fear without mention of the two classical examples
of its use on a national scale. In totalitarian Germany and
Japan, unquestioning obedience to authority was imposed
on every citizen. Under such a system, the leader was the
only individual with freedom of action and therefore the
only one without resentment, conscious or unconscious. In
the groups below him each individual exercised his authority
and vented his resentment on the persons who, in turn, were
under him. Finally, the head of the family became a strict
disciplinarian in relation to his wife and children and took
out on them his resentment toward all those who were
above him in authority.

Leaders of such countries know that the pent-up resent-
ments of the mass will eventually be directed against them

The Two-Year-Old

in the form of revolution, unless that emotion can be turned
upon others, preferably "our enemies," real or imaginary.
Thus persecution of minority groups and, finally, wars are
essential to the continuation of the totalitarian form of
government. The release of this intense resentment ac-
counts for the extreme cruelty of the Germans and the Jap-
anese in the Second World War. In Japan, where authority
is a part of religion, these resentments generate a terrible sense
of guilt, since they are, in the last analysis, directed against
the emperor, whom the people have been taught to venerate
as the head of the state and as a true god. This sense of
guilt accounts for the frequency of suicide in the Japanese
military forces.

Parents often ask when or how they should "break" a
child of thumb sucking, enureses, soiling, drinking from
the bottle, or some other behavior that they do not like and
which they believe has continued longer than necessary.
By "breaking" they mply force. The answer is that a
child should never be broken to or from anything. When
these habits continue longer than they should, the probable
reason is either that the child has not been able to grow
sufficiently to take on the responsibility in question or that
the parents are expecting their normal youngster to grow
up too rapidly. If undesirable behavior continues beyond
the period when it might reasonably be expected to change,
one should try to determine why growing up has been too
difficult for the child. When emotional needs are met and
expectations are not too great, children take on responsi-
bilities at the proper time. They do things when they are
ready, that is, when they have reached the right level of
growth. Incidentally, it is interesting to note that graduate

29 -

A Psychology of Growth

nurses very often wish their children to take on responsi-
bilities far beyond their age. This apparently reflects the
type of training that student nurses receive in hospitals,
where precision of procedure and good results are essential.

It is not too much to expect that a child of two and a half,
whose parents have adopted the proper procedure, should
have taken full responsibility for toilet during the day, sleep
and food habits, dressing, and playing alone for short periods
of time; he should have learned that there are a few things
he cannot do, and he should have accepted his responsi-
bilities and his limitations without undue fears or resent-
ments. In consequence, his mental health is almost
assured.

The parents who try to reason with a very young child are
inevitably doomed to disappointment in their method and,
what is more painful, in their child. It would seem to be
highly desirable to appeal to the child's intelligence in an
effort to make him understand what he should or should not
do; but the child cannot reason. A three-year-old thinks in
terms of simple associations; his observations are elementary
and concrete, and he is quite incapable of understanding
the processes of the adult mind.

A final rule about discipline: "when you don't know what
to do do nothing; then you will be right about 99 per cent
of the time."

Chapter Three

Adjusting to Environment

All children are normally jealous; they resent the new
baby. Play is important from an educational standpoint.
In play children are normally aggressive, at times destruc-
tive, and they always fight. They can nearly always settle
their differences by themselves. Progressive nursery schools
provide safe group play. Self-reliance and habits of
cooperation are developed by free play.

BROTHERS AND SISTERS

THE advent of a new brother or sister is not, as adults
hope, a source of joy to the other child, but more often
an affliction and the cause of new behavior difficulties.
The groundwork of trouble is laid even before the arrival
of the baby, particularly if no one has told Johnny what to
expect. For some time, perhaps, mother has had to rest
when Johnny wanted her to play; there have been con-
fusion and whisperings and unexplained changes in the
household, which made him feel insecure. This insecurity
approaches panic when mother suddenly goes away. The
nurse or aunt or friend who takes her place tells Johnny
that he has a baby brother, but Johnny doesn't care about
a baby brother; he wants his mother and she is gone. Un-
prepared for these unsettling events, apprehensive because
of mother's absence, Johnny not unnaturally becomes very
troublesome to the adult in charge of the household.

. 31 -

A Psychology of Growth

Mother's return with a baby does little to improve the
situation for Johnny. The baby is the new sun around
which the household revolves and Johnny feels himself a
very minor and neglected satellite. Johnny sees mother
nursing and bathing and dressing the interloper and hold-
ing him in her arms, where Johnny would like to be cuddled.
She has less time for him than ever. In return for all that
he has lost, Johnny has nothing but a brother, with whom
he cannot play and on whose account he must be quiet and
clean and obedient. Everybody asks him if he doesn't love
the baby. Of course he doesn't. He resents his mother's
attitude and hates the baby.

This is not theory, but a conclusion based on evidence
acquired through play therapy and talking to young chil-
dren. Hatred is their normal reaction to a new baby.
For a detailed description of play therapy that demonstrates
normal jealousy, read "Studies in Sibling Rivalry," by
David M. Levy, M.D. 1 Adults should face the fact with-
out surprise or disapproval. They cannot persuade Johnny
to love his brother, either because that is desirable or be-
cause it is naughty not to do so; and such an attempt will
lead only to a serious, lasting sense of guilt. It is far
healthier to allow Johnny to express his resentment and to
let him know that his feelings are not unnatural or wicked.
If we recognize that jealousies are entirely normal and
sympathize with Johnny, instead of blaming him, we can
help him slowly to accept the readjustments in the family
relationship and gain some security as the result of having a
brother. With proper management we can restore his self-
confidence and security by letting him feel the importance
of being the older child and playing a more responsible role

Adjusting to Environment

in the family group. Slowly he learns to love his brother, as
well as hate him. This is a good time for him to learn that
he can love and hate the same person at the same time and
that he cannot help feeling the way he does.

PLAY

Somebody once described a genius as an individual who
learned as an adult what he knew instinctively when he was
a child. This idea deserves serious consideration. We
might translate it into terms of child care by saying that the
successful adult is one who has been allowed to grow natu-
rally, retaining and developing the traits that were his at
birth. Play is an important element in this process, because
it is (1) a source of the infant's earliest groping motions,
which later develop into motor coordination and mechani-
cal skill; (2) a release for emotional energies and a fruitful
field for the growing imagination. The greatest emotional
satisfactions in life, which result largely from the fullest
possible use of mind and body, are, therefore, rooted in
play activities. This applies also to creative work, which
stems from imagination, originality, and the trial-and-error
methods that play develops. Thus play, if not the mother
of invention, is at least a very close relative.

Incidentally, play is not limited to children. It is a
fundamental need that manifests itself throughout life. All
work and no play makes John an incomplete man, as surely
as it makes Jack a dull boy. Play is a valuable outlet for
pent-up resentments or aggressive destructive behavior,
which might otherwise be directed into undesirable conduct.
No child and no adult can be good all the time; he would
burst. 2

A Psychology of Growth

In the unrestricted play of children we see a dramatiza-
tion of their feelings and mental processes.

At the age of one or two, they are equally likely to caress
dolls and play with them gently or try to pull out their eyes
and hair. Sometimes when babies are placed together,
they slap, claw, and bite one another. This behavior may
be interpreted as normal curiosity or as evidence of an
aggressive, destructive pattern already developed in the
infant by insecurity and frustration of growth and emanat-
ing from the instinct of self-preservation, attack being the
best defense. At any rate, babies of this age require some
supervision.

During the next few years, their propensity for knocking
down block towers, bursting balloons, and breaking toys
gives evidence of the satisfaction that children derive from
destructiveness. Children like to play together and, al-
though they often show affection for one another, a few
minutes later one may take pleasure in hitting the other
over the head with any available weapon. They nearly
always may be allowed to settle their differences by them-
selves. Because of these rapid changes, young children
need intelligent and consistent management. Wrong
methods of handling them can do much harm. In manag-
ing children, (1) it is necessary to recognize that they are
like this and that there is a reason for their behavior;
(2) adults must understand that these expressions of re-
sentment are neither good nor bad, but that they are simply
natural and must be accepted.

NURSERY SCHOOLS

The child's fourth year is the period of very nearly per-
petual motion. The three-year-old is still unable to con-
34

Adjusting to Environment

centrate on any one thing for more than a few minutes,
unless it is connected with other children or with some
physical activity. He is constantly in need of energy out-
lets. This, therefore, is the time when his requirements for
mental growth can be provided by group play, such as a
good nursery school affords.

Not all nursery schools fall into this category, however.
While many of them are very helpful to mental growth,
there are others that are distinctly harmful. The school is
helpful insofar as it provides a safe place in which children
can engage in group play. It does harm when it attempts
to impose impossible standards of behavior or makes a
fetish of "good" habits. The former type of school brings
together a group of small children, provides them with crude
toys, and, for the most part, leaves them alone to play as
they like, work out their own standards of conduct, and
settle their own differences. The other'type of school goes to
great pains to get children into the habit of hanging up their
coats, putting their rubbers in a row, washing their hands,
marching to the toilet, washing their hands again, eating
everything that is put in front of them, taking naps without
wiggling, behaving decorously, and exhibiting social graces
entirely foreign to the minds of young children. Such train-
ing is not only useless, but it actually blocks mental growth
and makes normal development impossible.

Because nurses are often called upon to help organize play
groups, it is important for them to recognize these funda-
mental differences. In so doing, they can use as a guide
the practices previously recommended for the home. The
child may safely be allowed to act on his own initiative and
without unnecessary regulation. The school should pro-
vide facilities and permit the child to use them as he sees

A Psychology of Growth

fit. If he has play materials, he will readily invent uses
for them. Given the companionship of children of his own
age, he will soon learn how to get along with them. By
the time he is old enough for nursery school, he should be
entirely responsible for going to the toilet he has sense
enough to know when he wants to urinate. Food should
be placed in front of him and he should be permitted to eat
or go without. Altogether, the nursery school should con-
tinue the program of making the child feel secure and per-
mitting him to act independently, up to the limit of his
capacity. The four-year-old child is able to take full
responsibility for food, sleep, dressing, and toilet habits; and
he can play with other children for longer periods with very
little adult supervision.

The interests of boys and girls begin to diverge when they
are five or six years old. All through these early years, we
find constantly growing differences in the degree of mechani-
cal skill and motor coordination reached by individual
children; but just as these skills and coordinations develop
in unvarying succession, so the children's interests also
develop in sequence. In other words, all children do the
same things in the same order, differing only in regard to
the age at which they begin to do them. First, they play
with small objects, piling them on top of each other; later
they play with shovels; then they want to use a hammer,
ride a tricycle, skate, dig tunnels, and build huts. They
form clubs and secret societies, then fraternities, and finally
women's clubs and rotary clubs.

In their play, children form habits of responsibility and
self-reliance and gain valuable experience in social relations.
When they are allowed to play freely, they learn the im-

36 .

Adjusting to Environment

portant lesson of give and take. Without any adult expla-
nation or lecturing, they discover that it is important for
them to share their tools and that is pleasant to divide the
work on their various projects. They try different ways of
doing things and invent new ways, learn to help and to
accept help. Of course they fight, but they also learn how
to settle their differences. Each one wants to hold the
center of the stage and finds that he can have it only a part
of the time. They have their accidents and often hurt
themselves; but these experiences develop caution, which
is a habit of being careful when doing dangerous things
not bad compensation for a few bumps.

Throughout their play period, children should be encour-
aged to use imagination, to work out their own problems,
and to learn by experience. Nurses and parents must be
content to play the minor role of sympathetic bystander.
They can do nothing more helpful than to express interest
in whatever a child is doing, to praise him for every achieve-
ment, and to restrain their own impulses to show the
youngster how to make his mud pies and his snowballs or
even to make them for him. While they may advance
suggestions if a child asks for a little help, they should always
make him feel that he is the one who is doing the job on
hand.

Just as children derive no benefit from the tasks that
adults perform for them, so they find no particular satis-
faction in playing with complicated mechanical toys that
are run by pressing buttons. As a matter of fact, parents
who spend large sums of money on such playthings are not
gratifying their children and, by giving them predigested
mechanics, are actually interfering with the development

37 .

A Psychology oj Growth

of their natural resourcefulness, imagination, and creative
ability.

The best provisions for play are crude materials, such as
blocks of varying size and shape, lumber, hammer and
nails, pails and shovels. The best place for play is a large
room or lot where children can be left alone. Naturally,
we must guard them from serious injury in the house and
keep them inside a fenced yard, if that is necessary to pre-
vent them from running into danger outside; but within
those limits we should give them complete freedom to work
out their own ways of doing things and their own social
rules and regulations. This culture may seem primitive
in the eyes of an adult, but it serves the children's purposes
very well. It is, indeed, far superior to an adult-created
and imposed culture, where standards of behavior are
always too high for children.

In this program there is no room for the teaching of man-
ners, truthfulness, honesty, orderliness, or consideration for
others. Observers see that children naturally exhibit a
certain amount of these graces, but as we shall find when
we study intelligence growth, they are abstractions that
children do not have the intelligence to understand or the
emotional development to appreciate before they reach
adolescence.

Free play is valuable not only because it offers the oppor-
tunity for development but also because it provides an
essential release for the child's aggression and the resent-
ments and anxieties that it produces. Resentment and
anxiety are normal emotions. It is as unfair to condemn a
child for having them as it would be to scold him for being
hungry, as unhealthy to force him to repress them as it

Adjusting to Environment

would be to refuse him food. Since play relieves these
emotions, it should not be regulated by adult standards of
propriety. Games that adults often deplore, such as cops
and robbers and others in which children pretend to kill
one another, should be encouraged and not suppressed by
the organized play program of well-meaning but misguided
leaders. Children should learn by experience that some-
times they love people and sometimes they hate them;
sometimes they are confident and sometimes they get
frightened; but that no blame attaches to these emotions.
If we are to teach them anything about their play activities,
it should be that they cannot help feeling as they do, that
it is right for them to express their feelings, and that adults
understand and approve.

Note that we have emphasized the importance of free
play. This is not the same as unsupervised play. Although
children should be allowed to choose their games and work
out the details, there are times when restriction becomes
necessary. Skilled supervision offers protection and help
to that one child who sometimes is selected as a sacrifice to
the pent-up resentments of the others in the group. Parents
or some supervisor, furthermore, should know what children
are playing. For example, homosexual practices, which
cause great distress in later life, can start with childhood
play. The supervisor who finds children engaged in sex
experiments should not become perturbed, because such a
reaction can create disturbances in the minds of the young-
sters. An adult's anger may cause the suppression and
repression of the children's normal curiosity and implant
in their minds many fears about sex.

Helping adults to arrive at this understanding and to

A Psychology of Growth

view children with approval is another great task for the
nurse and the physician. They must reassure parents and
convince them that normal play and the free, natural ex-
pression of emotion, even when they are distasteful to the
adult, are vital to growth and mental health. The nurse
and the physician must remind parents constantly that sup-
pression of normal emotions, such as fear and jealousy and
resentment, is one of the prime causes of mental ill-health
in the adult.

REFERENCES

1. LEVY, DAVID M., M.D., Studies in Sibling Rivalry,

Research Monograph 2, American Orthopsychiatric
Association, p. 937.

2. BRILL, A. A., "The Value of Motion Pictures in Educa-

tion, with Special Reference to the Exceptional Child/*
p. 216, Child Research Clinic of the Woods Schools, May,
1940.

3. BEVERLY, BERT L, "In Defense of Children," pp. 72-

135, The John Day Company, New York, 1941.

40 -

Chapter ------------- Four

Intelligence

Intelligence, one aspect of the mind, is the capacity
to think and to solve problems. Like other aspects of
growth, intelligence develops according to definite sequence.
Individuals with the same general intellectual capacity differ
widely in individual intelligence characteristics. Intelli-
gence tests, properly interpreted, are of great value. Spell-
ing, reading, and writing difficulties are usually innate.
Environment has a marked effect on intelligence growth,
especially during infancy and young childhood.

THAT aspect of growth which we call intelligence, that
is, the capacity to think and to solve problems, is not
one unit characteristic but comprises many elements, which
we must consider separately. As in the case of other forms of
growth, there are wide variations in the intellectual develop-
ment of different children and little uniformity within a given
individual. Nevertheless, studies of intellectual growth
indicate that, like physical and emotional development,
it follows certain specific patterns. Just as each muscle
and each of the various systems of the body develops *in a
known sequence, so manifestations of the intelligence appear
in a regular order.

One cannot leave this simple description of intelligence
without pointing out that it is inaccurate and oversimpli-

41 -

A Psychology of Growth

fied, useful only for descriptive and clinical purposes; in
reality, there can be no consideration of any behavior except
in terms of the individual as a whole. Because we are
attempting to discuss one aspect of behavior, which cannot
be studied except in relation to behavior as a whole, there
is much difference of opinion as to what intelligence really
is. One description is anatomical; that is, the influence on
behavior of the cerebral cortex, and especially the frontal
lobe. This is the part of the brain that has developed most
in the evolutionary process the part that accounts in a
large measure for the superiority of the human over other
animals. From a clinical standpoint, we can consider
intelligence in terms of tests, in the same way that we apply
measurements to physical growth.

In early infancy there is less obvious differentiation
between mental and physical growth. At this age the tests
for intellectual growth and indexes of it are largely physical
signs. If the central nervous system develops normally, the
general behavior of the infant proceeds according to a fixed
schedule. The most detailed and accurate information
about the mental-growth patterns of infants is the result
of studies made by Dr. Arnold Gesell * and his coworkers
at the Yale Clinic. In order to obtain a complete picture
of growth patterns and to determine the intelligence level
of infants, Gesell has described developmental sequences
under four different headings: (1) motor growth, (2) adap-
tive behavior, (3) language behavior, and (4) personal-
social behavior.

1 . In the category of motor growth he has checked gross
body, control and fine motor coordination; posture, head
balance, sitting, standing, creeping, walking, prehensory

Intelligence

approach to an object, grasp and manipulation of the
object.

2. The adaptive-behavior division relates to finer sensori-
motor adjustments to objects and situations; coordination of
eyes and hands in reaching and manipulations; ability to
utilize motor equipment appropriately in the solution of
practical problems; capacity to make new adjustments in
solving simple problems (that is, resourcefulness).

3. Under language behavior are included all visible and
audible forms of communication: facial expression, gestures,
postural movements, vocalizations, words, phrases, and
sentences. While the development of speech requires social
situations, it also offers clues to the condition of the central
nervous system.

4. Under the heading of personal-social behavior Dr.
Gesell deals with the child's reactions to his environment.
Although they are affected by outside influences, they still
indicate intrinsic development. Bladder and bowel con-
trol, for example, are cultural requirements, but they de-
pend upon neuro-motor maturity, as well as intelligence and
emotional growth. The development of this central nerv-
ous system governs the child's ability to cooperate in all
phases of life.

Many observations of large numbers of children have
shown that these behavior patterns, which unfold in a
definite sequence, are all indexes of intelligence growth.
By means of such studies it has been possible to set up
criteria for the average child; that is, we can say that at a
given age he should have reached a certain level of growth.
These criteria form the basis for intelligence tests. While
accurate descriptions of intelligence growth in infants are

A Psychology of Growth

fairly recent, accurate mental tests for older children were
developed almost forty years ago.

In 1908, Simon and Binet French physician and psy-
chologist, respectively perceived the sequential growth pat-
terns in children and began, in an empirical manner, to find
a set of tests that could be used as a measure of intelligence.
After giving a large number of tests in homes and schools to
children who were considered average and normal, these
investigators accepted as a criterion for each age group those
questions or problems which a majority of the children of
that age were able to pass. For example, they asked all
children, "How old are you?" A large percentage say,
70 per cent of the five-year-olds knew their ages, while
30 per cent of the four-year-olds, and 90 per cent of the
six-year-olds answered correctly. Therefore, since few of
the four-year-olds, the majority of the five-year-olds and
nearly all of the six-year-olds answered correctly, the investi-
gators considered this question a test for children five years
of age. In the same manner, six tests were devised for each
year from three to eighteen. These tests that Simon and
Binet worked out have been revised and improved several
times, the latest revision having been made by Lewis
Terman and Maud Merrill. 2

Intelligence tests are given with the same accuracy that
applies to blood chemistry. For example, the examiner
secures the complete cooperation of the child, makes certain
that he is comfortable in every way and that he is not
frightened. He gives the tests and records the responses
(graded as right and wrong) according to exacting, detailed
instructions. When he uses the Stanford scale, the ex-
aminer gives the set of tests for the lowest year in which the

. 44 .

Intelligence

child passes all tests and continues to the year where all
tests are fmiled. The following case illustrates the method.
John's age is five years and four months. We find that
he passes the following tests (right answers marked + and
wrong answers ).

YEAR 5

+ 1 . Picture completion (completes drawing of man)
+ 2. Paper folding (folds 6-by-6-inch paper in triangle)
+ 3. Definitions

+ What is a ball?

+ What is a bat?

+ What is a stove?
+ 4. Copying a square
+ 5. Memory for sentences
+ 6. Counting of objects

Since John passed all tests for Year 5, this is the basal year.

TEAR 6

+ 1. Vocabulary

2. Copying a bead chain from memory

+ 3. Mutilated pictures (recognition of what is gone from

picture)
+ 4. Number concepts (picks up three, nine, five, seven

blocks from twelve. Score + if right three times)

5. Pictorial likenesses and differences (picks out like

figures from two cards)

6. Maze tracing

TEAR 7

1 . Picture absurdities (what is foolish in pictures?)

2. Similarities (wood and coal apple and peach ship

and automobile iron and silver)

45 -

A Psychology of Growth

+ 3. Copying a diamond

+ 4. Comprehension (what is the thing to do in various
situations?)

5. Opposite analogies (brother is a boy sister is a )

6. Repeating five digits

TEAR 8
All answers were wrong.

To obtain this boy's mental age we take his basal age,
five years, and give him two months' additional credit for
each test that he has completed correctly (since there are
six tests for each year, he receives two months' credit for
each test). Therefore, he receives six months in Year 6
and four months in Year 7, making his mental age five years
plus six months plus four months, or five years and ten
months of age.

The intelligence quotient (usually referred to as I.Q.)
offers further valuable information. It is obtained by
dividing the patient's mental age by his chronological age
(real age). In this case the mental age is five years ten
months, or seventy months, and the chronological age is
five years four months, or sixty-four months. Seventy
divided by sixty-four is 1.09. The patient's I.Q., there-
fore, is 1.09, usually expressed as 109. That means that
this boy is 0.09 more capable in general than the average
child.

Here, then, is a boy of high average intelligence. His
mental growth will probably continue at the rate he has
already established; and since the intelligence quotient is
fairly constant in all persons, we can expect his I.Q. to
remain about 109 throughout his life. This is not an

Intelligence

invariable rule, however. It sometimes happens that, when
a child is given a second psychometric examination (intelli-
gence test) at a later date, he is found to have an I.Q. as
much as twenty-five points higher than the original one.
Probably this means that environmental difficulties and
emotional disturbances that were not recognized at the
time of the first examination interfered with the tests and
caused the original rating to be incorrect.

Children are classified according to their I.Q. on the
basis of the following classification:

0-30 Idiot

30-50 Imbecile

50-70 Feeble-minded moron

70-80 Borderline feeble-minded

80-90 Dull and backward

90-110 Adequate average
110-120 Superior
120-140 Very superior
140- Genius

What does this signify in terms of formal education?
For example, how high must a child's I.Q. be to enable
him to finish high school and college? Authorities generally
agree that a boy or a girl needs an I.Q. of about 104 to
graduate from a first-class high school and one of 110 to
profit by college training.

Intelligence quotients for some eminent persons have
been estimated as follows:

John Stuart Mill 200

Francis Galton 200

Goethe 185

Macaulay 180

Voltaire 170

J. Q. Adams 165

Pope 160

. 47

A Psychology of Growth

Tennyson 155

Samuel Johnson 155

Wordsworth 150

Byron 150

Lincoln 125

George Washington 125

U. S. Grant 110

Copernicus 105

Faraday 105

This table indicates that persons with fairly low LQ/s
have achieved great success. Clinical experience bears out
this observation. Two capable psychologists who examined
a boy when he was eight years old found that his I.Q. was
97. He subsequently finished high school with a fairly
good record and when he graduated from an engineering
college he was near the top of his class. Another boy of
twelve, who was doing mediocre schoolwork, was found to
have an I.Q. of 104. Later he finished college and became
very successful in business. These cases are cited to warn
against placing too much reliance on the I.Q. It might
be compared to a white blood count in the diagnosis of
appendicitis. Although every physician wishes to know
the count, he would never allow the result to influence
his diagnosis greatly.

Experience in testing during the past twenty-five years
has caused experts to change their conclusions about the
average limit of intelligence growth. Originally they placed
average adult mental age at sixteen years, but present
studies now indicate that fourteen years is more accurate.
In other words, maximum intelligence growth in the average
individual is about fourteen years (which is analogous to
stating that the average adult is five feet, seven inches tall).
Beyond this point intelligence capacity is increased by

Intelligence

experience. For further information on tests for children,
see "The Measurement of Intelligence, 55 by Lewis M.
Terman, 4 and "Directions for Administering Forms L and
M," by Lewis M. Terman and Maud A. Merrill. 6

Long after the formulation of reliable intelligence tests
for older children, we were still unable to learn the mental
age of infants until, a few years ago, Gesell and his associates
worked out their norms of development. Every nurse will
be interested in these valuable tests and, since they should
be read as a whole, the reader is referred to "Developmental
Diagnosis, 53 by Arnold Gesell and Catherine Armatruda. 1
Note especially pages 27 to 86.

These developmental schedules are of value in determin-
ing the developmental age of the infant and in demonstrat-
ing the sequence of growth. For example, at four weeks
the baby clenches a cube in his hand; at sixteen weeks he
looks from the cube to his hand, arm active; at twenty-
eight weeks he transfers the cube from one hand to the other;
two cubes are matched at forty weeks; at twelve months he
applies cube on cube without releasing them; at eighteen
months he builds a tower of three, and at two years builds a
tower of seven. At three years of age he builds a tower of
ten cubes and imitates a bridge. These progressive achieve-
ments give one measure of his increasing intellectual capac-
ity, improved motor coordination, and emotional growth,
as manifested in the pleasure he derives from doing things.

In an analogous manner many other tests for infants have
been devised and from them it is possible to compare a given
child^with the progress of the average child of the same age.

The chart below, prepared by Gesell, is useful for sum-
marizing behavior.

. 49 *

A Psychology of Growth

mELTMTNAKY BEHAVIOR INVENTORY
A|* JLO *u*. Date VI

Cue No. 00

Zmt

MOTOR

ADA*TIYB

LANGUAGE

PERSONAL-SOCIAL

4ta.

Lack* head control

BfcfmfaHMtaf

ImpMMvefae*

Stare* at surrounding*

lone

AiymmctrK in supine

Drop, toy immediately

Small throaty tound*

Listens 'to sound

I6wk.

Head erect. *liht bobbing

Incipient approach. rattl*

Coot

Spontaneoui social imile

Symmetric lupin* posture*

Regard* rattle in hand

Laughs .loud

Hand pl.y

Uwk*.
Jon*

S.U. U.nm, forward

R**ehe*Atra*ptoy

Squeal*

Feet to mouth

Transfers toy

M m sound (crying)

40 wk*

ZOM

Sits well, creep*

Combine* 2 toy*

Dada-Mama

Nursery tricks

Pull* to feet at rail

Pick* pellet, thumb ft inde*

On* other word

Perdi self cracker

Siwks

'Zone

Walks, one hand held

Cube into cup

Two other words

Co-operate* in dressing

Tnes tower I cube*

Respond* "Give it to me

11 mo*.
ZOM

W.Iks. lone, toddlw

Tower, two cubaa

4-6 words

Points & vocalizes w.ntt

Six cube* into cup

Cattt toys

ZOM

Walks well alone

Tower J-4 cube*

10 word*

Toilet regulated day

Seat* self small chair

Imitate* a stroke

Jar*o

Carries hugs doll

yr.
Zone

Run*

Tow.r 6-7 cube*

Join* 2-J word*

Asks (or toilet day

Up down stair* alone

Imitate* circular scribble

Names J-S pictures

Puts doll to bed. etc.

.lyr*.

ZOM

Ride* tricycle

Imitate* house' of cubes

Sentence*

Feeds self well

Stands 1 foot, momentarily

Imitate* croa*

Give* full name, tt*

Putsonsoxunbu.lon,

INSTRUCTIONS (I) Check the most advanced behaviors in n<k *rH a) ktlanar. <!) The check* will indicate an *pr<uiuf maturity ape lonr

<) NO DIACNOSISCAN BE MADEON THERASISOF THIS INVENTORY. Grots deviation (rom actual a. or marked disparity between bchavu

indicate* the need (or diagnostic behavior examination

CHARACTERIZATION, (phyucal (actors, social factor*, posture, attention, rapport, emotion speech, etc)

Since tests designed to measure general intelligence do
not reveal individual mental characteristics, it is necessary
to find others that provide more detailed information about
.the child. Individuals who have the same I.Q. have not
necessarily reached a uniform state of development in all
particulars; indeed, they show a wide divergence both of
growth and of innate capacity in different fields. In addi-
tion to mental age, therefore, we speak of the height age,
weight age, dental age, reading age, spelling age, arith-
metic age, performance age (relating to motor coordina-
tion, mechanical skill, etc.), and others. Research workers
are now making a great effort to devise a means of obtaining
a fairly complete cross section of an individual's develop-
mental level, showing both his general capacity and his
particular abilities or difficulties. In order to do this, it

Intelligence

may be necessary to give at least twenty-five different tests.

As a result of tests and observations, it is clear that a
child's chronological age is hardly a gauge of his mental
ability. It is manifestly unfair to assume that he should
be able to cope with given problems merely because he is
six or seven years of age. As far as intelligence is con-
cerned, the eight-year-old may be five years old or ten years
old. He may at once have the mathematical ability of an
eleven-year-old, yet be able to read and spell no better
than a six-year-old. He may be a musical genius or devoid
of musical ability. He may have considerable manual
dexterity or none at all. Until we are able to determine
his aptitudes and deficiencies, we cannot have an adequate
conception of his educational needs; and it is necessary to
fulfill these needs if his mental growth is to continue un-
impeded and if he is to get satisfaction out of the things that
he does.

Some children have superior intelligence as applied to all
subjects with which they have to deal; some, of average
intelligence, may have highly developed special abilities;
others, with average or high intelligence, have certain
intellectual handicaps of a more or less serious nature.
Mathematics is closely correlated with general intelligence
and many children who have a high I.Q. are in the genius
group so far as mathematical ability is concerned. Master
chess players and outstanding mathematicians, such as
Isaac Newton, belong in this group. That does not mean,
however, that all children who are poor in arithmetic are
necessarily below the average in general intelligence. Not
infrequently, they are rated superior. Conversely, it some-
times happens that a child of average intelligence has read-

A Psychology of Growth

ing and spelling ability far beyond expectations on the basis
of his I.Q, Musical ability seems to be a special talent
one that bears little relationship to intelligence.

Many children have serious special handicaps, which are
entirely disproportionate to their general ability. This is
particularly true of individuals who have specific reading,
writing, and spelling difficulties. These selective dis-
abilities were recognized long ago, and poor reading,
especially when associated with writing and spelling dif-
ficulties, was ascribed to mental deficiency. In 1896, Dr.
James Kerr, an English ophthalmologist, published a series
of such cases. The condition has been described as a
"specific disease entity" called* congenital word blindness.
Because of its similarity to acquired word blindness, caused
by injury or vascular accident, scientists have suggested
that it may be due to a congenital defect in the development
of the brain areas for registering visual word memories.

Dr. Samuel T. Orton 6 made the most important con-
tribution to the recognition of this disability in a relatively
large number of children and to the realization of its serious
consequences. He pointed out that many school children
who were considered mentally deficient, because they were
unable to learn to read, were not subnormal but were suf-
fering from this word blindness. The condition, according
to Dr. Orton, occurs more often in boys than in girls.
Features that he found to be fairly common to this group
of children were (1) difficulty in differentiating P and (),
B and Z); (2) a tendency to confuse palindromic words, such
as was and saw, not and ton, and to reverse paired letters and
whole syllables; (3) very frequent confusion of diphthongs,
such as ea and ae\ (4) facility for mirror writing and draw-

Intelligence

ing, shown very early in life, and more than average ability
to read from a mirror. Dr. Orton found no defect in
auditory memory but a failure to relate the printed word
to its concept. Some hitherto unrecognized factor prevents
certain children from acquiring easy association between
the visually presented word and its concept and limits their
ability to express the concept in writing, thus causing poor
penmanship and spelling.

In explanation of this difficulty, Orton offered the theory
that it was due to a lack of cerebral dominance, that is, a
confusion of handedness. Right-handed individuals have
specially developed areas in the left side of the brain (Broca's
area) that have to do with the names of objects and particu-
larly with visual word memory. Left-handed persons have
similar areas in the right side of the brain. Individuals who
experience this type of reading difficulty almost always
present a history of left-handedncss in their immediate
families; they themselves do some things with the right
hand, some with the left hand; in other words, they suffer
from a confusion of handedness. Most persons have an eye
dominance; that is, they see primarily with one eye, while
the other follows. Children with these reading difficulties
commonly have the dominant eye on the side opposite that
of their handedness.

Corresponding difficulties arise in spelling. At the pre-
school age a child learns the names of objects and acquires
the ability to speak them. When he goes to school, a large
part of his training consists of associating these spoken words
(or auditory memories) with the printed symbols that repre-
sent them; that is, the spoken word "man" with the com-
bination of letters m-a-n. Soon after he has made this

. 53 -

A Psychology of Growth

association (the spoken word with the printed symbol for
it), he must reproduce the symbols by spelling and writing
the words. The child who has a tendency toward mirror
writing and who fails to build an easy association between
the various sensory "engrams" (visual, auditory, kines-
thetic) produces many reversals in reading and spelling.
For example, he writes B for D, F for 7~, G and P for Q. He
is unable to recall the order of certain letters and habitually
transposes them in such combinations as ea and ae, ei and
ie. He also confuses the position of syllables and may often
reverse letters, writing tac for cat and tar for rat. The fol-
lowing examples illustrate characteristic spelling difficulties
of this order.

At the age of six and a half, David had already begun to
have serious difficulties in school. His parents told the
physician whom they consulted that the boy was inattentive,
uninterested in school, and that he liked only to play. His
teacher reported that he showed off and annoyed his class-
mates. He was well physically and had an I.Q. of 125.
Upon further interrogation, the parents reported that
David's development had been normal except for delayed
speech (not uncommon in these cases), a habit of doing some
things with one hand and some with the other, and a tend-
ency to draw backward and upside down. They reported
also that his grandfather was a "terrible speller."

Work with David revealed that he could not read or write
the simplest first-grade words, not even his own name. He
boasted that he was a good fighter, which was not true since
he had poor coordination. It was found that David's school
employed the flash system of teaching reading; that is, the
teacher showed the children printed words and they were

- 54

Intelligence

expected to remember the names. Since most children are
visualists, this method is usually more efficient than the
former system of teaching the alphabet and the sounds of
the letters before asking children to learn whfcle words.
David, however, had poor visual memory and, although he
saw the same word many times, he could not remember its
name. The physician explained this situation to the mother
and advised her to employ a tutor and to have him teach
the boy according to the auditory and kinesthetic method.
David's father refused to take this advice, insisting that the
child was only lazy and spoiled and in need of discipline.

Two and a half years later, the patient was examined
again. He had remained in the first grade for two years
and was now threatened with failing the second grade. His
father thought he was stupid and announced that he would
whip him if he failed again. The teacher had lost all
patience with the child. He was showing off more than
ever and had many fights with other children. At home,
he teased his younger sister incessantly and was negativistic
and disagreeable. He said that he hated school, where he
was in the "dumb" class, and liked nothing but movies.
The following words are samples of his spelling: girl, girld;
the, thae; bad, dab; boy, dog; school, shoow. Analysis of this
work showed that the boy was spelling by sound and
guess. He was unable to read such words as "fence,"
"around," and "over." The word "the," he called "it";
"boy," "dog;" "on," "and."

Both parents finally agreed to let David have the special
type of tutoring that had been recommended at the time of
the first examination, and four months later he was doing
satisfactory work in the third grade. His reading was then

- 55

A Psychology of Growth

average for the class; his spelling was poor, but improved.
One could predict that he would be able to continue through
school, even though he might be poor in spelling. The
most marked improvement in David, however, lay in his
mental attitude. His mother reported that he was a "dif-
ferent boy." This metamorphosis was caused by the boy's
understanding of the nature of his difficulty; his feeling of
success in school, for the first time; and the changed attitude
of his parents.

In this connection, one should remember that, while the
ability to spell correctly is helpful, lack of it is not a critical
handicap in life. Spelling difficulties cause criticism in
school and in training courses, but they should not be taken
too seriously.

Tom, an eleven-year-old, had experienced difficulty in
reading ever since he had started going to school. His
teachers complained that he did not work and spent most of
his time looking out the window. In the first five years of
his school life he was diagnosed as retarded, having arrested
emotional development, lack of focus of his eyes, and hypo-
thyroidism. The two latter diagnoses were contrary to the
findings of a competent ophthalmologist and the results of a
basal metabolism test. After two years of failure in school,
he was placed in the "opportunity room," known to every-
one except the teachers as the "dumb room." (Inciden-
tally, such rooms, which are designed for children who are
mentally deficient or for any reason unable to follow the
regular school program, usually offer more custodial care
than opportunity.) During these school years, Tom became
a major behavior problem. He was large for his age and
grew into a bully. He beat other children severely, broke

Intelligence

windows, and made himself objectionable to everyone,
including his parents.

Examination showed that Tom was normal physically.
His LQ, was 135 but he had a mixed handedness; his right
hand and his left eye predominated. The parents reported
that the boy's paternal grandfather was partly left-handed
and was poor in spelling. The paternal grandmother wrote
and spelled badly and did not like to read. Tom was very
proficient in arithmetic. He liked shopwork and made
many electrical devices by following pictures and diagrams.
In reading, however, he did not know such words as "re-
member," "envelope," and "regrettable." He also made
many word substitutions, such as they for there, over for under,
in for on, went for gone. He spelled carrot, caret; everyone,
everone; bottom, bottoner; farther, Jorther; either, aether; tomorrow,
tomoro; remember, rremenber. Here, again, is evidence of poor
visual word memory and spelling by sound and guess.

Although Tom became extremely cooperative and made
every effort to develop his visual memory, his progress was
very poor. However, with special tutoring that developed
auditory and kinesthetic memory, he showed slow but con-
tinuous improvement. After two years of this help, he was
able to read sufficiently to keep up in his schoolwork and to
spell well enough to express himself to understanding
teachers. In his case, as in the previous one, the change in
his general attitude constituted his outstanding improve-
ment. After a few months' time he became a studious,
cooperative child.

It was Kenneth's schoolteacher who referred him to a
physician for examination. At the age of eleven he was
enrolled in his third school system. In the two previous

57 .

A Psychology of Growth

ones he had been considered retarded. He was well
physically and had an I.Q. of 99, but he could not learn to
spell. When asked to write, from dictation, "four score
and seven years ago our fathers brought forth on this
continent . . . ," he produced the following: u for cree and
care yers curtey or fcrythr beril orre on theis certhe." This
boy's ability to do schoolwork increased three years in six
months' time after the principal began to give him special
help thirty minutes a day.

It is extremely important to recognize these cases, not
only because of the obvious difficulties to which they give
rise, but also because they always culminate in emotional
disturbances. In fact, they might be used to illustrate
what happens when a child is thwarted. The child is con-
vinced that he is stupid and is correct in assuming that he is
not liked by his parents and schoolteachers. Since failure
in school is a reflection on both parents and teachers, they
are all eager to disclaim any responsibility for the condition,
and the child is censured at home and in the classroom.
When he is unable to do the schoolwork, he loses interest;
because he feels stupid and bad, he shows off before the
other children; because his classmates ridicule him and call
him "dumb," he assumes the air of indifference or, more
frequently, fights back and tries to get even with them.
Though neurologists and psychologists have understood this
condition for more than twenty years, most teachers do
not recognize it.

Patients who suffer from these disabilities are often
referred to the school nurse, because teachers and parents
have been educated to suspect visual difficulties when
children cannot learn and because eye-muscle unbalance is
often associated with the condition. If the nurse bears in

58 -

Intelligence

mind the nature of word blindness, she will find that it is
easily diagnosed from the family history and from the
patient's writing and drawing.

In the treatment of one of these cases, the first important
step is to acquaint the parents, the teachers, and especially
the child with the nature of the difficulty. It is necessary
for the physician to reassure the patient by telling him that
he is not a stupid but an intelligent child, although he was
born with a special handicap. He should be told that,
owing to this handicap, he may always be a poor speller,
but that with proper training he can learn to spell well
enough to get through school. When the teachers under-
stand the source of the pupil's difficulty and he is given
adequate help, his conduct and his classwork improve and
he becomes a happy, cooperative child.

There are other special defects, of which the most com-
mon are poor motor coordination and lack of a sense of
rhythm. Children who have the former handicap may not
be able to write well and those who lack a sense of rhythm
cannot learn music.

Most schools are not equipped to give the special help
needed by children with these various handicaps, especially
in cases where the condition is severe. Such conditions,
particularly those which relate to writing and spelling, have
been treated by many methods. The methods that have
been most successful were developed by Dr. Grace M.
Fernald, who has described them in her book, "Remedial
Techniques in Basic School Subjects." 7

ADOPTION

A discussion of intelligence, especially in the case of
infants, would be incomplete without added emphasis on

- 59

A Psychology of Growth

the effects of environment upon the rate of growth. This
appears strikingly in orphanages, where there are so many
babies that it is not possible to supply the growth needs of
all. Not uncommonly, therefore, babies who appear back-
ward while they are in these institutions and who fail to
pass the intelligence tests for their ages experience rapid
mental growth when placed in good homes and often show
superior intelligence.

This phenomenon is illustrated by the case of Peter, who
was taken from a good orphanage at the age of eleven
months. After he had been given careful tests and had been
observed for several hours, it appeared that he probably
had normal intelligence. Since the foster parents wanted
a child whom they could expect to grow up to take a place
in a family of intelligence and education, a six-month test
in the home seemed advisable, During little Peter's first
few months in his new home, he changed from a rather
apathetic, expressionless, inactive baby to one who was alert,
active, animated, and happy. At the age of four, intelli-
gence tests showed that he had an I.Q. of 120, a high degree
of intelligence, of which he had given no evidence while he
was in the orphanage. Any pediatrician who sees many
adopted babies frequently observes this acceleration of
mental growth when children are removed from institutions
to private homes.

Observation of such cases, in addition to our knowledge of
the importance of satisfying growth needs, leads to the con-
clusion that babies should not be kept in orphanages longer
than is absolutely necessary. Orphanage executives agree
that it would be desirable to use such institutions only as
clearing stations and to make the turnover as rapid as
60

Intelligent

possible. Prospective parents of adopted children should
take babies at a very early age, but only on a six-month or
one-year trial basis. The reason for the latter rule is the
possibility that parents who adopt a baby soon after its birth
may later find that they have taken into their care a mentally
retarded child.

This discovery may have painful consequences, as in the
case of baby Grace. She was adopted at the age of two
weeks, with the understanding that her background was
good and that her real parents were highly intelligent.
When she was six and a half, however, her first-grade
teacher reported that Grace was making no progress in
school. Intelligence tests showed that she had a mental
age of five years, an I.Q. of 76. Further investigation of
the little girl's antecedents revealed that the assurances
given to the prospective parents before her adoption had
been based on mere opinion, rather than on accurate
knowledge. Although the foster mother and father were
able to give the child every opportunity for education, there
was nothing that anyone could do to raise her I.Q. The
parents, particularly the mother, could not accept a re-
tarded child, and the adoption was a great misfortune for
all concerned.

When it is available, prospective parents are entitled to
accurate information about a baby's intelligence and should
know whether or not there is serious mental disease, such as
epilepsy, in his background. On the other hand, the baby
should be given only to parents who are able to supply his
needs for normal growth and give him a chance to grow
up in mental health. Determining the attitudes of prospec-
tive parents requires the services of skilled investigators.

A Psychology of Growth

Edith is an example of the bad results of an unhealthy
parental attitude. At the age of eighteen, she was placed
under the care of a physician because of her fear of vomit-
ing, especially in public. "I am terrified of what people
will think of me," she said. For several years she had ex-
perienced increasing fear of public opinion, of failure to
pass examinations, failure to be accepted by a good
college sorority, and many other anxieties. She had an
I.Q. of 125.

Investigation of the girl's history revealed that she had
been adopted at the age of two weeks. The parents were
college graduates and both came from very good families.
During the child's infancy, her schedule was extremely
rigid. She was never held, was strictly disciplined, and
became a very good, tense, apprehensive little girl. After
several interviews, the mother admitted that she had never
wanted the baby and had never "felt right" about her.
It was the father who wanted the child. "He knew about
her," the mother said, "and was crazy about her, and so,
since I could never have a baby, I went along with him."
The relationship between the mother's attitude and the
child's mental health is readily apparent. Cases such as
this indicate the need of careful studies of the infant and the
prospective parents before adoption if we are to safeguard
the child's mental health.

REFERENCES

1. GESELL, ARNOLD, M.D., and CATHERINE S. ARMATRUDA,
M.D., "Developmental Diagnosis," Paul B. Hoeber,
Inc. Medical Book Department of Harper &
Brothers, New York.
62

Intelligence

2. TERMAN, LEWIS M., and MAUD A. MERRILL, "Measur-

ing Intelligence," Houghton Mifflin Company, Boston.

3. Bakwin and Bakwin, "Psychologic Care during Infancy

and Childhood," p. 77, D. Appleton-Century Com-
pany, Inc., New York.

4. TERMAN, LEWIS M., "The Measurement of Intelligence, 5 *

Houghton Mifflin Company, Boston.

5. TERMAN, LEWIS M., and MAUD A. MERRILL, "Directions

for Administering Forms L and M," Houghton
Mifflin Company, Boston.

6. ORTON, SAMUEL T., "Reading and Writing and Speech

Problems in Children," W. W. Norton & Company,
Inc., New York, 1937.

7. FERNALD, GRACE M., "Remedial Techniques in Basic

School Subjects," McGraw-Hill Book Company, Inc.,
New York, 1943.

Chapter ,-- Five

Mental Deficiency

Mentally deficient individuals present problems to their
parents, schools, society, and themselves. These indi-
viduals do not have the intellectual capacity to understand
the rules and regulations of society. There are many
causes for mental deficiency. For the mental health of the
parents and family, an infant who is of very low mentality
should be placed in an institution as soon as possible.
Educable mentally deficient children can become happy,
useful citizens if given adequate training.

INTELLIGENCE is a matter of growth. At one extreme of
mental growth we find the idiots, in whom there is
practically no development of the mind; at the other ex-
treme we find the geniuses, whose mental growth has pro-
ceeded far beyond the average. Near the lower end of the
scale we have mental deficiency, or amentia, a condition
in which the mind has failed to reach complete or normal
development.

The psychologist differs from the biologist and the sociolo-
gist in defining mental deficiency. In the psychological
meaning of the term, a feeble-minded individual is one
whose I.Q. is 70 or less. From the biologist's and the
sociologist's point of view, Tredgold * defines amentia as
"a state of incomplete mental development of such a kind

Mental Deficiency

and degree that the individual is incapable of adapting
himself to the normal development of his fellows in such a
way as to maintain existence independently of supervision,
control or external support." This statement, which is
similar to the legal definition, implies that some individuals
who have low I.Q/s may, nevertheless, be capable of sup-
porting themselves and getting along without supervision or
control. From the biological and the sociological stand-
points, therefore, they may not be classed as mentally
deficient.

Psychologically, on the other hand, no individual can
make a normal adjustment to society unless he is capable
of understanding its important standards honesty, truth-
fulness, justice, and the like. These are all abstractions.
Intelligence tests show that abstract thinking does not begin
to develop before. the mental age of twelve years, and the
individual whose intelligence quotient is 70 or below never
reaches that age level. One test for a twelve-year-old is
the series of questions: What is charity; envy; justice;
revenge; courage? These are everyday terms and yet,
until children reach the mental age of twelve years, they
do not know the meaning of them. What is justice, for
example? We all know the meaning of this word and yet
we probably could not agree on a definition, because it is a
general term one that, in part, means the same thing to
all of us and, in part, has a different meaning in each
person's mind. To the mentally deficient individual, how-
ever, these terms have no meaning.

Another demonstration of intelligence growth and the
inability of mentally deficient individuals to do abstract
thinking can be made by showing a picture to children of

A Psychology oj Growth

different ages. The two-year-old, when asked to point
them out, can indicate the boat, the tree, and other ele-
ments in a certain picture. The three-year-old can volun-
tarily name these objects. The seven-year-old describes the
picture in concrete terms, saying, "There is a boat in the
water. There are men in the boat. There are trees on
the shore." The normal twelve-year-old will probably
say, however, "The boat must be going down the rapids,
because the man and the woman look scared." This
observation of an abstract concept indicates that the child
has some insight into the situation depicted and can under-
stand the possible consequences. The importance of the
ability to do abstract thinking cannot be overemphasized.
We do not expect it of normal children below the mental
age.of twelve or of mentally deficient individuals who never
reach this level of growth.

Mental deficiency has been ascribed to many different
causes: inheritance, encephalitis, anoxemia, poisons, brain
hemorrhage, birth injury, vascular anomalies with result-
ing thrombosis of the vessels, and lack of development
usually called cerebral agenesis which is probably the
most frequent. When cerebral agenesis occurs in the child
of mentally deficient parents it can be easily explained as a
congenital or familial condition due to poor stock or poor
germ plasm. It is not so easy to account for the condition
in that large group of mentally deficient children whose
parents have normal or superior intelligence; but scientists
have suggested that it might be due to the bringing together
of certain latent strains in the germ plasm, or to some toxic
effects on the germ plasm at the time of conception, or to
encephalitis before or soon after birth.

66 -

Mental Deficiency

Mental deficiency resulting from an insufficient oxygen
supply for the fetal brain during labor has been the subject
of much discussion during the past few years. Some
medical men feel that the sedation of mothers during
labor may cause this condition. During infancy, encepha-
litis, especially of the vkus type, may cause sufficient
destruction of the cortical or subcortical areas of the brain
to result in feeble-mind edness. Although the same con-
dition in older children hardly ever causes damage, one
should give a guarded prognosis when an infant of fifteen
months or younger develops encephalitis.

Science is familiar with mental deficiency caused by
rupture of the blood vessels and the brain tissue at birth.
Since the blood vessels at the base of the brain or in the
temporal region are the ones that are usually injured, caus-
ing motor paralysis, the amount of damage to the intelli-
gence varies. For reasons that are not fully understood,
however, the rupture of a cerebral blood vessel in an infant
or a young child usually causes mental deficiency. In these
cases there are always localized neurological signs; either
the patient has paralysis or paresis, which is localized to
one side of the body, or, if there is damage to both sides of
the brain, one side of the body shows greater weakness than
the other.

Not uncommonly, damage to the brain, resulting in
mental deficiency, is caused by the rupture of a cerebral
blood vessel between the sixth and thirty-sixth months of
life. In these cases the child has a "stroke," or an apoplec-
tic attack. The onset is acute and is marked by high fever
and convulsions, which may last for several hours or days.
Following this, a child who previously may have been

67 -

A Psychology of Growth

altogether well and normal, will suffer from weakness, and
then from paresis on one side of the body and a degree of
mental deficiency that varies with the individual. In some
cases, a child may have a second hemorrhage on the same
or the other side of the brain. This condition was first
described as polioencephalitis of Striimpfel. It is, however,
neither a polio nor an encephalitis, but a brain hemorrhage
that is due to a congenital weakness of the walls of the blood
vessels in the brain. The same damage, with a similar
clinical picture, can be caused by thrombosis of the cerebral
blood vessesls.

Mental xieficiency is not only a great handicap to the
child, but also the source of a serious problem in the home.
The mentally handicapped child requires special considera-
tion there and also in the school and in society at large.
As Wile 2 has pointed out, "the inferior child struggling
against incapacity and overdemand is no more a victim
than the superior child whose mental gears are not en-
meshed in educational dynamics. Among these groups are
found an abundance of nonconformists in behavior, retard-
ates, truants, delinquents, and neurotics. 53

From the point of view of the most normal parents, the
discovery that they have a mentally deficient child is a
serious blow. The factors contributing to their distress
may vary in intensity with individual cases, but these
usually include unconscious biological resentments against
bearing an abnormal child, the resultant social stigma, fear
for the future well-being of the youngster, and lack of pride
in his present accomplishments or lack of hope for future
achievements. In addition to these trials, many parents

Mental Deficiency

are afflicted by others, which are even more distressing.
One of these is the idea, which is deeply ingrained in many
minds, that every misfortune in life is punishment for wrong-
doing. Nurses and physicians should be aware of that
possibility and should assure the parents who come to them
with their problems that the child's deficiency is not due
to anything that the mother or the father did or did not do,
should or could have done. It can best be described as one
of the misfortunes of life over which no one has any control.
A mother whose child was an idiot (because of cerebral
agenesis) was typical of those parents who blame themselves
for their children's deficiencies. She suffered great distress
because she had felt, even before a medical examination
revealed the full truth, that something was wrong with the
baby. That is a normal reaction; mothers generally suspect
the truth before physicians inform them that their children
are developing slowly. In this case, the mother was
abnormally disturbed and had become depressed and
mentally ill because she believed that her child's condition
was due to the fact that she had been a "very bad girl. 35
In her childhood her mother had caught her masturbating
and had convinced her that she was very wicked. When
she married, she had a great deal of trouble in making a
sexual adjustment. In discussing her problem with a
physician, she said that the first time she saw the baby she
knew that something was wrong with him but that "out
of dread" she waited four months before getting a medical
opinion. She was convinced, she said, that this defective
child was given to her as punishment for her bad habit.
After the doctor's assurances had removed her sense of

A Psychology of Growth

^ she was greatly improved and was able to face the
tragedy of having a subnormal child. Later she gave birth
to a normal baby.

Because of the popular stigma attached to the words
"idiot," "imbecile, 55 "feeble-minded, 55 "moron, 55 and "not
bright, 55 they should not be used in discussing subnormal
children with their parents. The terms "mentally handi-
capped 55 and "slow growth 55 convey the same meaning and
are less offensive to many people. Often after a physician
has pointed out that a child is not doing the things that
are normal for 'his age and has explained that he will never
be able to do regular schoolwork, one of the parents will
say "but he is bright. 55 The reply then should be that he
is a fine, bright child, but that he will never be able to
handle academic subjects and will have to learn to work
with his hands.

Mentally deficient children are not necessarily a loss to
society or lifelong burdens to their families. Some of them
are demonstrably educable, and authorities now recognize
that they may find a niche in society and become useful
citizens.

This has not always been the case. As late as 1912,
Fernald called feeble-mindedness "the synonym of human
inefficiency and one of the greatest sources of human
wretchedness and degradation; the social and economic
burdens of uncomplicated feeble-mindedness are only too
well known. The feeble-minded are a parasitic, predatory
class, never capable of self-support or of managing their
own affairs. The great majority ultimately become public
charges in some form. They cause unutterable sorrow at
home and are a menace and a danger to the community. 5 '

. 70

Mental Deficiency

This attitude echoed through much of the psychological,
criminological, sociological, and educational literature of
the early twentieth century. Experts held that a state
institution was the logical guardian of feeble-minded
individuals and advocated it as a means of relieving parents
and society of their presence in the home and at large in
the community. During the past quarter century, ideas
concerning the management of these individuals have
undergone a great change, until today authorities realize
that the mentally handicapped can learn to do many
kinds of work efficiently, and that the community not only
can but should use them for constructive purposes.

Fernald himself was one of the authorities who ushered
in the new era, after he found that state institutions were
not having good results with the mentally handicapped.
When he made a follow-up study of all the individuals dis-
charged into the community from the Massachusetts School
for the Feeble-minded from 1890 to 1914, he found that
35 per cent were complete failures, despite the fact that
those who were allowed to go home were only the ones who
appeared to be the most promising. Similar studies, made
later by Matthews, Stroms, Folley, Brown and others, also
showed that the training afforded by public institutions was
not having encouraging results. Between 21 and 40 per
cent of the feeble-minded discharged from state institutions
were failures in society; that is, they became serious be-
havjor problems or were completely dependent for support.

Quantitatively, too, institutional care was insufficient.
The mere number of mentally subnormal children has made
it impossible for any state to care for them all. In one
city alone, an investigator found 21,000 mentally handi-

A Psychology of Growth

capped children. Strayer 3 arrived at that figure in 1932
as the result of a survey of the Chicago public schools. The
state of Illinois, according to careful estimates, probably has
more than 200,000 children with varying deviation from
the normal. Such figures, which are typical rather than
unusual, indicate the reason why no state has been able to
provide institutional care for even 10 per cent of this group.
Furthermore, it is the higher grade of subnormal children,
those who have seldom been considered institutional cases,
who need the most specialized attention. This help has
always been considered a community problem.

One of the dangers that go hand in hand with mental
retardation is the possibility of delinquency. This relation-
ship has been demonstrated many times. A study made
by Glueck of 1,000 male delinquents in the Boston Juvenile
Court showed that 28.2 per cent were dull, 17.1 per cent
were borderline cases, and 13.1 per cent were feeble-
minded, making a total of 58.4 per cent who were mentally
retarded. Thus Glueck found a much higher proportion
of children of lower intelligence among delinquents than in
the general population. In studies of male and female
delinquents, Glueck found that 78.9 per cent were retarded
two or more years below the school grades normal for their
ages. Wile 2 quotes statistics showing that in New York,
in 1932, 29 per cent of the delinquents were mentally
retarded; in Boston, in 1937, 37.8 per cent; in Chicago, in
1923, 58.6 per cent of the fourteen- to fifteen-year-old
boys going through the boys 5 court were retarded two or
more years.

No figures are available to show the percentage of
mentally retarded individuals in the group that is dependent

Mental Deficiency

upon society for support (the relief load in normal times).

The foregoing in no way proves that mental retardation,
per se, is the direct cause of delinquency or dependency, but
only that the subnormal individual, being particularly sub-
ject to these ills, requires more than the average safeguards.
Instead of receiving needed help, however, the majority
of these children are made to meet obstacles unknown to
the normal child. They are rejected children and, from
early childhood, suffer from their parents' chagrin and dis-
appointment. At school they are unable to keep up with
their contemporaries and miss the satisfaction of accomplish-
ment that is enjoyed by normal children. After repeated
school failures, they are untrained for any kind of employ-
ment. In this situation lie untold causes for personality
difficulties, which might result in delinquency or depen-
dency.

While these problems may sometimes result from mental
retardation, they are more often symptoms of social mal-
adjustment that have emotional rather than intellectual
causes. A study by Shimberg and Reichenberg 4 shows
that mentally retarded individuals with good personality
traits make a much better adjustment than those individuals
who have poor personality traits. In this respect, the
experience of the mentally handicapped parallels that of the
normal individual; that is, adjustment in society depends
more upon normal emotional growth and development than
upon any other factors. Since the mentally handicapped
encounter more serious obstacles than do normal children,
their emotional problems are greater and there is more mal-
adjustment among them. When we remove these obstacles,
however, or oflfer kindly, intelligent help in surmounting

A Psychology of Growth

them, the handicapped child should be able to grow into a
happy, useful individual.

A healthy individual may be described as one who is able
to use his native resources in the most efficient manner and
thereby enjoy the greatest accomplishments of which he is
capable. This applies as much to the person who is
retarded mentally as to the normal individual. Both can
enjoy physical and mental health if their environment pro-
vides them with the opportunity for reaching a maximum
growth and development. In the case of the mentally
deficient child, the determinants for mental health are not
dissimilar to those for the normal individual.

The first essential for mental health is security, and this
begins in the home. Whatever the child's condition and
however disappointed the parents may be, it is necessary
for them to accept him as he is and to make him feel that he
is loved and wanted. Lack of such security is one of the
principal causes of mental ill-health for these handicapped
children. To be sure, it is very difficult for parents to
accept the mentally retarded child. Whether they feel
that he will not be a credit to them or fear for his future
welfare, they are likely to reject such a child and to react
to him by overprotection at one time and at other times by
overcorrection. Either they try to do everything for him
and to shield him from the world, or they try to force him
to behave like a normal child. Both courses are likely to
lead to serious emotional disturbances. For the welfare of
the child and of the family, therefore, it is necessary for
parents to face the inescapable facts and to govern their
actions accordingly.

Parents, expecially mothers, know when their babies arc

Mental Deficiency

not normal; they arc seldom fooled. It is best that their
suspicions be confirmed by expert medical opinion as soon
as possible, because the earlier they know the truth and
the more help they get in accepting it the more security
they can ultimately give their children. If an infant is
hopelessly retarded, however, he should be placed in a
public institution or under private care before the mother
leaves the hospital. This is advisable as a means of pro-
tecting the mental health of the parents and other members
of the family.

Security outside the home comes when the child is ac-
cepted by the community and the school. Unfortunately,
most teachers resent a pupil who is mentally handicapped
and make every effort to be rid of him. This is particularly
true in those systems where the teacher is held responsible
for a child's failure to make good progress and knows that
she is judged, not by the success that he achieves within his
individual limitations, but by absolute, arbitrary standards
of excellence. For this, among other reasons, handicapped
children need special educational facilities.

The second essential for mental health, which is a corol-
lary to the first (security), is the opportunity for the child
to grow up according to his own pattern. In order to
meet this requirement, it is necessary for those who teach
and care for the child to understand his growth patterns
and to let their expectations be determined by his ability
rather than by their hopes. They should help the child
to get satisfaction from learning to do things up to the
limit of his capacity, however great or small that may be.
When adult expectations exceed a child's ability, he reacts
by overcompliance on the one hand and overdefiance on the

A Psychology of Growth

other. These reactions, based on insecurities and accom-
panied by fear and resentment, lead to dependency or
delinquency.

For all these reasons it has become apparent that mentally
handicapped children require specially trained teachers and
special educational facilities. Authorities also recognize
that the best training has resulted from state programs that
provide special aid to cooperating local school systems.
Some states, notably Massachusetts and New York, have
had programs for many years. More recently, Penn-
sylvania, Wisconsin, Ohio, Michigan, California, and finally
Illinois, have begun to develop plans to meet the great need
of the mentally handicapped. The different programs
vary in detail, but they are based on the belief that retarded
children attain the greatest mental health when they are
kept in their homes or in suitable boarding homes and are
trained in accordance with their individual capacities and
scholastic needs. This system, of course, does not apply
to children with extremely marked handicaps, intellectual,
emotional, or both. For their training it is necessary to
provide state institutions.

In the case of other children, several types of education
are now offered. Provided that the teachers give handi-
capped children special consideration, many of them can
continue in regular elementary school classes. Others, who
have more marked handicaps, do better in special classes.
When children belonging to either group reach the age at
which vocational training is indicated, they receive the
greatest advantages from special schools operating as part
of the local school system.

A state protectorship, set up with public funds, may offer

Mental Deficiency

further aid to the mentally handicapped. This protector-
ship, designed to provide such supervision, treatment, and
training as each child may need, should function in coopera-
tion with the parents, the community, and the local school
system. It can be a means of relieving parents of much
anxiety about the welfare of a handicapped child after they
themselves are no longer able to supervise him and provide
for him.

Proper care will help a child to realize all his capabilities,
whatever they may be. The mentally handicapped child
will not go so far as his normal brother, but there is no good
reason why his emotional growth should be stunted or why
he should be prevented from making a good adjustment to
society. Children who have security and are allowed to
grow up according to their own patterns develop habits of
self-reliance, which give them the confidence and courage
to face problems and to solve them. Unconsciously they
develop good work, play, and health habits by doing the
things that they want to do, in a program adapted to their
individual abilities and emotional needs. Each one accepts
responsibility for his behavior up to the limit of his mental
capacity. The one who does not have the intellectual
capacity to do the abstract reasoning and complicated think-
ing of normal individuals may still attain normal emotional
growth and will usually accept adults' norms of right and
wrong to a remarkable degree.

Thus fortified by security in the family and in the com-
munity, and by confidence in himself, the mentally handi-
capped child is ready to take his place in society. If society
accords him that place and permits him to feel that he is
needed, he will be able to complete a process of emotional

77 -

A Psychology of Growth

and social growth that transforms a once helpless and
hopeless group into useful, productive citizens. It remains
for labor and industry to accept these individuals and to
give them the numerous types of jobs for which their home
and school training have fitted them. Employment is a
double-edged instrument which gives the individual self-
respect and protects society from the delinquency and
dependency of large numbers of people who might other-
wise be public charges.

Unfortunately, a happy ending is not possible in every
case. There will be some children who cannot grow up
successfully because of adverse home conditions. Some
children will need supervision by public agencies or place-
ment in boarding homes; others will develop signs of
delinquency and may have to be placed in state institutions.
It should be possible, however, for the large majority to
have mental health and to lead useful, happy lives.

REFERENCES

1. TREDGOLD, A. F., "A Textbook of Mental Deficiency,"

p. 124, William Wood & Company, Baltimore, 1937.

2. WILE, IRA S., Integration of the Child The Goal of an

Educational Program, Mental Hygiene, Vol. 20, 1 939.

3. STRAYER, FRANK, quoted by Frank Beals, American

Association on Mental Deficiency Conference, 1939,
Chicago. Edited by Edward T. Humphreys.

4. SHIMBERG, MYRA, and WALLY REICHENBERG, "The

Success and Failure of Subnormal Problem Children
in the Community," Judge Baker Foundation,
Boston, A. B. Mental Hygiene, vol. 17, 1833 (Quote
Fernald, Walter).
78

Chapter ------------- Six

The School Child

The nurse is an important part of the school system.
Proper health education is of great value as a part of
education. Progressive educators teach children; other
educators teach subject matter. Education is learning to
get along with others, physical and mental well-being,
development of special abilities and interests, and the right
to realize one's ability and importance. During this
period of growth, play continues to be important. War
games, comics, magic, and motion pictures are valuable.

THE nurse is becoming an accepted and important part
of the school system. This has come about because of
the increasing emphasis on preventive medicine in present
health programs and because educators as well as physi-
cians recognize that physical growth is closely associated
with mental development. The nurse is the intermediary
between the educator and the physician, besides being the
teacher of good health practices to children. She is aided
by the fact that children, even more than adults, are
interested in themselves and curious about their own bodies.
They can be taught about themselves and can be shown
methods of improving their bodies without having their
unalterable defects emphasized. This implies that the
nurse can distinguish between the innate constitutional

79 -

A Psychology of Growth

differences of normal children and physical defects that
require medical attention. She should be able, with medi-
cal aid, to distinguish between small stature and under-
weight; anemia and light complexion; normal hyperactiv-
ity and "nervousness"; defective vision and poor visual
memory; diets in the home that are adequate, although they
do not follow the narrow nutritional food lists, and those
that mighjt cause malnutrition; as well as to recognize the
signs of acute and chronic illness.

Much harm has been done to children in the past by
using well-intentioned devices to force them to eat more
food than they wanted or needed, and to gain weight beyond
their capacity; by suggesting that all children have their
tonsils and, adenoids removed; and by giving advice con-
trary to that of their personal physicians. As a result,
children have been taught that they were ill when they were
entirely well; their unchangeable handicaps have been
impressed upon them and their feelings of inferiority, pro-
duced by these physical handicaps, have been increased.

Health education in the school is best developed not only
through the efforts of the school nurse but also by means of
the. health standards and examples set by the teachers and
administrators. The daily program; the emotional tone
of the classroom; the facilities for play, sanitation, and safety
all can be based on special consideration of the physical
characteristics of children. Pupils can receive valuable
information about healthy living through the attitude of
teachers and nurses toward the care of accidents, illness that
occurs in school, precaution against and control of com-
municable diseases, routine health examinations by the
children's personal physicians, and planned instruction that

- 80

The School Child

emphasizes simple physiology (knowledge about the body)
and medical facts that they can observe for themselves.

Children learn more, for example, and are more im-
pressed by seeing what happens when white rats are fed on
different diets than by listening to boring lectures about
eating spinach, which they may hate, or cereal, which may
be nauseating to them. Another medium for helpful
health education is found in motion pictures that take up
the subjects of food and physiology and present them in an
attractive and interesting, as well as informative, manner.
Further information may be found in "Health Education." 1

PROGRESSIVE EDUCATION

Since the nurse's work must be correlated with the school
program, it is necessary for her to understand and apply the
educational methods of the teachers. During the past
twenty-five years, there has been much discussion about pro-
gressive education, and the controversy continues. Pro-
gressive education was introduced by those educators who
rebelled against the older method and substituted educa-
tion as a part of growth and development for a system that
was devoted to forcing children to act like "ladies and
gentlemen" and to memorize set facts so that they might
regurgitate them on examination papers.

The chief criticism of progressive education has come
from persons who considered that this new approach meant
that children should do exactly as they pleased in school and
that, therefore, they would neglect those subjects in which
they were not interested and thus fail to learn all that was
necessary. Those who believe in progressive education feel
that teachers can make schoolwork so interesting that, with-

- 81

A Psychology of Growth

out adhering to a rigid schedule, they will command the
respect of the children and stimulate their interest.

In the progressive school, time is set aside each day for
arithmetic or reading, for example, but no two children
are required to do the same amount or quality of work.
The rate of progress and the amount of help given by the
teacher vary with the individual child. The pupil is
praised for his accomplishments and, if he has difficulty,
the teacher looks for the reason instead of criticizing him
for his failure to come up to some set standard. The pro-
gressive school determines what a child should learn and
finds interesting ways of teaching him that material.

The fundamental difference between the standard and
the progressive educational system lies in the fact that the
former teaches subject matter, the latter teaches children.
Hughes Mearns, 2 Elizabeth Hubbard, 3 and others have
demonstrated that, with few rules and regulations in the
classroom, they could interest pupils and stimulate them to
do things far beyond the previously estimated capabilities
of children. Most schoolteachers, however, do not possess
this ability and find it necessary to have definite study
periods and assignments. This method can be followed
successfully if the teacher observes and takes into account
the growth and development of each individual child. It
represents progress in education comparable to that which
has taken place during the same period in medicine and
other branches of science.

The progressive school will be in harmony with the
nurse's ideas, because its curriculum is built in accordance
with recent data presented by medical science. Growth
follows the same general principles during the school years

The School Child

as In any other period and the progressive educator, no
less than the nurse or the physician, knows that it is not
uniform and that no two children are alike. In the past
we had to accept the self-evident truth that six-year-old
Johnny was three inches taller than Jimmy, who was the
same age; but because no difference in mental stature was
visible to the naked eye, we expected one of them to learn
to read merely because the other had that ability. Assum-
ing that there was a definite time when every child should
read and write and learn decorum, the old-time teacher
considered school a place where the same set of facts was
forced into the minds of all children, and rigid adult stand-
ards of behavior were imposed upon them, just as home was
the place where the young were forced to eat and to obey
orders with military promptness. According to present
concepts, education is the process by which the individual
develops his mental and physical usefulness while becom-
ing acquainted with himself and the world, and gaining
knowledge necessary to an understanding of both. Wash-
burn 4 says that education is (1) learning to get along with
others; (2) physical and emotional well-being; (3) the right
to health and happiness; (4) the right to develop special
abilities and interest, that is, the right to be different; (5)
the right to realize one's own organic unity.

In the school, as in the home, the child's greatest need is
security. When he enters school, the teacher becomes a
substitute parent; and, as Elizabeth Hubbard points out,
she should make each youngster feel that she wants him
and approves of him. Like the parents, she must accept
each child as he is, recognizing the fact that he has certain
individual, unalterable characteristics. Just as no expert

83 -

A Psychology of Growth

would mistake Mary's fingerprints for Betty's, so the intelli-
gent teacher will note differences in their physical charac-
teristics, besides varying degrees of motor coordination and
mechanical skill, and will base her expectations of per-
formance upon their capacity rather than upon any arbi-
trary standard. The same thing holds true in regard to
individual differences in mental capacity and the intel-
lectual attributes that determine each child's ability to
handle the different school subjects. Emotional responses,
which vary as widely as physical and mental characteristics,
result from innate qualities and emotional patterns acquired
in early childhood.

The needs of the school child are the same as those of the
infant, but the former does not require immediate satis-
faction. Whereas the infant wants attention the instant he
is hungry or cold or frightened, the school child is able to
wait a short period for the fulfillment of his needs. The
postponement does not lessen his satisfaction. This ability
to derive satisfaction from delayed responses is a sign of
mental growth.

After the child has mastered the simple problems of build-
ing with blocks, shoveling sand, and coloring pictures in his
paint and crayon books, he finds that he has exhausted the
pleasures to be found in these pursuits. It is no longer
enough for him to play with simple toys and run up and
down by himself; he looks for other activities and finds
satisfaction in performing more complex and more difficult
feats. He wants to go to school and he wants to leari;. It
is fun to read and write and spell, to work with other chil-
dren, to play more involved games, and to find a greater
outlet for his individual abilities. The school, therefore, is

The School Child

able to make his mental growth a continuous process by
offering progressively complicated problems, which at once
grow out of the pupil's past experience and arouse the
curiosity that will lead to further intellectual exercise.

Self-expression, which Washburn gives as a second basic
need of every school child, has already been described. It
is the child's performance of those acts that make him feel
useful and give him satisfaction in his accomplishments.
While he is expressing himself, and in the process of learning
new skills, he is also establishing further habits of self-
reliance. As applied to school, self-expression involves
putting materials together in new ways and taking responsi-
bility for assigned work. Every normal child will get up
in the morning, dress, eat breakfast, and go to school on
time if left to his own devices. Provided that the expecta-
tions of the school are within his capacity, he will take full
responsibility for his classroom work without any prodding
by his parents. Indeed, his need for self-expression is a
greater force than any parental cajolery and provides
stronger motivation for study than do any exhortations.

The child's third great need during the school period is
social integration. This is best achieved by means of
play, in course of which lessons are learned through actual
experience in handling materials, dealing with contem-
poraries, and making necessary adjustments. Organized
play with limited supervision stimulates mental growth,
adds to the child's independence, and helps to channel his
interests along the lines of his individual aptitudes. If we
are to preserve his mental health, we must let him play
those games that conform to his emotional characteristics.
Sometimes the games may seem cruel or uncivilized and

85 -

A Psychology of Growth

altogether unfitting for little ladies and gentlemen, but
suppressing the games does not eradicate the emotions that
prompted them; permitting the games gives the child an
opportunity to dissipate emotions that are not likely to be
harmful except when they are kept locked up within himself.

The war games, which are often the delight of the nine-
year-old and the despair of conventional adults, are ex-
tremely helpful to the participants. Such games do not
manufacture animosities and blood thirsti ness; they are an
outlet for the child's preexistent resentments, a dramatiza-
tion of mental conflicts between good and bad, the child's
normal wishes and the demands of society.

It may allay some adult fears to mention an incident
recently reported in The New Yorker. A mixed group of
white and colored boys who were in the habit of playing
together, proposed a new game, race riot. Plans for the
game went well until the boys discovered that there were
more whites than Negroes. This, they all agreed, was
unfair; so some of the white boys offered to play that they
were colored, thereby making the two sides equal in num-
ber. That being arranged, the riot proceeded to its ami-
cable conclusion. Of course, it should be remembered
that the sense of fairness displayed by this group does not
always hold. Young boys and girls commonly have too
many resentments, born of feelings of inadequacy and lack
of approval; they get satisfaction from picking out a single
child or a minority group to torment. For this reason,
playground supervisors are valuable.

At about the time when children reach the second grade
in school and continuing until puberty is reached, they go
through what has been described as the "almighty" stage of

The School Child

growth. They exude confidence in themselves and regard
their own conclusions as supreme authority. Advice from
grownups is unwanted and ignored. A boy becomes pri-
marily interested in other boys and a girl, in other girls.
Both are far more interested in the ideas of their comrades
than in those of their parents or teachers. Any amenities
that once they may have imitated now tend to disappear.
If manners, cleanliness, honesty, or consideration for others
meant anything to them in the past, they no longer do so.
The conservative school, which emphasizes social graces on
the report card, indicates a fundamental lack of under-
standing of normal children.

It is necessary to understand children's minds in order to
answer many of the questions that puzzle and trouble their
mentors. Among these are problems concerning comic
books, motion picturers, and the radio, in relation to the six-
to eleven-year-old schoolboy and schoolgirl.

Many laymen and lay organizations have expressed great
fear that comic books lead to anxieties, delinquencies, and
confusion in children's minds. Fifty years ago, adults
expressed that same concern about the assumed evil in-
fluence of the popular dime novel. In the opinion of
Bender and Lurie 6 comic books are comparable to the
mythology, fairy tales, and puppet shows of past ages. As
they have come down through the years, fairy tales have
brought the same thrills to generation after generation of
children (and none have been the worse for them). Jack
and the Beanstalk, Cinderella, Alice in Wonderland, and
now Superman are living literature, in that they express
emotions that the human mind can readily understand.

The comic book was developed for the preadolescent

87 .

A Psychology of Growth

child. He has accepted it eagerly and used it as an emo-
tional outlet. During the preadolescent period especially,
the child feels his weakness, smallness, and other limitations,
on the one hand; on the other, the revelation of his growth
pattern (aggressiveness). Because his war games, his in-
vestigations of haunted houses, his attempts to dig secret
tunnels and to find buried treasure do not wholly satisfy
him, he escapes into fancy. The omnipotence of Superman
and other characters who possess immeasurable strength
and resourcefulness, as well as magic wings and magic
carpets for limitless flight, fulfill the wishes of boys and girls.
Magic, radio, and death-dealing rays, with which comic-
book heroes combat the forces of evil that confront them,
offer a dramatic solution to the problems in the minds of
preadolescents. One magazine on magic is reported to
have a circulation of nearly one-half million copies a month.

In comic books, bad people and destructive forces are
forever opposing good people and constructive forces. In
the child's mind, too, there is always a conflict between
good and bad, right and wrong. When he attacks his
own problems he becomes aggressive and ambitious and
tries to build up his own importance, but at the same time
he recognizes his weakness and his limitations and keenly
feels the competition of others, which is the use of aggressive
forces against him. The battle that rages in his mind
develops in the child a sense of guilt and a feeling that he
deserves punishment. The comic book dramatizes this
personal battle and gives the child an emotional outlet;
the invariable triumph of comic-book right over comic-
book wrong brings him satisfaction.

When millions of children will spend a dime or several

The School Child

dimes every week for comic books, it may be because these
books supply something that these young people need badly.
That something is a release for strong, baffling emotions.
Those comic books which fulfill this need are greatly in
demand; those which fail to do so go into the discard.
From the point of view of the adult, therefore, they are a
fairly accurate index to the problems in the child's mind.

The boy or the girl who is disturbed by reading comic
books is the insecure youngster who was already disturbed
before he started to read. Prohibition of the books will not
solve his difficulty any more than addiction to the books can
be said to cause it. He should be allowed to read the stories
if he cares to, but he should have sympathetic help from
adults who try to understand his feelings.

A mother who brought a bright but apprehensive nine-
year-old boy to a physician because of nervousness ascribed
his condition to "those terrible comic books," radio pro-
grams, and motion pictures. Careful studies, on the other
hand, indicated that Jimmy's difficulty was due to the
parents' unreasonably high standards. If he had carried
out their wishes, they would have eliminated much of his
childhood. They wanted him to read "good literature,"
to get high grades in school, and to be a "little gentleman."
Fortunately, Jimmy showed signs of "battle fatigue" and
the parents, to their credit, realized that something was
wrong and that the boy needed help. They were willing
to change their program and, when they permitted the
child to do things that they had previously forbidden (even
to swear a little), his nervous signs disappeared. Ten years
later, the mother proudly reported that her son enjoyed
good books.

A Psychology oj Growth

Like the comic book, the motion-picture play has caused
'much alarm. Thoughtful adults are continually wondering
whether children will become criminals as the result of see-
ing gangster pictures or soldiers of fortune patterned after
heroes of adventure plays. In answer to this question, we
get an emphatic No from Dr. A. A. Brill, 4 an outstanding
psychiatrist, who has made extensive studies of motion
pictures and criminality. "In my psychiatric experience/ 5
he says, "I have never seen a male or female who has com-
mitted any crime because of something he or she has seen
or read. It has often been said that there is such a rela-
tionship but these statements are not true." According to
Dr. Brill, children of eight to twelve years enjoy the motion
pictures because they have strong, repressed emotions that
are vicariously relieved by melodrama. For this reason,
the motion picture is useful to the child, rather than
harmful.

In common with the comic book, the gangster motion
picture portrays a battle between good and evil, and good
always wins out. Actually the lessons that these motion
pictures teach are more acceptable probably more valu-
able and surely less harmful than the nagging that adults
inflict on most children.

The value of motion pictures was illustrated by the case of
a ten-year-old girl who was very "nervous" that is, tense
and afraid to go into a dark room and to go to bed alone.
She was an insecure child, unprepared for preadolescence,
and her nervous behavior followed sex play and the ex-
perience of being scared by an older brother. One of the
things that had made a great impression on the little girl
was a motion picture in which a good man saved the life of

90 -

The School Child

a bad man. The latter tried, in turn, to kill the good man,
who was saved at the last minute, while the bad man
was killed during the attempted crime. The girl enjoyed
repeating this story and told it at least thirty times. Al-
though she never gave the details twice in the same way, she
invariably brought out the struggle between the good and
bad men and the fact that the good man always won. Her
repeated discussion of this motion picture became the basis
for the physician's treatment of her difficulties and thus
her rapid improvement was due at least in part to the
motion picture.

REFERENCES

1. "Health Education," National Education Association

of the United States, Washington, D. C.

2. MEARNS, HUGHES, "Creative Power," Doubleday, Doran

& Company, Inc., New York, 1928.

3. HUBBARD, ELIZABETH, "Your Children at School,"

The John Day Company, New York.

4. WASHBURNE, CARLETON, "A Living Philosophy of

Education," The John Day Company, New York,
1940.

5. BENDER, LAURETTA, and REGINALD LURIE, The Effect

of Comic Books on the Ideology of Children, The
American Journal of Orthopsychiatry, vol. 11, pp. 540-
554, July, 1941.

6. BRILL, A. A., "The Value of the Motion Picture in

Education, with Special Reference to the Exceptional
Child," p. 16, Child Research Clinic of The Woods
Schools, May, 1940.

91 .

Chapter -- Seven

Fears

Fear is a primary emotion, valuable or a handicap. Loud
noises, sense of falling, insecurity, and lack of approval
are the most common causes. Medical fears are common.
Nurses can allay much of the fear of their patients. The
seriousness of a situation (amount of fear in the child)
depends upon the attitude of parents. It is also influenced
by the condition of the child's mind at the time.

FEAR is a primary emotion based on one of the strongest
instinctive forces that motivate behavior, self-preserva-
tion. Without fear, the individual would not long survive.
It is, therefore, one of the most valuable attributes of the
living organism. Nevertheless, the person who deals with
children should always remember that excessive fears
impede normal growth and development and make it
extremely difficult for the individual to adjust to his
environment.

Evidence of fear is present from the moment of birth.
The infant responds, by crying, to the insult of being cast
into the world. The sense of falling and, as soon as the
mucus is absorbed from the middle ear, loud noises will
cause him to protest. In these reactions it is difficult to
differentiate between fear and resentment. They are closely
allied; but whether, as some psychologists believe, the in-

Fears

dividual is first frightened and then angry, or the other
way around, fear is certainly one of the baby's earliest
reactions.

Two other causes of fear in infancy and childhood are
lack of security and uncertainty. The infant is distressed
and shows signs of anxiety when he is separated too long
from his mother. The period varies at different times of
the day and in different infants from thirty minutes to
several hours. As soon as the baby has grown intellec-
tually to the point where he can recognize individuals as
such and actively protest, he shows his fear by crying when
strangers approach, becoming especially disturbed if they
try to hold him. This reaction begins when the child is
four to six months of age and, as he gains strength, increases
in violence up to eighteen to twenty-four months.

The dispersal of thousands of families as a result of war
conditions amply proved the closeness of the relationship
of the child to his parents, particularly to the mother. In
fact, the effects of separation were so injurious to children
that it seemed best to keep the younger ones with their
mothers, even when there was danger of the most disastrous
air raids.

Since fears are readily communicable, babies often
acquire them from contact with persons who are frightened.
The mood of the baby also parallels that of the mother,
with the result that anxious mothers have anxious babies.
Such infants are usually more tense than others and, there-
fore, are easily disturbed.

Changes in routine, living conditions, and surroundings
stimulate anxieties in infants and young children, as is
illustrated by the following cases.

A Psychology of Growth

A nine-month-old baby was happy and contented and
slept well until her mother rearranged the furniture in the
nursery. It was later discovered that the new arrangement
placed the baby's bed in such a position that light shone
on it and she could see reflections and shadows from the
street. When her bed was returned to its original position,
she again became a contented child.

Fifteen-month-old John, who was taken to visit his grand-
parents, accepted the new bed and strange surroundings so
easily that on the first night of the visit he fell asleep at the
usual time. -That night there was a electrical storm.
Thunder and lightning had not previously disturbed the
child, but now he was very badly frightened; he could not
feel secure in new surroundings during a storm. There-
after, for several years he awakened and cried when he
heard thunder or other loud noises in the night.

Worried grandparents sent for a physician because an
eighteen-month-old grandchild, with whom they had been
walking the floor, had not slept for twenty-four hours. She
refused to eat, cried when put to bed, and expressed acute
unhappiness. Even when she was held by her grand-
parents, her pupils became very large and she showed all
the physiological signs of fear.

The baby's history revealed an emotionally disturbed
mother and serious discord between the parents. The
mother had precipitated the immediate trouble by suddenly
going out of the city and leaving the baby with the grand-
parents. They had not seen much of the child and their
small, dark apartment contrasted most unfavorably with
her own home. It seemed advisable, in those circum-
stances, to place the baby in a hospital, assign very fine

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Fears

student nurses to care for her, and instruct them to sit down
and hold her as often and as long as she wanted to be held.
In spite of the strangeness of the hospital and the new con-
ditions in which she found herself, the baby felt enough
security and confidence in the nurses so that she slept, the
first night. In two days she was entirely normal.

Another little girl, twenty-six-month-old Alice, swallowed
some medicine, which her mother thought was poisonous.
The child was rushed to a hospital, where her stomach was
washed and she was kept for a week, to make sure that no
signs of poisoning would develop. During that week she
saw her mother only two or three times and, on each occa-
sion, little Alice cried violently. After she left the hospital,
she was irritable, cried frequently, followed her mother
around the house, refused to take a nap, and never fell
asleep until late at night. Well-meaning friends suggested
to the mother that the nurses had "spoiled" the little girl.

To the physician it was obvious that the cause of the
trouble was the child's anxiety. She had been seriously dis-
turbed by her mother's terror when she discovered that
Alice had taken the medicine. The experience of being
rushed to the hospital and having her stomach pumped,
followed by the week-long, almost uninterrupted separation
from her mother, had been a very frightening ordeal for
the child. This was explained to the mother and she was
advised to hold the little girl on her lap and rock her as much
as she wanted to be rocked. After a few days of this treat-
ment, she began to show improvement and, within two or
three weeks, she was practically normal again. For a long
time, however, she was frightened unless her mother took
her along whenever she left the house.

A Psychology of Growth

The same kind of care brought favorable results in the
case of another little girl. This two-and-a-half-y ear-old
began wetting herself during the day, sucking her thumb,
and crying a great deal, after her mother went away on a
trip. Clearly, the sudden disappearance of the mother
created anxieties in the child's mind. The nurse in whose
care the mother had left the little girl was a reliable woman,
but rather stern. Her strict discipline did nothing to dispel
the anxiety that the child suffered as the result of her
mother's sudden departure. Restored security, brought
about as the result of more affectionate treatment by the
nurse, and the mother's return caused the child's behavior
to improve in a few days. In six weeks she seemed entirely
well again.

Similar cases come under the frequent observation of
every nurse and physician. It is easy to make the mistake
of attributing such behavior problems to overprotection
and overindulgence. Careful analysis, however, reveals
that the root of this particular evil is anxiety produced by
some definite situation that has diminished the child's
sense of security and confidence in his parents.

Many other anxieties spring from a child's contact with
persons outside the home, and not a few of these have a
medical basis. Since a child develops an anxiety when his
movements are restricted, it is necessary for the nurse to be
careful not to hold him too tightly when the physician is
making an examination. Furthermore, the young child is
less frightened when the mother or the nurse holds him
gently than when he is placed on an examining table. For
that reason, the nurse should hold him in her arms when

Fears

he is receiving an inoculation or any other treatment that
disturbs him.

In dealing with older children, we should take into
account the ancient fears aroused by the thought of illness
and death and the innumerable superstitions that, even
today, are strong in the minds of many parents. An
unfortunately large number of persons still hold the view,
which was almost universally accepted a hundred years
ago, that illness is retribution for some disobedience of the
laws of nature or of parents. Every day, mothers and
fathers use this concept to warn their children of the dire
consequences of their acts or to assure them that their
illnesses are punishment for their sins. When Ralph has
a cold, his mother says: "It serves you right; you didn't
mind me and wear your rubbers. If you weren't such a
bad boy you wouldn't be sick," When Jean persists in
running out into the garden, her father says, "If you don't
listen to me and stay indoors you'll be sick and maybe
have to go to the hospital."

Children with heart trouble often say that they are ill
because they ran about more than their parents wanted
them to, and diabetic children explain that they became
ill because they paid no attention when they were warned
not to eat too much sugar. Disobedience of parental
injunctions not to play too hard, get wet, chilled, or over-
heated is believed by many children to be the reason for
their illnesses. In other words, they are sick because they
have been bad, and if they are very sick or have been very
bad, they may die for their misdeeds. This belief in the

relationship between disobedience and illness can easily

. 97 .

A Psychology of Growth

become the source of anxiety in children and produce
serious disturbances.

In many cases, hospital experiences also lead to anxiety
states, and not without cause. Threats of hospitalization,
with which misguided parents sometimes try to govern sick
children, make the hospital seem a terrible place. So also
do the gruesome stories that children often overhear and the
recitals of other children who have been hospitalized and
who delight in exaggerating their most unpleasant experi-
ences. The average child, therefore, is frightened by the
mere concept of the hospital. Treatment in one often
confirms his worst fears. The hospital, at best, is not the
most pleasant institution. Operations and the care of the
sick are its business; deaths do occur. The sights, sounds,
and smells that greet the incoming patient are not reassur-
ing. When a child finds himslf in this alien environment,
separated from his parents, and feeling that he may never
see them again, he naturally becomes terrified.

The fear of never seeing parents again, which is particu-
larly prevalent among charity patients, may have serious
consequences, even after the child returns home. Such
was the case with nine-and-a-half-year-old Louise, who,
three weeks after she had been discharged from the hospital,
began to have spells in which she would tremble, cry, and
sometimes ask, "Where am I?" Inquiry into her hospital
experience revealed that she had been placed in a con-
tagious ward for treatment during an attack of scarlet fever.
The strange room, the uniformed attendants, and the
suspicion that she might never see her parents frightened
her badly. When she cried, the nurses scolded and told
her that if she did not behave they would lock her in a room

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Fears

by herself. After she had been assured that no one would
hurt her, she was given serum intramuscularly. Later, she
developed an ear infection. Again she was told that she
would not be hurt and then both eardrums were punctured.
She was very ill and spent some weeks in the hospital.
Because the sight of her parents caused her to cry bitterly,
they were told to look in on her only when she slept. This
apparent desertion convinced her that she would never see
her family again.

The effects of such a terrifying experience persisted after
the girl's recovery and discharge from the hospital. In the
safety of her home, she would imagine that something was
going to happen to her and would experience again the
sensations that she had known when the doctors and nurses
had examined and treated her in the hospital. The result
was the recurrence of uncontrollable trembling and crying.

This little girl was treated over a period of two and a half
years, with the excellent cooperation of her parents, and
results were fairly satisfactory. The parents and the physi-
cian spent much time playing with the child and rebuilding
her confidence in them and in nurses. They urged her to
describe her hospital experiences and to talk about her fears
and her hatred of those who attended her. She told
repeatedly that her parents had often threatened to take her
to the hospital and leave her there if she did not behave,
and it was for this reason that she had thought she would
never see them again. In time, she realized that, because
of her fears, she had caused trouble and had given the nurses
some justification for their sternness. Everyone admitted
that the parents, physicians, and nurses had lied to her and,

as in the case of all children, her own self-confidence was

. 99 .

A Psychology of Growth

bolstered by the knowledge that not even these superior
beings were always infallible and absolutely truthful. It
reassured her to find that her elders did not betray her again
and that, as she grew older and wiser, she could usually
tell when they were "fooling" her. Later she had her
tonsils removed without undue anxiety.

Misunderstanding and uncertainty cause unnecessary and
unsettling fears. An eight-year-old boy became disturbed
after a circumcision because his mother had told him
facetiously that they were going to "cut it off/ 5 and he
believed that his penis had been amputated. A boy of
eleven, who was somewhat backward mentally, became a
serious behavior problem following an operation on his
hand. Bandages covered the whole area and the child
believed that the physician had amputated his hand.

Since fear reactions are almost inevitable in the case of
children who are removed from their parents and placed
in strange institutions, which they do not understand and
where they cannot feel comfortable, nurses and physicians,
as well as parents, should give full consideration to the
implications of hospitalization. Even a simple operation,
such as the removal of tonsils and adenoids, may be the
source of a painful emotional experience if there is not
careful and intelligent management.

Parents often make the serious mistake of telling the
child many silly falsehoods about his coming operation and
encouraging him to think of it as a kind of party, where he
will meet other children, be highly entertained and offered
ajl the ice cream and cake he can eat. When the time
comes, he is dismayed to find that he must go to the hospital
early in the morning without a bite of breakfast. At the

100

Fears

door he encounters that peculiar medicinal odor common
to hospitals. The usual entrance procedure is not reassur-
ing, and when it is concluded, the child learns that he has
to undress and go to bed. If he is a charity patient, his
parents are told to leave. The nurse's statement that he
will be all right and that mother and dad can come back
later does not allay his mounting fear. The fact remains
that he is alone in an unknown place, surrounded by strange
people in unfamiliar white uniforms. He may even be so
unfortunate as to be under the care of "professional"
nurses and doctors, that is, those very strait-laced, unemo-
tional, efficient women who, happily, are fast disappearing,
and those equally aloof physicians who grunt rather than
talk. (The distinguished psychiatrist, Dr. Frankwood E.
Williams, 1 classified this behavior as infantilism.) At any
rate, the small patient now realizes that he is not going to
a party and that his parents have lied to him. Robbed
of the security that had been based on confidence in his
parents, and beset by all the uncertainties of an inexperi-
enced and uninformed person in an unfamiliar situation,
he is provided with innumerable fear stimuli.

This, moreover, is only the beginning. Next the child is
jabbed in the ear, to have his hemoglobin taken. After
that he is wheeled to the operating room, where the people
are dressed like ghosts and many shiny instruments are laid
out for them to use. The doctors are intent on their prepa-
rations, and unnecessary operating-room discipline prevents
anyone else from speaking to the forlorn child. Now he is
placed on an operating table and forcibly held down while
he receives the anesthetic. However^carefully an anesthetic
is administered, it produces a certain amount of asphyxi-

101

A Psychology of Growth

ation; since it is sometimes given to children by inex-
perienced assistants, the effect may be little short of strangu-
lation. When the patient wakes up feeling sick, there is no
mother to soothe him. No one pays attention to him except
a strange nurse, whose attitude may be unduly stern. A
child never undergoes this experience without feeling
frightened.

To be sure, some children must go to the hospital and,
in course of their treatment, must suffer unavoidable pain.
The amount of fear that these experiences stimulate, how-
ever, can be reduced at least 75 per cent by intelligent
management of the patient. First of all, parents, physi-
cians, and nurses should never lie to a child about these pro-
cedures or lead him to expect impossibilities. Before the
day of the operation, the parents or the doctor should tell
him that he is going to the hospital, should explain its
purpose and nature, and should let the child know exactly
what is going to happen to him. This can be done without
exciting alarm. Then, when the child who knows what
to expect finds everything to be just as described, he has
confidence in his nurse and his physician and the comfort
of knowing that he can believe them when they tell him
that he is going to be all right. This child contrasts
sharply with the one who has been deceived. The latter,
after he has found pain where he has been promised pleas-
ure, loses faith in everybody and, when he is told that all is
well, he has no means of knowing that this statement is
not an untruth like the other tales that preceded it. In-
stead of having his initial fears allayed, he has acquired
new ones.
When children are uncertain, they can develop almost

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Fears

unbelievable ideas, which, in turn, aggravate their normal
apprehensions. Eleven-year-old Jim presented a good
example of this tendency. He was a boy of normal intelli-
gence who went from a small town to a hospital in a large
city for examination and beginning orthodontia. All
through the trip he was negativistic and whert he reached
the hospital he cried and refused to allow physicians to
examine his mouth. His pupils were very large and he was
unmistakably frightened. Asked what he was afraid of,
he cried again and said, "What are you going to do to me?"
The psychiatrist told him that he wanted only to talk to
him, and began by asking the boy to tell what he thought
was going to happen. After some urging, Jim explained
that he thought the doctors were going to put a "draft"
in his mouth. Since a draft, as he understood the term,
was a current of air such as that caused by opening win-
dows, he imagined that the physicians intended to put a
hole in each lower mandible so that air could blow through
his mouth.

The origin of this idea was a conversation between Jim's
parents and the family physician. The boy had overheard
a discussion of his case in which someone used the word
"graft." Jim had misunderstood and, from the supposed
word "draft," had drawn his own appalling conclusions.
After he had revealed this misunderstanding and the
psychiatrist had carefully explained the prospective ortho-
dontic procedure, Jim's fears disappeared and he became
very cooperative. Thus in thirty minutes the boy was
relieved of his anxiety and the physicians were saved much
more than that amount of time in their examinations and
initial treatment.

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A Psychology oj Growth

A child's psychological preparations for an operation
and other hospital procedures, therefore, should be carried
out with the same precision that is applied to surgical
preparation. If the child has not been prepared by the
parents or the physician, the nurses should take the responsi-
bility for helping him to understand exactly what is going
to happen and how it is going to be done. In addition to
making this verbal explanation, it is helpful to take the child
to the operating room the day before the operation, in order
that he may see what it is like and be spared the painful
fears of the unknown. If he is allowed to smell the gas,
he will learn that, while it is not pleasing, neither is it
distressing or to be feared. Another valuable and safe
procedure is the administration of a sedative, such as
nembutal, the night before and again thirty minutes prior
to the operation.

Children who are more than four or five years old accept
operations without difficulty if they have confidence in their
parents, nurses, and physicians. Such was the case with ten-
year-old Jack, who had osteomyelitis of the femur. He was
frightened and in pain. When his physician told him that
he- had an infection like a boil in the bone of his leg, the
patient asked, "What are you going to do to me? 33 The
physician explained that they would take the boy to the
operating room and give him something to smell that would
make him go to sleep, after which he would not feel the
opening of the leg. "O.K.," said the boy.

A few days later, a focus developed in the other end of
the femur and pain returned. The physician told Jack
that the previous condition was present in another place,

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Fears

and again the patient asked, "What are you going to do
to me?"

"The same thing as before," the physician answered.

"O.K.," said Jack, entirely willing to have another
operation and showing no signs of undue anxiety.

Of paramount importance also is the attitude of the
nurses in charge. Their management of a child, or, for that
matter, of any patient, can make all the difference between
distress and peace of mind. The nurse becomes a sub-
stitute mother and the extent to which she can make a child
comfortable depends upon her ability to impart a sense of
security, based on the comforting assurance that she likes
him and that he can trust her. It is her first duty, then, to
win the patient's confidence. She can accomplish this
best, in the case of a child, by sitting down beside him for a
few minutes, playing with him, showing him that she likes
him and that he can expect to enjoy doing things with her.
A nurse who does not like children or who does not like a
particular child should be allowed to report those facts to
the head nurse or to the nursing office and should not be
required to take care of any youngsters or of the particular
individual, as the case may be.

It is essential, also, for nurses and physicians to remember
at all times that patients are frightened and that unreason-
ableness is a consequence of feeling ill and distraught. The
nurse must take an objective attitude toward her patient's
behavior and remarks and never, under any circumstances,
construe them as a personal affront. She cannot hold this
point of view, of course, unless she has confidence in herself.

The effect of a potentially frightening experience is

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A Psychology of Growth

determined by the circumstances under which it occurs and
the condition of the child's mind at that time. A loud
noise, for example, or some chance remark that would not
disturb the child at all if he heard it in the security of his
home, may frighten him badly when he hears it in the
hospital. He may develop a fear of the dark if he is placed
in an unlighted room for punishment, although darkness
would hold no terrors for him if it were not associated with
the feeling that he is bad and that grownups do not like
him. Fear of the toilet may develop when an anxious
grandmother, for example, places the child there and com-
municates her own concern. Another child may acquire
an intense fear of water, as a result of being taken into the
lake by a playmate in whom he has no confidence. In
these and similar cases, it is insecurity preceding dis-
agreeable experience and coupled with it that precipitates
the new fears. In addition to the unhappiness that they
cause, these anxieties based on insecurity make for per-
sistent concern over sex matters, bowel problems, fear of the
dark, fear of being alone, fear of illness, fear of fire engines,
fear of animals and of many other things.

Injudicious parents often build up additional positive
fears by telling a child that they will go away and leave
him or that they will call the policeman to deal with him
or that his actions will have some dire consequences.
Other parents produce similar results by telling a child that
everything he does is bad and that he will be punished for
his sins, by constantly pointing out the virtues and talents
of another child and thus implying adverse criticism, and
by expressing dissatisfaction when a little son or daughter
is unable to do the things that are expected.

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Fears

REFERENCE

1. WILLIAMS, FRANKWOOD E., "Adolescence Studies in
Mental Hygiene, 55 Farrar & Rinehart, Inc., New
York, 1930.

107 -

Chapter Eight

Causes of Behavior Problems

Parental attitudes are the most important cause of
behavior problems. Some children are rejected by one or
both parents. Parents commonly see dejects in their child's
behavior, which represents a problem in their own minds.
Hostility toward children may also be due to the inse-
curity of the parents themselves, as well as to fatigue and
financial problems. Parents wrongly humiliate their chil-
dren in front of others. Another cause of misbehavior is
insisting upon standards that are too high for the child.

BEFORE taking up the more serious behavior problems
of children it may be well to consider the environ-
mental conditions that provoke them. "As the twig is bent
the tree's inclined" is a truth long recognized and, in many
cases, acted upon all too fully. Modern psychology has
shown the dangers of bending the twig and the desirability
of permitting it to grow according to nature's pattern. We
have seen the child reach normal emotional growth and
retain his mental health when he has not been bent to his
parents' will but has been given security, standards of
behavior in conformance with his abilities, and the right to
assume those responsibilities that he is capable of handling.
If these requirements are not fulfilled, the child tends to
deviate from what is considered normal conduct and begins
108

Causes of Behavior Problems

to exhibit behavior problems. The underlying cause may
be an inherent defect that makes a good parent-child
adjustment impossible or it may be lack of environmental
advantages; but the results are the same.

When a child who is driven by forces within himself in
the form of growth energy attempts to gain satisfactions in
life and is thwarted in his efforts, his behavior is likely to be
the kind that is usually called abnormal. As Plant * has
said, it is not a case of abnormal behavior in the child but
normal behavior in an abnormal environment. Since
parents' attitudes are the foremost environmental factors
affecting children's behavior, it is well to look to them for
the common conditions that interfere with normal growth.

Babies are not universally guaranteed the rights of life,
liberty, and the pursuit of happiness. Bernfield 2 has
pointed out, as have others, that in primitive societies babies
are not always guaranteed even the right to live. "We
must realize," he writes, "that our present attitude toward
the child, the present value we ascribe to life, is the result
of long psychological development. Not all races and
civilizations feel that birth guarantees a child the privilege of
living, not all regard the death of the child as a disaster, or
the killing of the child as a crime. The number of tribes
who, on principle, kill a percentage of their children, a
category (perhaps the first born) or a group (perhaps the
weaklings), is very large and the motives very various."

Bernfield goes on to say further that the protection of the
infant in our civilization is due not to the absence of hostile
feelings but to economic social pressure. Parents who do
not want children and who are resentful toward them at
birth are not uncommon. They seldom express these feel-

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A Psychology of Growth

ings, of course, except to a psychiatrist who is alert to the
possibility of their presence and whom the parents trust
because they know he will respect their confidences. This
hostility is accompanied by a sense of guilt and usually the
parent goes to extremes of superficial indulgence in an effort
to compensate and to prevent the feelings from becoming
apparent. Such a situation is frequently at the bottom of
serious behavior problems and children's anxieties.

Nurses and physicians often discover this hostility through
the utterances of mothers during labor. "I hope this will
be the last," a mother will say, or, "I'll never go through
this again/' Other examples are such frequently heard
remarks as, "What a woman has to go through !" "Having
a baby is like laying an egg; now I can go on with my work
[profession]," and "If it hadn't been for his father I wouldn't
have all this mess."

This hostile attitude toward children was clearly responsi-
ble for the troubles of a nine-year-old girl who complained
of headaches, was very restless and dissatisfied, and refused
her mother's affection. She was the third pregnancy, the
first two having been voluntarily terminated with abortions.
In discussing her problems, the mother said, "When my
husband and I were married I was determined not to have
a child, but with the third pregnancy I decided to have a
family." Later she added, "It is true that I never liked
children and did not want them, but at last my husband
and I decided to have a family. It was the thing to do."
The result could easily have been foreseen: an insecure
problem child. She now refused her mother's attempt to
give her affection because she felt it was not genuine.

Some mothers like children when they are babies and do

110

Causes of Behavior Problems

not care for them as they grow older. This was true in
the case of Brace's mother. At the age of five and a half he
was given to much crying and expressed many fears,
particularly in relation to his mother. He often asked if
his grandmother's house was on fire, if his own house would
burn down, if his mother had enough money, and if she
was going out without him. He always wanted to help
his mother and run errands for her in the house. A careful
history revealed that the mother had nursed Bruce until he
was nine months old and had given him much affection.
His growth had been normal until a second child was born
when Bruce was three years old. At that time, the little
boy's behavior underwent a marked change.

This was not a simple case of jealousy. When the mother
was questioned further, she admitted that she was one of
those women who like children only during their infancy
and stop caring for them when they are big enough to run
about. For that reason she had stopped giving affection
to Bruce and lavished it all on the new baby. She did not
realize that the little boy's fears and the so-called naughti-
ness for which she had been punishing him were due to the
change in her own attitude and his resultant insecurity.

Another frequent expression of a mother's hostility is her
refusal to nurse her baby. She usually tries to conceal her
real reason for not wanting to nurse the child by saying that
it will interfere with her social activities, or by making other
excuses. One mother, who had plenty of breast milk,
steadfastly refused to nurse her baby in spite of the argu-
ments of her obstetrician and his rising anger. Pressed for
her real reason, she finally explained that when she put the
baby to her breast she hated him and felt sure that if she

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A Psychology of Growth

had to give him breast feedings she would always hate him.
Since she refused psychiatric help in order to learn the
underlying reason for her attitude, the baby was given arti-
ficial food. This mother was an intelligent woman and
tried very hard to give the baby good care; nevertheless,
when the child was examined at the age of four, it was found
that he cried a great deal, did not eat well, sucked his
thumb much of the time, fought against going to bed, had
night terrors, and still wet the bed.

A student nurse evidenced the same attitude. During
the course in psychology she voiced serious objections to
breast feeding and said that she would not nurse her chil-
dren. She brought up the question of breast feeding several
times while the course was in progress and her attitude never
changed. Some months later, when giving a baby a bottle
in the hospital, she held the infant on her knees as far from
her body as possible with his neck resting on her left wrist
and the bottle held in the right hand, almost at arm's length.
All during the feeding she was looking around the room,
obviously bored with her job. It is not difficult to guess
what kind of children she will rear.

Many parents make up their minds in advance that they
want a boy or a girl, a blond or a brunette. When their
babies do not meet their specifications and they usually
do not the parents are greatly disappointed and often find
it difficult to accept the infant who is born to them. "Oh,
it had to be a girl !" they say, and, "I don't want him; I
want a little girl!" "I don't know anything about boys,"
a mother will say. "I can't bring one up." A father will
exclaim, "Why did we have to have a little shrimp like

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Causes of Behavior Problems

this?" Such attitudes are signposts that point to future
behavior problems.

Frequently resentments stem from some characteristic in
the child that a father or a mother associates with a person
whom he or she dislikes. This is particularly true when
there is discord between the parents. More than one mother
has said, "I would rather see my boy dead than have him
grow up to be like his father." That is an honest expression
of attitude toward a child who resembles the father, whom
the mother hates. Nearly all parents observe that " Sonny"
walks like his paternal grandfather or uses his hands the
way Aunt Florence uses hers, or that "Sister's" posture is the
counterpart of Cousin Ann's and her laugh might easily
be mistaken for Cousin Carol's. It is most unfortunate
when the parent dislikes the relative whom these manner-
isms suggest, because in that case the resemblance stimu-
lates resentments toward the child.

Such was the difficulty in the case of nine-year-old
George. His mother reported that he was unruly and
inattentive in school, that he fought with children in the
neighborhood and stayed out late. Inquiry revealed that
the child was George, Junior, and that he closely resembled
the father, from whom the mother had separated when the
baby was nine months old. Her second marriage was also
unsuccessful and, in her unhappiness, the mother's resent-
ment toward the child increased further. She asserted
that every time he displeased her she saw his "no-account
father coming out in him." "I get so mad at him," she
admitted, "that I can't whip him myself. I ask my hus-
band to do it for me." She also reported (this was not

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A Psychology of Growth

confirmed) that the head of George's school refused to take
him back after an absence until his- stepfather had spanked
him in the school office. His teacher was said to have sug-
gested that a good method of punishment would be to
make the small boy kneel all day. Naturally, therefore,
George felt that everyone hated him. He was frightened
and insecure; and it was not surprising that he ran away
from home. This is an extreme case, but it illustrates con-
ditions that, to a certain extent, are behind many behavior
problems in a large number of children.

Hostility toward children does not necessarily mean that
their parents did not want them. It may be due to inse-
curity in the parents themselves, fatigue, economic worries,
and lack of information about rearing children. A mother
who has two or three small children and does all of her
housework becomes overfatigued and irritable, especially if
she is not very strong. A father who works long hours or
has serious financial worries finds that it is hard to be patient
with children and to enjoy their company. Normal chil-
dren do many things which, though neither wrong nor
harmful, are disturbing to adults. Such actions often bring
about a very unwholesome attitude on the part of parents
who are already disturbed for other reasons. Attempts of
the parents to restrict their children's normal (though
irritating) behavior result in added friction and reinforced
hostility.

Anyone who analyzes the behavior problems of children
would do well to keep in mind two questions: (1) What do
parents see in a child that is not there but that represents a
problem in their own minds? (2) What attitudes are the
parents trying to force upon a child who is not old enough

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Causes of Behavior Problems

to understand? The answer to the first question usually
reveals that parents are hostile to a child because he reminds
them of someone whom they dislike. The second question is
answered by finding out what qualities the parents consider
most important in their children. They usually head the
list with such characteristics as obedience, truthfulness,
honesty, nobility, cleanliness, good manners, respect, and
consideration for others. No two parents agree absolutely
on the order of importance, which suggests that none of these
characteristics is very vital. When parents are pressed for
their reasons for considering a certain attribute important,
they usually cite some unpleasant experience in their own
childhood that fixed the idea in their minds. Unless these
prejudices are analyzed for the parents, they will be unable
to understand that all normal children disobey, lie, steal,
swear, become noisy, break windows, track mud into the
house, and often make themselves very annoying to
adults.

Further dangers lurk in the tendency of a parent to relive
his own childhood in his children, to try to force upon them
a compensation for his own shortcomings and disappoint-
ments. The case of sixteen-year-old Tom illustrates this
situation. His grandfather was a very successful business-
man and an extremely strict parent, who, when his son
(Tom's father) wanted to study medicine opposed the idea
and forced the boy to go into business with him. The son,
in turn, was very strict with his children and tried to com-
pensate for his own thwarted desire by insisting upon Tom's
studying medicine, although Tom had no interest in the
subject. Young Tom was very resentful and, in spite of
(rather than because of) the way his father treated him,

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A Psychology of Growth .

asserted that when he had children he would "knock them
around aplenty" if they didn't mind.

This type of behavior is very common. A mother whose
husband wet the bed until he was an adult worried greatly
over the possibility that her child would do the same thing;
as a result of that anxiety, he did become a bed wetter.
Another woman, who got into great difficulty because of
harmless sex play as a child, later kept a morbid watch over
her children and was both disturbed and disturbing when
she saw actions of which she did not approve. Most fathers
overrate obedience. Those who were brought up very
strictly and received much corporal punishment usually
vent their old resentments on their children and demand
implicit obedience from them. Similarly, the " tough"
businessman who frightens all his employees, because he
himself is frightened, insists on efficiency in the home and
tries to apply his rough-shod business methods to the
management of his children.

There is likely to be trouble also when parents do not
agree about their children. In fact, it disturbs a child more
to have his parents disagree about discipline and methods
of. bringing up the family than it does to have them follow
the poorer of the two methods that they advocate. If, for
example, the father believes in strict discipline and the
mother is inclined toward leniency, it is better for them both
to be either strict or lenient than to pursue the two methods
at once, because this practice leads to confusion in the
child's mind. After all, the important consideration is
neither strictness nor leniency but the necessity for making
the child feel that he is all right and that his parents
want him.

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Causes of Behavior Problems

Parents also err by humiliating a child in the presence of
others. They may do this consciously or thoughtlessly, but
the results are the same and cannot be good. For example,
a very active three-and-a-half-year-old boy was playing in
the room where his father, presumably a well-educated
man, was talking to a guest. Some of the child's antics
were normal activity, some were a dramatization for the
audience. "John," said the father, "I think you are silly.
Stop doing that." He repeated this formula six or seven
times within an hour. Each time, the boy appeared to be
embarrassed and was quiet for a few minutes; then he would
begin the same behavior again. Criticism of children in
another person's presence is never indicated.

The precept "Do as I say and not as I do" is equally
harmful. Parents should never expect good conduct to
result from the hypocritical practice of forcing upon children
a code that they permit themselves to violate. For ex-
ample, many children whom the parents reprove for lying
know very well that their mother and father lie and laugh
about it. One nine-year-old boy reported with much
feeling, "If I swear, my dad slaps me in the mouth, but he
swears all the time." Uncertainty and resentment are
inevitable consequences of such a situation.

Other behavior problems are likely to be in the making
when parents proclaim that they live only for their children.
It is well to be suspicious of those mothers and fathers who
constantly complain that they "work their fingers to the
bone" for their children. They are often persons who are
desperate for approval and are disappointed when their
unreasonable labors do not evoke from their children the
admiration and consideration that they desire. These

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parents are unwilling to permit their children to grow up
and learn to take care of themselves, because keeping them
dependent gives the mother or the father a false sense of
importance.

In analyzing the frustrations of children that are caused
by these various factors one should remember that they are
induced less by resentments toward the youngsters than
by lack of adequate praise and expressions of satisfaction
with them. Many different elements may be at the root
of the trouble but, all in all, the problem child is one who
shows signs of distorted mental growth.

REFERENCES

1 . PLANT, JAMES S., "Personality and the Cultural Pattern,"

Commonwealth Fund, Division of Publication, New
York, 1937.

2. BERNFIELD, SIEGFRIED, "The Psychology of the Infant,"

translated by Rosetta Hurwitz, Brentano, New York,
1929.

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Chapter ------------- Nine

Behavior Problems

Enuresis is a symptom and indicates that growing up has
been made too difficult. Enuresis is usually but one of
many complaints. Fear and resentment are the two main
causes, with emotional immaturity as a contributing factor.
Children stop soiling and wetting when they are ready.

Eating is an important emotional outlet, having physio-
logical and emotional attributes. All well children eat a
sufficient amount of food for health and gain. Poor
appetites in well children are due to coercion.

Stuttering indicates that the individual is under a great
deal of tension in his own mind.

Spoiled children are mentally ill individuals. The con-
dition is caused by over protection or rejection.

Stealing may be the normal behavior of well children or
the compulsive behavior of those who are mentally ill.

ENURESIS

ENURESIS, or urinary incontinence, may have organic
causes, such as defects of the genitourinary organs and
spina bifida, or cord lesions resulting from trauma, tumor,
or infection. We are concerned here, however, with that
large group of children whose urinary incontinence has no
organic cause.

Enuresis is about three times as common among boys as

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A Psychology of Growth

among girls. In spite of the fact that there may be no
organic basis for the condition, the children who suffer from
it often present striking physical similarities. About 75
per cent of the boys are small and rather weak and have
effeminate faces. The girls who wet the bed, on the other
hand, are more often of a quite opposite type. They are
likely to be large, clumsy, and unattractive.

Normally, children assume the responsibility for toilet
habits during the day when they are twelve to eighteen
mdnths of age and, during the night, by the time that they
are two or three years old. Many children, however, con-
tinue to wet the bed beyond these periods or, after having
stopped, begin again. This habit often becomes a seri-
ously disturbing element in the family life, not only because
of the odors and the additional work that it occasions but
because the mother does not have a normal mental attitude
toward her children when one of the older ones wets the bed.

Parents, therefore, frequently take children to a physician
because of enuresis. A careful history is likely to reveal
that this is only one of many complaints in the child, such as
thumb sucking, nail biting, excessive crying, bad eating
habits, poor progress in school, and inability to get along
with other children. When it is the sole complaint, it
is probably due to organic lesion; when it is one of
many problems, it can usually be traced to an emotional
disturbance.

If a child who once assumed responsibility for toilet
habits later reverts to bed wetting, it is probable that the
enuresis followed some unhappy or disturbing experience.
In many of the cases that have been studied, the enuresis
began wHen one of the parents, most frequently the mother,

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Behavior Problems

became ill or was obliged to be away from the family, or
when the patient had had trouble in school and elsewhere
outside the home. When enuresis is regarded from the
point of view of the child's emotions, it appears that fear
and resentment are important elements.

Possibly the child wets the bed during very frightening
dreams. Since fear can cause an individual to lose sphinc-
ter control even while he is awake, it is not surprising that
a child who dreams he is being murdered can be sufficiently
frightened to wet himself at night. This stimulus operates
the more powerfully because children do not distinguish
well between imagination and reality and a large percentage
of them believe that dreams come true. In any case,
children who wet the bed are almost invariably fearful,
and their dreams concern terrifying encounters with rob-
bers, kidnapers, and ghosts. In some cases, however, emo-
tional immaturity is the predominant factor.

George, who had nocturnal enuresis off and on up to the
age of seven, was an extremely apprehensive child. Two
frightening experiences in his third year had upset him
rather badly and caused him to cry at night and object to
sleeping alone. Later, when he entered school, he was
inattentive and unwilling to work, although he was suf-
ficiently intelligent. Physically George was slender and
small for his age, attractive, and very much like his mother.
This resemblance appeared also in his mental and emotional
attributes. She, too, was a very fearful individual, whose
condition was the result of an unhappy childhood, and she
was still dominated by her mother. During George's
sickly infancy, she had despaired of rearing him and had
transmitted her unhealthy attitude to the child. Accus-

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A Psychology of Growth

tomed to much attention, he became furious when his
younger sister received any notice.

George was a very clean, quiet child, who did not adjust
well to other boys and their rough play. He played with
girls by preference and said he wished that he had been
born a girl, because boys did bad things. In his dreams
he was beaten by a witch, who resembled his mother. His
daydreams took him back to infancy and he derived satis-
faction from imagining himself in a crib with his mother
bending over him, changing his diaper and giving him
medicine.

This little boy was taken to a physician because of
enuresis, but quite obviously the trouble was only a symp-
tom of a complex mental and emotional problem.

The other personality disorder frequently observed in
children subject to enuresis is resentment. In the minds
of both children and adults, excretory functions appear to
be closely allied to expressions of this emotion, as has been
illustrated many times by actual cases. One such case
is that of one eight-year-old girl whose father, becoming
infuriated when he found she had taken two cookies instead
of one, upbraided her for deceit and lying, spanked her,
and sent her to bed. After that experience, she began to
wet the bed.

A younger child, Betty, was taken to a physician because
of nocturnal enuresis. The condition had been present
for four years, although prior to its onset the little girl had
been dry at night for almost a year. At the time of the
examination, she was six and a half. Her younger sister
was then four years old; that is, her age coincided with the
period of Betty's enuresis.

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Behavior Problems

Every time that Betty went to the physician's office, he
asked her what she would like to do. One day she answered
that she wanted to draw. She was given paper and pencil
and proceeded to draw pictures of a very ugly man and
woman, whom she labeled "Father" and "Mother," a small
girl who was designated as baby, and a larger child whom
she called "the girl." When asked what she wanted this
family to do, she replied that the baby would turn into a
witch, who would then change the mother into a witch;
after that the mother-witch would transform the father and
"the girl" into witches. In reply to questions about the
attitude of the girl toward the baby, Betty dilated on the
hatred that the older child felt for the younger and concluded
by telling how "the girl" threw the baby out into the yard
and killed her. Further questioning elicited the informa-
tion that "the girl" had always hated her sister; she had
hated the infant the moment she saw her and this feeling
had increased when she saw the mother nursing her. At
that time "the girl" hated the mother, too, and wished that
they would both go away. When the physician asked
Betty how "the girl" in this play felt about herself, she
answered that she knew herself to be very bad because she
hated the mother and the baby and killed the latter. Betty
added that, because of "the girl's" wickedness, mother
chased her and beat her.

While she thus played the part of "the girl," Betty ex-
pressed her jealousy and her fear in many ways. At the end
of three-quarters of an hour she said, "This is the end of the
story. The play is over." In her case, hatred of her sister
was bound up with fears about herself because she harbored
this hatred.

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A Psychology of Growth

At the age of ten, John was still wetting the bed. Inquiry
showed that his parents had wanted him and had given
him good care until he was two and a half years old. At
that time, however, his mother began to work outside the
home and left little John in the care of his grandmother,
who never liked the child. Probably because it was she
who was in charge at the time when John should normally
have established good toilet habits, he failed to do so,
although he had previously assumed all responsibilities
appropriate to his age. Certainly the environmental con-
ditions were not conducive to normal growth. Another
factor in the case was the relationship between the boy and
his sister, who was six years older. After the mother had
gone to work, the sister often took care of little John and
played that he was her baby. Up to the time when he
was examined at the age of ten, he still liked to have his
sister rock him and to imagine that she was nursing him.
In his daydreams he was a baby about two years old, he said.
He expressed few fears and resentments. They must have
been present when he was placed in his grandmother's care,
but they were deeply buried in his unconscious mind. At
the time of his examination, his attitude was one of inde-
cision. On the one hand, he wanted to grow up and, on
the other hand, he enjoyed remaining an infant.

This case illustrates delayed emotional growth, with the
patient remaining at that level at which he received sufficient
satisfaction. It contrasts with those cases in which the
patients first reach a higher level of growth and then, when
problems become too complex for them, return to a more
immature stage. These two phenomena occur at all ages
and enuresis is not the only symptom.

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Behavior Problems

While circumstances vary widely in the many cases
studied, they present a uniform pattern of environmental
and innate difficulties. In every case, it is evident that the
child is having a hard time growing up; the boy, perhaps,
because his small stature makes him the object of ridicule;
the girl, because of domestic maladjustments. Under such
circumstances, the individual does not mature emotionally
but throws off responsibility and returns to a more satisfying
emotional level. The resultant enuresis, then, is a con-
tinuation of or a return to an infantile habit.

So many therapeutic procedures have been tried in the
treatment of this condition that the history of enuresis reads
like the history of therapeutics itself. Practically every
office therapeutic procedure has been employed in an effort
to prevent bed wetting, and many other remedies have
been contributed by the laity. Whenever, in medicine,
apparent beneficial results are obtained by so many diver-
gent methods, there can be only one agent common to all.
That agent is suggestion.

The fact is that children assume responsibility for toilet
habits when they are physically and emotionally ready.
They stop wetting the bed when they want to do so; that is,
when they have sufficient incentive. The child wishes to
please adults and to gain the personal satisfaction of accom-
plishment and will normally overcome his enuresis for these
reasons. If he fails to do so it is because growing up is too
difficult for him. The treatment, therefore, consists pri-
marily of an effort to learn what personal or environmental
factor causes him to persist in or revert to infantile behavior.
Enuresis that is caused by insecurities and deep-seated fears
and resentments requires long psychiatric care. On the

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A Psychology of Growth

other hand, that which is traced to jealousies, difficulties in
school, inability to get along with other children, too much
forceful discipline, and other environmental conditions, can
be cured by improving the external situation.

In working directly with the child, praise is very helpful,
also tangible signs of approbation, such as gold-star charts
and similar devices. It is possible, also, to teach the child
that dreams are not true, that he can tell himself in his sleep
that he is only dreaming, and that therefore he has no need
to be afraid. He can learn also that it is possible for him
to wake himself at night, if he wants to end a bad dream
or if he feels like urinating. In other words, he can stop
wetting the bed if he chooses, and he can be made aware
of that fact.

Many children who really want to stop fail to make the
effort because they are convinced that the condition is due
to weak kidneys or bladder or to some other organic cause.
Any procedure, such as the use of medicine, restriction of
fluids, and the like, that is based on these assumptions is not
good medical practice, because it not only fails to teach the
child responsibility for his actions and to eliminate his
personality difficulty but also confirms his belief that there
is something wrong with him organically, when actually
there is no evidence of disease. Such an attitude is a
marked characteristic of the neurotic individual.

Treatment should be directed to the whole child rather
than to the symptom itself. Enuresis is analogous to a
fever. The physician is no longer concerned with the fever
as such but, recognizing that it is one important symptom,
he looks for and endeavors to eliminate the cause. The
treatment of enuresis should include (1) making the child

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Behavior Problems

responsible for himself, (2) psychotherapy, and (3) adjust-
ment of environmental difficulties.

Fecal incontinence, a rarer and more serious condition, is
like enuresis, in that it is very undesirable behavior without
organic cause. The psychological causes are similar, but
fecal incontinence is nearly always an expression of intense
resentment. It occurs almost entirely during the day,
rather than in the night as is most frequently the case in
enuresis.

The case of Edward illustrates these points. He was a
very intelligent, physically well, good-looking ten-year-old
who had been soiling himself from two to twelve times a
week since he was three years of age. When he was taken
to the doctor for examination because of his incontinence,
he readily became very talkative. Before the end of an
hour, he was freely expressing his hatred of his parents and
admitting that he had daydreams in which he hoped they
would die. At night he frequently dreamed that his parents
were killed or that they were killing him. Questioning
brought out many resentments caused by his parents'
attitude toward him. He complained that, although his
father swore, he would slap the boy's mouth if he uttered an
improper word. Edward also described punishment that
he had received for bad manners, tardiness, talking back,
low grades in school, and other unimportant matters. Pre-
sumably, Edward's parents wanted a child, and apparently
they had given him fairly adequate care, with the help of
nurses, during the first few years of his life. By the time
he was about three, however, they began to be disturbed by
their own fears that the child would not be accepted socially
because of racial and other characteristics. For that reason,

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A Psychology of Growth

they tried to impose impossibly high standards of behavior
upon him. Unable to meet their requirements, he re-
sponded with resentment and consequent incontinence.

Treatment of such a child should be designed to build up
his self-confidence and sense of security and to resolve his
mental conflicts. To that end, it is necessary to convince
the parents also that there is nothing wrong with the child
and that, if he cannot measure up to their standards, it is
only because those standards are too high for any child of
Edward's age. The parents must learn that they can
accomplish more with praise than with blame.

FOOD PROBLEMS

Two of the health problems which cause the greatest con-
cern today are related to food. These are anorexia in young
children and obesity in older ones and adults. This is not
surprising in view of the fact that the acquisition of food is
among the primary satisfactions of the baby and has been
described as one of the three basic needs of men, the others
being sleep and warmth. Eating and drinking are among
man's foremost emotional outlets and are a great source of
satisfaction. He takes food not only because he is hungry
but also for the emotional gratification derived from eating.
On the other hand, the acquisition of food is one of the
most complicated of physiological processes and is inti-
mately associated with emotional growth. Any disturb-
ance of the process is consequently a matter of decided
importance.

Under normal circumstances, all well children eat a
sufficient quantity of food for health and growth. It is
necessary only to offer them proper food and to allow them

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Behavior Problems

to eat as much as they like. Some children require far
greater amounts of food than others and in this matter each
individual is his own expert, who knows better than anyone
else how much he should have. Even in any one individual
the appetite fluctuates to a very considerable extent. It
frequently happens that a child will eat a large amount of
food for a time and then a very small quantity. Sometimes
he goes on a food jag. That, too, is entirely normal.

None of the variations would be a matter of any moment
if parents did not believe that they were. Our forefathers,
who were not enlightened by radio commercials and
admonitory magazine and newspaper advertising, took it for
granted that Johnny would eat when he needed food just
as he breathed when he needed oxygen and he did.
Unfortunately, parents of today have become so acutely
conscious of the importance of food that they often make it
difficult for Johnny to find satisfaction in eating. They
have heard that poor appetite is a sign of serious illness,
that a child should be up to a given weight, that he should
have so many vitamins and so many minerals, not too much
starch but plenty of this brand of evaporated milk and that
brand of canned vegetables. He must have some of these
foods once a day, some twice, and some three times or he
will not grow up to be a champion. The constant bom-
bardment of this sort of propaganda is not only confusing
but, in the case of apprehensive parents, extremely unset-
tling. Although their idea of the kind and amount of food
needed by their children changes from week to week, they
become seriously disturbed if the youngsters do not accept
the diet currently advocated by some supposed authority.
This anxiety, which is more communicable than measles,

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A Psychology of Growth*

is soon transmitted to the child, often with more or less
disastrous results.

Since eating is one of the most important primary pleas-
ures, any disturbance of that emotional process naturally
distorts mental growth. It is significant that maladjusted
or neurotic adults usually exhibit food idiosyncracies.
They are convinced that something is the matter with them
because their tastes and habits differ from the model
presented by a certain diet list or because they are above
or below the weight designated as normal on some chart
that they have consulted. Lowell S. Selling, in a study of
100 draft-board rejectees and 100 traffic offenders, other
law violators, and domestic-relation cases, found that men's
tastes and reactions to food were a clear reflection of their
mental lives. Vitamin deficiencies, for example, appeared
to be caused not by the inability to get adequate food but
by the same personality factors that caused draft-board
rejections and legal offenses. Persons of low mentality
who violated traffic regulations because of inability to tell
right from wrong made comparable mistakes in the matter
of eating. Among the rejectees, most of the neurotics had
food eccentricities that appeared to be connected with their
neuroses. None of the rejectees had a diagnosable physio-
logical ailment, but all complained of indeterminate dis-
turbances, which they attributed to eating certain kinds or
combinations of food.

A child who is in contact with such an individual fre-
quently becomes alarmed about his own preferences in food.
If the adult extends the anxiety that he feels about himself
to include the child, the effect is likely to be serious. The
child not only begins to fear that he is abnormal, but he

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Behavior Problems

uses food as the means of obtaining additional attention or
as a method of fighting back when difficulties become too
great. Refusal to eat becomes a valuable weapon with
which he counters parental opposition to some project or
habit and endeavors to get even with his elders. This may
begin at a very early age; witness a smart three-year-old
girl who one day sat with her chin in her hand, looking very
forlorn, in imitation of her mother. "Mommy worries,"
Frances said, "when I don't eat."

In a normal household, a food problem often has its
origin in sickness. Poor appetite is usually the first sign of
illness shown by a child. Parents understand that, but they
do not know, or, in their anxiety, seldom remember the
converse, that convalescence is marked by the return of
appetite. If they restrain their impatience to have the child
eat until he is ready to do so, no harm will be done. By
urging him to eat before he has the desire for food, they
accomplish no immediate good and may do much ultimate
harm.

Frances, mentioned above, further dramatized the prob-
lem. After eating breakfast at half past seven, she played
out of doors until dinnertime, at one o'clock. She had a
slight cold and, by the time she came to the table, she was
extremely tired. Although she ate very little dinner, she
asked for cake for dessert. She ate only a few bits of cake,
however, and then asked for pie. After she was given the
pie, which she did not eat, she demanded cookies and candy.
When they were denied her, she cried bitterly and, as her
mother carried her from the room, she said tearfully, "I
want candy, I want cookies, I want jello, I want !" What
she wanted was someone to rock her to sleep, but since she

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A Psychology of Growth '

did not realize what her desire was, she expressed her
unsatisfied need in the form of a demand for various foods.

A doctor, when a mother calls him to say that her child
has suddently refused to eat, is almost certain that the
youngster has a mild throat infection or is developing some
other illness. This condition often continues for several
days, during which the child's appetite remains poor and
he may become pale and lose some weight. Alarmed by
this situation, the parents may try to force the child to eat
and he then reacts in the normal way; that is, forced feeding
makes food distasteful to him; if it is carried too far, he
vomits. In a few days, when he recovers from his infection,
his appetite should normally return but by that time food
has become so repulsive to him that he is unable to eat,
even though he may be hungry. Therein lies a common
battle between parents and their children.

"My child won't eat" is today the reason most frequently
given by parents for consulting physicians and nurses. Yet
food problems are a new development. Until about forty
years ago there was no such thing as anorexia except during
illness. The problem is a product of the rapid advance in
our knowledge of nutrition, unaccompanied by sufficient
judgment to apply our new-found information wisely. It
is one thing to sit down and figure out the number of calories
that we think a child needs and decide upon the kinds of
food that should supply them, and quite another thing to
require the child to accept the concoctions we have selected
and eat the quantity we have decreed. This is impossible,
even in the case of a newborn baby; as the child grows older,
we fall farther and farther from the mark. We know the
various essential food elements and the approximate

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Behavior Problems

amounts of each that a child requires at any given age; he
alone knows what he wants in a given day. Probably
dietitians have greatly hampered child feeding by their
great skill in making all kinds of undesirable food acceptable
to the palate. Nevertheless, when we give children plain
simple foods meat, potatoes, vegetables, bread, butter,
milk, and fruits and leave them alone they eat a sufficient
variety and sufficient quantities to meet any nutritional
requirements. That is why our ancestors, without benefit
of nutritionists, avoided the food problems that beset their
supposedly well-informed descendants.

STUTTERING OR STAMMERING

Stuttering is one of the most disturbing handicaps that
is met in medicine. Although it has been the subject of
much study and research, theories regarding stuttering
remain protean. In a very excellent book, Hahn 1 sum-
marizes the theories of some twenty-five or thirty American
and European authorities on the subject of stuttering, show-
ing that no two of these investigators agree as to the exact
cause of the condition. In general, however, they regard
stuttering as a neurosis caused by a persistence of infantile
frustrations into later life, a psychological inhibition that
has an emotional basis, or the result of a combined physio-
logical and functional defect. All the authorities agree
that as a stammerer approaches adolescence he becomes
greatly disturbed about his handicap and develops serious
personality difficulties.

Stammering usually begins at the discipline age (two or
three years), upon entering school, or at adolescence. The
child who begins to stammer at adolescence usually gives a

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history of difficulties earlier in life. It is known that stam-
mering is more common in boys than in girls and that most
persistent stammerers are boys, but we have no satisfactory
explanation for these facts.

From a clinical standpoint, we see children begin to
stammer' when they are placed under excessive tension in
the home. That is probably the reason why many children
who talk correctly when they first learn to speak become
stammerers at the discipline age. The onset often occurs
at the end of infancy, when the growing child becomes very
active and the mother tries to keep him quiet. It may
coincide with the visits of grandparents or other relatives
who exercise too much authority over the youngster, or it
may appear when the parents become anxious and try to
eliminate some habit that they consider undesirable; again,
it may begin when the little boy or girl becomes very
frightened for any cause and cannot throw off this anxiety.
The following cases are illustrative.

Robert began to stammer when he was three years old.
His was an acute condition, which came on while his father
was away on a business trip and the mother was living alone
with the little boy and his baby sister. The mother lacked
self-confidence and had difficulty in managing the home.
Robert was an aggressive, active youngster whom the
mother felt she had to watch closely and, at times, discipline
severely because she was afraid of what her friends would
think of her. A few nights before the onset of the stam-
mering, this mother went on an errand and asked a neighbor
to watch the house, from her own home. After a short
time the neighbor heard Robert screaming. He had

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awakened and become very frightened when he found that
his mother was not there. For several nights he cried out
in his sleep and, during the day, came in from play at fre-
quent intervals to make sure that his mother was at home.
After the parents revised their method of handling Robert
and devoted a good deal of time to him every day, he
stopped stammering in a few weeks,

Jerry began to stammer a few weeks after he entered
first grade in school. At that time he did not play well
with other children. His kindergarten teacher described
him as a high-strung, sensitive boy who cried easily. At
home also he cried excessively and fought more than the
average child would with a younger brother. According
to his mother, he had always been thin and did not eat as
well as she thought he should. He had a tendency to left-
handedness and had stammered slightly when he was about
three years old. Altogether he was a sensitive, insecure
little boy who had never made a good adjustment. His
schoolteacher was very strict and emphasized promptness,
gentlemanliness, and cooperation. Under all these cir-
cumstances the first-grade program was too difficult for
him and the confusion over handedness was an additional
factor in the development of his stammering.

In order to help him overcome this handicap, he was
placed in another first-grade room where the teacher was
less tense and understood the nature of his problem. His
parents made an effort to build up his self-confidence and
an excellent playground instructor helped him to learn how
to get along with other children. His fears of being hurt
and not being liked were discussed with him. In six or

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A Psychology of Growth

eight months his stammering disappeared, but unless a care-
ful program is continued for many years, his difficulties
may return.

In origin, stammering is not unlike other anxiety mani-
festations. For example, many an individual who can walk
back and forth easily on an eight-inch plank that is placed
on the ground would fall off if he attempted to walk the
same plank suspended forty feet in the air. Similarly, the
stammerer has been compared to the child who is proud of
a new pair of shoes and is so anxious to keep them in good
condition that he inevitably stumbles and skins the toe. In
other words, a child's fear that he cannot perform a given
act that involves motor coordination may make it very
difficult for him to perfom that act.

Studies of schools have shown that, over a period of
twenty years, ten times as many stammerers develop in one
first-grade room than in another. The room that has the
large number of stammerers is the one where the teacher is
tense and frightens her pupils. It appears, therefore, that
stammering is related to definite fears. Although these
fears inhibit thinking, nevertheless, the child attempts to
speak. While he is waiting for his thinking to clear up so
that he can express himself, his speech becomes a repetition
of one sound or a return to many sounds and movements
that he made as an infant.

In stammering there is also a persistence of sucking or
infantile chewing, swallowing, and breathing actions. For
a detailed description of this approach to stammering, read
"For Stutterers, 35 by Smiley Blanton and Margaret Gray
Blanton. 2 One twelve-year-old boy described the con-

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Behavior Problems

dition well by saying that when he stammered he went just
like a baby sheep, baa-baa-baa. There is much about a
stammerer's general behavior that is infantile, and he does
not mature emotionally.

Many children begin to stammer when they are two or
three years old, but in most cases the condition clears up
in a few weeks without any special treatment. It is good
practice, therefore, to make no effort to correct a child,
but rather to wait and see whether or not he will improve
spontaneously. Parents should be told not to try to silence
a child who is stammering and not to ask him to repeat
what he has said, as stammerers can always repeat correctly.
Neither should they attempt to force a child to talk more
slowly, or offer any other suggestions. The best thing they
can do is to ignore the youngster's difficulty entirely. In
this way, they can possibly relieve the general tension under
which the child has been living and that may be sufficient
to end the stammering. It has been found also that rest
in bed and sedation will cause the condition to disappear
temporarily. In order to effect a cure, however, the sources
of anxiety should be investigated and eliminated*

In the case of a young child, stammering that does not
disappear within four to six weeks requires a more careful
investigation. This should be directed (1) toward dis-
covering the superficial conditions in the home that have
placed the youngster under tension, and (2) toward remedy-
ing these conditions. If the stammering still persists after
these measures have been taken, it may be regarded as a
psychiatric problem. Treatment of the child then makes
it necessary to determine what anxieties in the minds of the

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A Psychology of Growth

patient or the parents are causing the emotional disturb-
ance. Stammering in a six-year-old or an adolescent is
serious and calls for psychiatric help.

SPOILED CHILDREN

The term "spoiled child," which has no scientific mean-
ing, has come to have little significance of any kind, owing
to the fact that it is so often applied to the youngster who
exhibits any behavior that does not meet with adult ap-
proval. Because this designation is in such common usage,
however, it might be well to look at the typical "spoiled
child" and try to explain the reason for his behavior.

Generally he is that tyrannical youngster who, in order
to gain his own ends or to annoy his parents, teachers, and
others, deliberately does things that he knows are objection-
able. A child of this type makes immoderate demands,
which he himself realizes are impossible of fulfillment. He
is negativistic, disrespectful, unreasonable, and usually
destructive. He does not respond to ordinary methods of
management, either in the form of praise or in that of
discipline. Although he is thoroughly disagreeable to live
with, objective observation shows that he is not a bad child
but one who is very unhappy. His behavior is seriously
abnormal. When small children or even grown ones,
for that matter defy their parents, they are acting in
desperation.

"Spoiled children" fall into two categories those who
feel that they are unwanted or that they do not meet with
approval, and those who are overprotected. Two typical
cases illustrate the results of these conditions.

Eight-year-old Arthur was a "spoiled brat." His teach-

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Behavior Problems

ers said so. In the classroom he whispered incessantly,
jabbed other children with pencils, made noises, refused to
"get down to business," and was disturbing in every way.
What the teacher minded most was the broad grin that he
always wore when she corrected him. This infuriated her
so greatly that she spent a considerable part of her time
watching the boy and trying various methods of humiliating
him and "taking the cockiness out of him." On the play-
ground he fought with other children and made himself a
nuisance in many ways.

At home it was the same. Although the parents had
tried many different disciplinary measures, he persisted in
teasing his sister and brother, taking their toys, and fighting
with them. When there was company in the house, he
never failed to "show off." Most significantly, he had
nightmares in which he was being pursued by a* witch or
killed by giants, one of whom he identified as his own father.
Obviously he was a very insecure little boy, who harbored
the painful idea that he was bad and of no account.

A careful case history revealed that the boy belonged to
the type that is active from the moment of birth. As a baby
he had colic and kept his parents up many nights. In their
view, he was always a difficult child, becoming more dif-
ficult as he grew older. When he learned how to walk and
climb, he climbed and walked over the best furniture and
into forbidden places in spite of all admonitions. This
behavior distressed the parents all the more because it con-
trasted sharply with the model conduct of an older sister.
Then, before Arthur was past his own infancy, his mother
gave birth to another boy, whom she described as the most
precious baby in the world. At the time when Arthur was

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A Psychology of Growth

brought in for examination, the mother frankly admitted
that she did not like him as much as she did the other
children. The father, a successful businessman, was one
of those aggressive, efficient individuals who, because they
are basically frightened themselves, try to control everyone
else by fear. He asserted that he could never understand
Arthur but believed that the mother had spoiled him.

All the facts showed that Arthur was a rejected child, who
was neither understood nor accepted by his parents. Be-
cause it was his nature to fight back when insulted, he
became a troublesome little boy. Obviously, in order to
cure the boy, it was necessary to treat the parents and
teachers. They had to understand that his behavior was
the result of his feeling that he did not enjoy their approval
and his conviction that he was not liked. Since he never
received favorable attention, he felt compelled to do things
that would bring unfavorable notice and, until he could
feel that he was wanted and liked, no amount of disciplinary
action would correct his behavior.

After we have studied the attitudes of Arthur's parents
and teachers, we can readily see the reasons for his behavior.
A child, however, does not understand them and could not
alter conditions if he did. Adults who say that a child
does things to get attention often imply that his behavior
is inexcusable and expect him to change merely by telling
him so, usually in a scornful manner. Granted that the
child misbehaves to gain attention, he still cannot help act-
ing in this way. Saying that he does things for attention is
like saying that he has a fever. In either case, the patient
is ill and, if we are to help him get well, we must deter-
mine the cause and eradicate it. We must remember that

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Behavior Problems

children, like adults, do the best they can. When we
know all the factors that are involved, we can see that the
behavior of the "spoiled brat" is as logical as the adult acts
of wisdom about which we like to boast. When his conduct
is unsatisfactory, it is necessary to determine why he is
acting in this way and to improve his environmental con-
ditions.

Jimmy was another "spoiled child." At the age of nine
and a half, he resorted to violent temper tantrums as a
means of getting his own way. Frequently he would throw
himself on the floor and beat his head until his parents gave
in to .him. When he came home from school, he would
demand that his mother stop whatever she was doing in
order to play with him and, if she refused, he would push
and slap her until she acceded to his demands. His school-
mates disliked him and, although he had a high I.Q., he did
not get along well in school because he refused to do the
work that his teacher assigned.

Unlike the boy previously studied, Jimmy was an only
child. Although the parents were eager to have children,
they had been married six years before Jimmy was born.
He was received, therefore, both with delight and with
apprehension that caused the parents to watch over him
constantly. The overzealous mother fed and dressed him
until he was five years old and gave him everything that he
wanted. As a result, he continued to use an infantile type
of speech, to suck his thumb, and to wet the bed. At the
age of nine, he took little responsibility for himself.

Here, then, was an uncertain, dissatisfied boy, who tried
to relieve his unhappiness by making demands. Because
he had not been permitted to grow up and do the things

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A Psychology of Growth

of which he was capable, his behavior remained infantile,
and he used temper tantrums to force his parents to do what
he asked.

Children whose objectionable behavior causes people to
call them spoiled may be either those who are used as an
emotional outlet for their parents and not allowed to grow
up, or those who are rejected and made to feel that they
do not meet with approval. They are emotionally imma-
ture, frightened, and resentful. Their mental growth is
altered, just as another child's bones are bent as the result
of rickets and malnutrition. They should be regarded as
children who are unable to grow emotionally, and it is
necessary to find out how and why their growth has been
retarded.

Not all psychiatrists agree about the causes that produce
spoiled children, especially children like Jimmy. He is an
example of maternal, really parental, overprotection.
Levy 3 holds the opinion that the behavior of such children
is always due to unconscious rejection. Other psychiatrists
believe that some of these children are hated, while some
are affected by the insecurity and overanxiety of parents.
Clearly, the first of the two cases is an example of maternal
rejection. In the second, the child was wanted but the
parents, especially the mother, were very insecure. She
was always afraid that something would happen to her
child and got the greatest satisfaction from giving him more
affection and care than he needed or wanted. As a result,
this boy remained infantile.

STEALING

Among the many problems about which parents consult
physicians and nurses is that which is commonly called
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Behavior Problems

disobedience. From the point of view of the parent, this is
a serious offense; viewed objectively, it is the result of the
parents' attempts to force their children to meet standards
that are often unreasonable or to other frustrations in the
growing child. This applies as much to stealing as to other
lapses that parents view with less consternation. It is
necessary, therefore, to distinguish between those few cases
in which stealing is due to real mental illness and the great
majority, where the problem is simply one of parental
education.

Authorities on the subject of behavior know that it is as
natural for children to lie, swear, and steal as it is for them
to track mud into the house, wipe their dirty hands on the
towel, make noise, break a window now and then, and
disturb the neighbors. This is particularly true of the
preadolescent group. These children are enjoying their
last fling before being engulfed by the restrictions of adult
society. It is a statistical fact, borne out by psychiatric
studies, that this behavior is not abnormal and does not lead
to difficulties in adult life. The fact is that those children
who do none of these things are the ones who develop mental
ill-health when they grow up.

There is a type of stealing, however, that is pathological.
This is behavior of a compulsive nature. Children exhibit
it by breaking loose and stealing articles that they neither
want nor need. They make little or no effort to conceal
what they have done and feel better after they have been
punished.

A good illustration of this type of behavior is found in the
case of nine-and-a-half-year-old Frederick. This child, the
son of a high-school teacher and an efficiency expert, was
brought up by a grandmother, who prided herself on her

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A Psychology of Growth

competence and her determination to make the boy under-
stand that when she issued an order he was to carry it out
to the letter. From her point of view, he was, most of the
time, an exemplary little boy, obedient, clean, quiet, and
polite. Off and on, however, he wet the bed and occasion-
ally went through periods when he set fires and, in his
mother's words, "stole everything he could get his hands
on."

Frederick's difficulties bring to mind a statement made
by Dr. A. A. Brill. "It is not easy to be a civilized person,"
Dr. Brill said, "to wash your hands and comb your hair and
act at all times like a lady or gentleman. If you continue
to behave this way for a very long time you are likely to
burst, in order to ease the tension. For that reason, human
beings have made certain by-passes for themselves, in order
to provide some sort of outlet for their pent-up feelings."
The by-passes that Brill was discussing were motion pictures,
prize fights, and other forms of amusement. Frederick,
too, needed to find some outlet or he must burst. It was
impossible for him to behave like a nice old lady for 365
days a year. When the tension became too great, he
relieved it by stealing and setting fires, instead of employing
any of the outlets sanctioned by society.

Work with the boy revealed, naturally, that he was con-
vinced that he was bad and worthless and that nobody
liked him. He had intense resentments, particularly
against his grandmother and his mother, and because of
his feeling he was oppressed by a sense of great guilt.
Apparenty he made an enormous effort, most of the time,
to win his elders' approval and attention; but being an
active, alert, intelligent, aggressive boy, he could not always

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Behavior Problems

live up to their foolish expectations and every so often he
broke loose.

One frequent cause of compulsive stealing is an intense
sense of guilt that comes from indulging in homosexual
activities. This applies almost exclusively to boys and
appears especially in the late preadolescent or early ado-
lescent stage of growth. Such a boy is so disturbed by the
bad things he has been doing that he wants to be punished.
Rather than admit the real cause for his sense of guilt,
however, he takes to stealing, which, in comparison, appears
to be a respectable form of misconduct. Letting people
know that he has been stealing and taking his punishment
for being bad relieves his guilty feeling and, at the same
time, covers up what he considers his really serious sin.

Compulsive behavior of this kind is a sign of mental
illness. It is important to recognize this fact and the
corollary, that it can never be corrected by corporal punish-
ment, or, for that matter, any kind of punishment. It is a
mistake to place the patient in a military or a boarding
school, because that step will not correct the condition that
is responsible for his compulsive behavior. This type of
behavior should be considered a symptom, such as fever
or labored breathing or any other indication of an organic
illness.

Even when a child's behavior is so objectionable that
we feel we cannot tolerate it, we must realize that it is the
inevitable outcome of his experience. The misconduct of
the so-called mean kid is just as logical as the considered
acts of wise men. Our inability to understand the reasons
for it is an acknowledgment of our lack of wisdom or infor-
mation and does not indicate that the behavior is unreason-

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A Psychology of Growth

able. We must recognize that undesirable behavior is the
outcome of a person's attempt (whether he is a child or an
adult) to find an outlet for his unsolved problems and to
gain satisfaction or expression of his growth needs. In all
probability, he is motivated by fears, resentments, and a
sense of guilt, on the one hand, and on the other, by the
need for approval. It is fortunate that he is aggressively
trying to find a solution. This makes the prognosis better
than it would be if he became a shut-in, "broken" individual.

REFERENCES

1. HAHN, EUGENE F., "Stuttering," Stanford University

Press, Stanford University, Calif.

2. BLANTON, SMILEY, and MARGARET GRAY BLANTON,

"For Stutterers," D. Appleton-Century Company,
Inc., 1936.

3. LEVY, DAVID M., M.D., "Maternal Overprotection,"

Columbia University Press, New York.

146

Chapter ------------- Ten

Preadolescence

For boys this is the almighty age of growth. Girls
mature more rapidly and have more grown-up interests.
Serious anxiety states appear at this age. They occur in
rejected children (more often girls) who have had impossible
standards of behavior imposed upon them during infancy
and childhood. Anorexia nervosa is a serious nutritional
disturbance in girls who refuse to eat a sufficient amount of
food. The condition is emotional in nature and is caused
by fears of growing up.

PREADOLESCENCE is the period between childhood and
puberty. Although the growth patterns are the same
in all children, there is considerable variation in the chrono-
logical ages of boys and girls in this period of development.
Sex hormones are secreted and found in the urine of some
girls at the age of four and a half years, while in others this
phenomenon does not begin until they are seven or eight.
On the average, however, preadolescence extends from the
age of eight to the age of twelve. Younger boys and girls
play well together, but during preadolescence an antago-
nism develops between the sexes. Often there is so much
open hostility that boys and girls not only refuse to play
together but often fight one another.

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A Psychology of Growth

For boys this is the almighty age. They are absorbed
in their new growth and have a feeling of manliness; but
not being sure of themselves, they have to prove their
strength and independence to themselves and to everyone
with whom they are associated. They form groups, reject
adult ideas, and say, "I don't care." They have un-
bounded energy, which they expend mainly in physical
pursuits, such as all forms of athletics, or building club
houses and tunnels. They would like to become airplane
pilots. The adventures of Tom Sawyer and Huckleberry
Finn and Superman thrill them. They play war games,
occasionally like to make other children unhappy, and
sometimes carry their domination to the point of sadism.
During this period, they appraise their physical develop-
ment and compare themselves with others. Their own
shortcomings give them great concern and they often be-
come frightened by the thought that they are abnormal.

Preadolescent boys think that girls are stupid and silly
and are often contemptuous of them. "I don't see how
you can be so dumb," one eleven-year-old boy said to the
girl whom he later married. The girl was crushed, but
afterward she confessed that she had thought the boy was
wonderful in spite of what he had said.

Schools find preadolescence a difficult age. The boys
show off, feign indifference, and in general, either show
contempt for a woman teacher or fall in love with her.
Some progressive schools put boys and girls in different
classes, in the belief that the separation makes administra-
tion easier and more successful.

During this growth period, a boy first attempts to be
independent, especially from his mother. Actually, of

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Preadolescence

course, he is still very dependent upon her, though he feels
that women don't "know the score." Usually he idealizes
his father but resents any effort on Dad's part to "boss" him
or control his behavior.

Girls manifest an increased activity during preadoles-
cence. Although they have little sex interest, they want to
appear grown up and, more than boys, attempt to adapt
themselves to the realities of life. They dramatize them-
selves and like to assume adult roles with the appropriate
properties and costuming, such as higher heels and lipstick.
This play, however, is accompanied by much giggling and
self-consciousness. Some girls, on the other hand, become
tomboys. They are accepted by boys, in contradistinction
to the boy who is effeminate and likes to play with girls.
Ridicule is his portion.

Girls are hurt if they are not included among the leaders
in their schools and neighborhoods. Their clubs are secret
societies. In one private school there has been a "devil's
club" formed by succeeding groups for many years. The
rules of the club require members to use their fingers for
handling butter, to collect cigarette butts, and to smoke.
Girls have secrets which they confide to every other girl
with the solemn assurance, "You are the only person I am
going to tell."

At this age girls are tormented by feelings of inferiority
and inadequacy. As a result of this condition, coupled
with a desire for independence, they criticize their parents
and often identify themselves with older girls and wojnen.
Some girls, overwhelmed by a sense of inferiority, become
quiet, passive, and very unhappy. A greater proportion of
them, however, outwardly exhibit a noisy self-assurance.

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A Psychology of Growth

Preadolescent girls also work out plans for their future
and concern themselves with problems far beyond the
interest of boys of the same age. Girls try to appear sophis-
ticated, do better schoolwork than boys, and attempt to
gain recognition from adults. Sally Benson has described
this age group very well in her book, "Junior Miss."

Like boys, girls have many anxieties about their physical
growth. Breast development, growth of pubic and axillary
hair, size of abdomen, and posture concern them greatly.
While their physiological development is usually a source
of pride, they are sometimes sensitive about it and, if they
are very dependent upon their mothers, they may go so far
as to attempt to reject their maturity emotionally and, in
extreme cases, develop anorexia nervosa. Such was the case
with Barbara, a ten-and-a-half-year-old girl, who became
antisocial and unhappy. She imagined that she was unat-
tractive because her skin was dark, her abdomen protruded,
and one breast was larger than the other. An eleven-year-
old boy was similarly disturbed because comparison at the
"club" revealed that his genitals were smaller than those
of his associates.

Serious anxiety states are not infrequent during the pre-
puberty years, that is, from eight to eleven. They occur
about three times as often in girls as in boys and resemble
those of the adult with an anxiety neurosis. The child
suddenly becomes panic stricken, cries, and is overwhelmed
by the fear of terrible illness and possible death. This state
may be accompanied by perspiration, choking, gagging,
rery rapid heart, trembling, stomach-ache, dizziness, or
any other somatic complaint. The attack usually subsides
in thirty minutes to two hours. Inquiry into the cause

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Preadolescence

nearly always reveals that an anxiety attack has been pre-
cipitated by some unhappy occurrence, such as an un-
pleasant hospital experience, a serious fright, or the death
of a friend or relative.

Children who have these attacks are almost invariably
the good boys and girls, approved by their elders because
they are quiet, obedient, and respectful. They are, in
other words, children who have been broken to the will of
adults, sensitive children who have never been able to fight
back. Further inquiry usually reveals that, in addition to
having to conform to high standards of behavior, they have
been held to very rigid food and training schedules, espe-
cially during infancy. They have been fed every four hours,
to the minute, have been broken from the bottle when very
young, have been the subject of attempts at early toilet
training, and have been taught obedience to authority
without question. Work with mothers and fathers nearly
always reveals the still more significant fact that these
children were not wanted in the first place and never
enjoyed the affection that their sisters and brothers received
from one or the other or from both of the parents.

These various factors are illustrated in the case of Sally,
a pretty, intelligent ten-year-old girl who was taken to a
physician for examination because of spells during which
she cried, gagged, and said, "Am I going to die?" The
attacks usually occurred at night, but occasionally they
came on in the morning. Sally had the first one on her
ninth birthday. Thereafter they recurred frequently, and
the child lost weight, refused to go to school or to church,
and finally preferred not to leave her home at all.

Study of the case revealed that one of Sally's friends had

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A Psychology of Growth

died about four weeks before she had her first attack. The
day before the attack occurred, Sally's teacher had lectured
her pupils severely on the subject of some objectionable
behavior. Little Sally, who had always been a good child,
was not at fault, but the teacher's words frightened her
badly and she became extremely fearful of doing something
wrong and incurring displeasure. On her birthday, the
child suffered a great disappointment. The mother, who
was not feeling well because of her fourth pregnancy, failed
to give Sally a birthday present. On that day, the little
girl had her first attack.

After several interviews, the mother was able to say
frankly that she had never loved Sally as much as she loved
her two older children and the new baby. Although she
was not able to account exactly for the difference in her
feelings for the children, she recognized the fact that there
was something about Sally which she did not like. She
realized also that the strict schedule and rigid discipline
that she had inflicted upon the little girl were, at least in
part, an expression of resentment toward her.

The child revealed to the physician that she had many
frightening dreams, in which she was chased by a burglar
and a witch. Eventually she volunteered the information
that the burglar resembled her father and that, at times
when the witch removed her mask, she proved to be Sally's
mother. When the physician had obtained the child's con-
fidence, she began to talk about her fears of her parents and
teachers and her resentments toward them. Finally she
admitted that she hated both her parents and her teachers,
as well as her brothers and sister. After a number of talks
with the physician, Sally realized that her attacks were

152

Prtadolescencc

brought on by fears that accompanied her hates, especially
her feeling toward her mother. The first attack, it must
be remembered, occurred on the birthday when the mother
failed to give the child a present.

The little girl, who had received a very strict religious
training and had been convinced that it was a serious sin
to hate, did not doubt that she was a very bad girl. That
attitude was intensified by the fact that she was physio-
logically very mature for her age and was fast approaching
puberty, which is a time when children become increasingly
aware of what people think of them and when they ex-
perience a heightening of conscience.

The table on page 154 summarizes ten cases of acute
anxiety states studied by the writer. When the patients
are studied as a group, the similarity of the cases, particu-
larly in regard to precipitating factors, becomes readily
apparent and it is possible to see how unfavorable conditions
bring about mental ill-health.

Visual disturbances on a functional basis, apparently
due to spasm of the blood vessels, often begin during the
preadolescent period and occur with increasing frequency
into adulthood. It is possible to get tubular vision (in
which the patient can see only objects directly in front of
him) or marked generalized decrease in vision or hemia-
nopsia. The following cases illustrate this condition.

On Christmas Eve, when ten-year-old Frank was playing
with his toys, he found that he could see only those objects
that were directly in front of him. A careful history
revealed that he had many fears, that he thought he was
bad, and had been taught that if he did not behave Santa
Glaus would not bring him any presents. All of a sudden

- 153

A Psychology of Growth

FEARS

Case:
Sex:

Age at
onset

Precipi-
tating
condition

Parental
attitude

Schedule
in
infancy

Result o
training
program

Primary
fear

Outstand-
ing
symptom

Panic

1 F

Death of

Rejection

Rigid

Broken

Hate of father

Abdominal

Fear of ill-

friend

(father)

mother, and

distress

ness and

yr3.

Apprehen-

brother

death

sion

(mother)

2 F

Death of

Extreme

Rigid

Broken

Hate of

Nausea

Fear of ill-

mother

appre-

mother

ness and

hension

death

school-

mate

Sex in-

Rejection

Rigid

Broken

Hate of

Nausea

Fear of ill-

struction

(mother)

mother, fear

and vomit-

ness

of sex

ing

4 M

Death of

Rejection

Rigid

Broken

Hate of

Trembling

7ear of be-

friend

Appre-

mother,

ing killed

hension

father, and

friend

5 M

Extreme

Semi-

Broken

Hate of father,

Pain in

[llness and

appre-

rigid

mother, and

joints and

death

hension

brother

extremities

6 F

Death of

Rejection

Broken

Hate of

Abdominal

Fear of

sister

mother and

pain

T.B.,

sister

menin-

gitis

7 F

Rejection

?.igid

Broken

Hate of

Trembling

mpending

Apprehen-

mother and

and crying

danger

sion

brother

8 F

Rejection

^.igid

Broken

Hate of

Trembling

llness

mother and

and ab-

sister

dominal

pain

9 F

Exhibi-

Rejection

Rigid

Broken

Hate of family

nability to

Suffoca-

tionism;

and teacher

recite in

tion

fear of

school

teacher

10 F

Apprehen-

Rigid

mos.

sion

Rejection

he became very frightened, imagining that someone was
coming after him and that a burglar was looking in through
the window. It was then that the visual disturbance began.
When Frank was able to analyze his fears with the help
154

Preadolescence

of a physician, the difficulty cleared up and has not recurred
during the succeeding ten years.

Christine, a fourteen-year-old high-school girl, suddenly
"went blind" after class. The attack lasted about thirty
minutes and was followed by many others of shorter dura-
tion. At the time of the first attack, she went to the school
nurse and, later, to an ophthalmologist, who found nothing
wrong with her eyes. She was a highly intelligent but
emotionally disturbed adolescent. Inquiry revealed that
she had never lost all of her vision, as she had first reported
(these patients do not become totally blind), since she had
been able to go to the school nurse without assistance.
The first attack had been precipitated by a scolding, in the
course of which a teacher had accused her unfairly, the
girl believed of doing inaccurate work. Analysis of her
case showed the girl that she suffered a diminution of vision
when she became very frightened.

ANOREXIA NERVOSA

The uncommon, but serious, condition known as anorexia
nervosa is characterized by loss of weight, evasiveness, lack
of normal interests, and sometimes difficulties in school.
It usually begins during the preadolescent or the early
adolescent period. The physical examination is negative,
except for emaciation and possible food-deficiency diseases.
The condition occurs in girls who are extremely dependent
upon their mothers and who reject the idea of normal
physiological development.

Such was the case with Janet. She had been well, up to
the age of twelve, when she expressed a dislike for fattening
foods and began to lose weight. She ate nothing but

155 .

A Psychology of Growth

vegetables in small quantities, skim milk, and fruit. At
the same time, in an effort to deceive her parents about the
amount of food that she was consuming, she used many
different devices, such as eating by herself whenever pos-
sible, secreting food in her handkerchief and later throwing
it away, and disposing of her milk whenever no one was
watching. She insisted that she was not hungry, failed to
eat lunch at school, and feigned illness at mealtime when
she was at home. When her loss of weight became serious,
she was placed in a hospital, where all tests for organic
disease were negative.

Janet's mother was a very self-centered, neurotic woman,
who criticized the girl a great deal. When Janet reached
preadolescence, she became a tomboy and, because she was
a good baseball player, boys accepted her as a playmate.
Because she wanted to be a boy, she was disturbed when she
noticed that her hips were getting larger and her breasts
beginning to become prominent. This was the cause of
her dieting.

Patients like Janet are very resistive to psychiatric help,
insisting that there is nothing wrong with them. They do
best when removed from home. Usually they can be
placed in a boarding home, but sometimes it is necessary
to send them to a hospital and use insulin. When Janet
was forced to face the situation as the result of the insulin
reaction, she developed a hatred for her physician but
accepted psychiatric help. She then told that she had
wanted her mother's affection and approval and had re-
ceived very little of either. She also explained that she
had often heard her mother complain that menstruation
was a nuisance and that women had all the inconveniences

156

Preadolcscewe

in life. The little girl had other serious anxieties about sex
and for a long time insisted that she did not want to know
anything about "that stuff." She agreed to gain weight,
however, if she could leave the hospital. For months she
poured out her resentment against her mother, but finally
she recognized that her anger was due to a strong desire
for the mother's approval.

157

Chapter Eleven

Adolescence

This is a period of rapid growth marked by maturation.
Growth takes place at markedly variant rates in different
boys and girls. There are also wide variations in the
different aspects of growth in the same individual. At this
period of growth there are physical, intellectual, and emo-
tional changes. In the process of trying to grow up and
make an adjustment to society, many important problems
present themselves. Sex adjustment, independence, wean-
ing, and inferiority are problems common to all adolescents.
The seriousness of these and other problems depends upon
methods that have been used in rearing them up to this age.
Solution of the problems is essential for mental health.
Childhood insecurities, anxieties, and resentments add much
weight to the problems of adolescence.

ADOLESCENCE is a period of growth second only to
infancy in the rapidity with which the body develops
and life patterns manifest themselves. It is notable also
for marked variations in the rate of growth in different boys
and girls and the uneven development of the various aspects
of growth in any one individual. For example, some girls
begin to menstruate at the age of nine, while others who
are entirely normal do not reach this stage of physiological
development until they are nineteen years old. As a rule,
158

Adolescence

emotional maturation parallels this physiological change,
but that is not always the case. A girl may be physio-
logically mature and emotionally very immature. Boys
exhibit the same variations, though perhaps not to so great
an extent.

In reference to these various growth patterns, a group of
adolescents has been compared to a number of girls and
boys traveling from New York to California. 1 Some may
go by air, others by rail or sea, and still others on foot.
Practically all of them will reach their destination, but at
widely different times.

The growth changes that occur at adolescence are physi-
cal, intellectual, and emotional. Physical growth is usually
very rapid. Boys often grow seven or eight inches in a
single year. Though they may reach manly stature, how-
ever, they should not be judged by adult standards. A boy
or a girl whose chronological age is fourteen may have the
physical growth of the average sixteen-year-old, the intelli-
gence of the youth of eighteen, and the emotional develop-
ment of a child of eleven. How old is such an individual?
Because of the unevenness of his development, it is impos-
sible to decide what should be expected of him without
considering the different aspects of his growth separately
and determining the developmental level of each. Under
the circumstances, it is obvious that the youth himself will
become confused and disturbed about himself.

Because of their rapid growth, adolescents fatigue easily
and have poor motor coordination. They find it hard to
stand on their two feet like proper ladies and gentlemen;
they have to change position frequently. Often they are
accused, unjustly, of being lazy. Changes in resistance to

159

A Psychology of Growth

disease occur at adolescence. For example, there is a
marked decrease in respiratory diseases and a limited
resistance to tuberculosis; anemias are common. Ado-
lescents show an increase in surface temperature. The girl
who says, "I'm not cold," and wants to wear light clothing
is not following some freakish fashion, as adults often insist.
She is telling the truth as she understands it; she feels warm.
In addition to the development of secondary sex character-
istics, there are frequent changes in the metabolism and
fluctuations in the physiological aspects of the entire body.
These characteristics of adolescence are important because
of the effect that they have upon the individual's mental
attitudes.

There is a close relationship between the growth process
and the glands of internal secretion. In view of the over-
enthusiasm that sometimes results from the use of glandular
extracts, especially when they are administered in an effort
to correct variations in growth at adolescence, it is well to
note which conditions can and which cannot be treated in
this manner at the present time.

A deficiency of the anterior lobe of the pituitary gland
gives rise to Simmond's disease, a fatal disorder character-
ized by a general failure of the other endocrine glands,
particularly the sex glands, the adrenal cortex, the thyroid,
and the parathyroids. Acromegaly and giantism result
from overactivity of the anterior pituitary.

There is no evidence to prove that pituitary insufficiency
causes retardation in growth, obesity, or menstrual dis-
turbances. Pituitary dwarfism is a very rare condition.
Most instances of retardation in growth observed in children
result from thyroid rather than pituitary insufficiency.

160

Adolescence

Improvement in both physical and mental conditions is
obtained from the administration of thyroid extract.

There is no clinical condition due to overactivity of the
posterior lobe of the pituitary gland. Because diabetes
insipidus is often associated with destruction of the posterior
pituitary, the administration of the posterior pituitary sub-
stance is successful. Many cases of polyuria and poly-
dipsia seen in practice are psychogenic in origin and can
be successfully treated by psychotherapy.

Disorders of the hypothalamus involve many metabolic
and neuropsychiatric disturbances. The obesity of true
Frohlich's syndrome (which is an uncommon condition) is
due to the pressure of an expending lesion on the hypo-
thalamus. Lesions of the hypothalamus are sometimes asso-
ciated with peculiar appetites, vasomotor disturbances, and
high fever.

The development of precocious puberty in tumors of the
pineal gland is probably due to pressure on the hypo-
thalamus.

Hypothyroidism is common during adolescence and is a
factor in fatigability, lack of sufficient energy, indifference,
and lassitude. Changes in the degree of function of this
gland may be frequent during adolescence. For that
reason, it is sometimes necessary to repeat metabolic tests
once or twice a year in order to be accurate in evaluating
the effect of thyroid disturbances on behavior.

Hyper- and hypoparathyroidism may produce symptoms
suggestive of emotional disorders. Medication by which
these disturbances can be relieved is now available.

Much use has been made of pituitary and sex hormones
in treating dysfunction of the sex glands. On the whole,

161

A Psychology of Growth

these substances have been disappointing from a clinical
point of view, with the exception of chorionic gonadotropin
in cryptorchidism, where it has a distinct usefulness. The
male and female sex hormones have also a usefulness as
substitution therapy in supplying the glandular products
while the organs themselves are not functioning properly.
Because of the psychologic effects of glandular therapy, as
well as the possible harm it may do to the very complex
endocrine system, it should not be used except after thorough
examination and the discovery of positive evidence that it
may prove beneficial.

Growth changes create many anxieties in the mind of the
adolescent. He is especially concerned over differences
between his growth and that of his friends and is often
frightened by the possibility that there is something the
matter with himself. These worries may appear neg-
ligible in the eyes of the adult, who knows that most of them
are groundless. To the adolescent himself they are just
as important as he considers them to be, as is shown in the
following cases.

Mary was a happy, well-adjusted girl who did good
schoolwork and was popular with other children until she
was between eleven and twelve years of age. At that time,
she began to lose her friends, and the grief she felt was
reflected in her schoolwork. She also lost favor with her
teachers, became very unhappy, and cried easily. This
situation grew increasingly serious over a considerable
period of years. The cause was obvious. Although
Mary's growth was rapid, she showed no signs of secondary
sex characteristics. She did not menstruate until she was
seventeen years old. During the interval, she looked and

162

Adolescence

acted three or four years younger than her chronological
age. Her interests were those of a little girl until she was
more than eighteen, and thus the disparity between her
immature behavior and the conduct of her contemporaries
was constantly increased.

This delayed emotional growth created serious anxieties
in Mary's mind. She was convinced that there was some-
thing wrong with herself and attributed her friends' deser-
tion to that peculiarity. Because she no longer shared the
interests of her contemporaries, and her behavior seemed
juvenile lo them, she lost her self-confidence, became con-
vinced that she was stupid, and was alternately very critical
of her friends and of herself. These attitudes persisted for
many years, even though she was told the reason for her
predicament and every effort was made to restore her self-
confidence. Indeed, she was not able to understand the
reason for her maladjustment fully until she finally matured
and caught up with her group, at about the age of twenty-
one.

Analogous problems result from unusually early matura-
tion. There was Margaret, for example, whose parents
took her to a physician for examination because of temper
tantrums and inability to get along with other children. In
this case, also, the cause of the trouble was clear. Margaret
had begun to menstruate at the age of nine and a half. By
the time she was ten and a half, she had the emotional
growth and interests of a fifteen-year-old. The great dif-
ference between Margaret and her friends of her own age
made them and their mothers think that she was peculiar.
When, for that reason, they avoided her, the child became
frightened and frustrated. As in the case of Mary, who

163

A Psychology of Growth

matured late, it was necessary for parents and teachers to
be very patient and understanding in order to minimize
the child's maladjustment. The treatment of these girls
necessarily continued a long time until, in each case, the
patient's level of growth was equal to that of her friends of
the same age.

Although similar differences appear among boys, their
reactions are not usually so severe. Certain dangers,
however, are inherent in the situation. Because boys are
hero-worshipers, the one who develops rapidly often be-
comes the leader of his group. Unless he is stable and
well adjusted, he may lead the group into difficulties. The
immature boy, on the other hand, is easily led and will
do many things, even some that he knows are wrong, if he
thinks he will thereby win the esteem of the leaders of his
gang. One such boy stole many articles and was finally
caught breaking into a store to get baseballs and athletic
equipment. He hoped by this conduct to appear tough
in the eyes of his more mature friends. The penalty for
refusing to do what the gang wished was being called a sissy
and ostracized from the group.

Although there are no abrupt changes in intelligence
growth during the period of adolescence, certain lines of
development may regularly be expected. One evidence of
mental growth is the appearance of the ability to do abstract
thinking, which begins at the age of twelve. This is an
important development, in view of the fact that the norms
of society are abstract and the gradual understanding of
them is a vital factor in the adjustment of the child to his
environment, as stated on page 65. As a test of the twelve-
year-old's ability to understand abstract terms, one might

164

Adolescence

ask the questions: What is pity? What are envy, revenge,
charity, justice? From the point of view of the adult
these terms are so simple that parents are not always likely
to realize that they have no meaning for a child until he has
a mental age of twelve years. Even when a child has the
intelligence growth to comprehend abstract terms, they
do not concern him until he develops a social consciousness.
This occurs with the emotional growth of maturation. All
his life he has heard about the concepts of truthfulness, right,
and wrong, and has been expected to respect them; but it
is not until adolescence that he begins fully to appreciate
their implications and to comprehend the standards by
which he has always been supposed to live.

The most marked changes take place in the emotional
aspect of growth. This is shown particularly in the increase
of conscience at the approach of adolescence and during
that period. Although the still, small voice begins to
whisper to a child at a very early age late infancy or even
before it becomes much stronger and more insistent in
the preadolescent and adolescent boy and girl.

Idealism is stronger during adolescence than at any other
time in the life of the individual. It may serve the child
as a valuable guide in working out his own problems.
With proper cooperation, it can be used to develop social
and religious concepts and to help the youngster achieve
the necessary feeling that he has a place of some importance
in society.

At adolescence, for the first time, children see themselves
as others see them. Motivated by sex attraction, they
become acutely conscious of the impressions that they make
on others. For this reason, their behavior is often para*

165

A Psychology of Growth

doxical. A boy wants a good suit of clothes in place of his
old pants and sweater; the girl wants lipstick and nail
polish. Given their own way, they dress in the most
extreme fashion and affect a highly sophisticated manner
but only for a few hours, or, at most, a day or two at a time.
Following such a performance they go to the other extreme
wear their oldest clothes, perhaps, refuse to keep them-
selves clean, and try to appear absolutely indifferent to
anyone's opinion. In other words, they alternate between
very grown-up and very childish behavior. The reason is
obvious: they try to act grown up and find the task too
difficult. It takes many years before they can act grown
up all the time. Meanwhile, because of the difficulties
they encounter and the disappointments they suffer by
reason of their failures, they throw temper tantrums, are
moody and unhappy, and become a trial to their parents
and to others with whom they live.

Biologically, adolescence is characterized by maturation;
that is, the development of strong sex impulses and sex
attraction. Previously the child was interested only in
himself. In his own mind he was almighty, the one indi-
vidual in the world. With maturation, however, comes
deflation, and he realizes that he is only one of the multi-
tudinous individuals in the world. Now it becomes neces-
sary for him to recognize the demands of the social system,
and he begins to try too many problems in his mind. These
must be satisfactorily solved if he is to become a well-
adjusted adult. The seriousness of the problems is deter-
mined by the way in which he has been brought up. If his
growth has been normal up to this point, it will continue
with a minimum of difficulties; if it has not been normal,

166

Adolescence

the difficulties will be proportionate to his maladjustment.
Boys and girls bring to adolescence the confidence or in-
security, the self-reliance or need for help that they have
acquired during childhood. These qualities have a
strongly determining influence on their ability to solve
the inevitable problems that confront the near-adults.

There is, to be sure, a difference between inherent and
acquired problems. For example, the girl who does not
begin to menstruate until she is eighteen is emotionally
immature for a physiological reason. This condition is not
at all the same as the emotional immaturity of the youngster
who has found growing up too difficult and, therefore, has
a distorted growth or has regressed to a more immature
but more comfortable level.

Four major problems trouble the minds of all adolescent
boys and girls. In our civilization, one of the foremost
of these is sex, for the reason that the adolescent is caught
in a tug of war between his own developing sex impulses and
the demand of society that they be controlled. Whether
or not the child can cope with this situation depends upon
the knowledge that he has acquired. The child who has
been properly taught and is not frightened by sex will
welcome his maturation and get the greatest satisfaction
from love. Conversely, there will be conflicts, doubts, and
unhappiness in the mind of that child who has been given
the idea that sex is wrong and sinful, that normal sex
interests and habits are bad, or that they will make him
ill or affect his mind. The girl who has grown up normally
and understands about menstruation is thrilled by the onset
of this process. The frightened girl may experience great
distress during her first menstrual period and have similar

167 -

A Psychology of Growth

difficulty for the remainder of her life. Analyses have
shown that much of the discomfort of the menstrual period
is psychological rather than physical.

This fact is illustrated by a thirty-year-old woman who
complained of severe menstrual pains. When her history
was taken, she told that she had known nothing about
menstruation until her first period occurred. While she
was visiting an aunt, she awoke one night to find herself
"smeared with blood." This caused her to fear that some-
thing was seriously wrong and that she might die. Afraid
to disturb her aunt to ask for advice, she washed herself
with cold water. In the morning she talked to the aunt,
who said, "That was the very worst thing you could have
done. Now you'll have cramps for the rest of your life."
Although she had no pain with the first period, she fulfilled
her aunt's prediction and had "terrible cramps" every
month thereafter. Repeated gynecological examinations
were negative; but only after prolonged psychiatric treat-
ment did the patient realize that the cramps were due to the
dread of painful menstrual periods. With a slowly chang-
ing mental attitude, the cramps almost entirely disappeared.
' Thus there is a great need for intelligent sex education.
This should have begun much earlier. In fact, as we
have seen, the starting point should have been the attitude
of the parents and their instruction of the child from his
earliest infancy; but whether or not the child has had the
benefit of a healthy attitude on the part of his parents and
adequate sex education all along the way, he is still in need
of intelligent answers to the questions that arise as the result
of his own growth problems. Nurses are frequently con-
sulted about these matters, and they should be prepared to

168 -

Adolescence

discuss them intelligently. In order to do this a nurse
must first examine her own prejudices and difficulties and,
if necessary, correct her own attitude. She can obtain
much help from good books on sex education. Many works
on the subject have been published during the past ten or
fifteen years. A list will be appended at the end of this
chapter.

The second problem in the minds of all adolescents has to
do with independence. As they mature physically, chil-
dren like to feel that they are grown up in other ways.
"I'm going to do as I please," the adolescent tells his
parents. "You can't make me do anything." That is an
entirely normal expression of the child's feelings and almost
an exact statement of fact. Whether parents like it or not,
those who are intelligent realize that they cannot force the
adolescent to do any of the things that they consider most
important to go through school, for example, and to keep
out of serious difficulties outside the home. If they have
permitted the child to grow up normally, however, he has
developed sufficient self-reliance to avoid real trouble and
they have no need to fear the consequences of his declaration
of independence. As a matter of fact, they have given
this child increasing independence since his infancy; by the
time he demands freedom of action at adolescence, he
already possesses it. Such parents can have confidence in
the child's judgment and must have learned that he is
capable of taking care of himself up to a point that he
knows better than anyone else.

In spite of his demand for independence, the adolescent
knows that he needs help in solving many of the important
problems that confront him. Although he wants inde-

169 -

A Psychology of Growth

pendence, he is still dependent upon his parents and upon
other adults. As a matter of fact, the more indirectly he
asserts his independence, the more certain it is that he is
fighting his own desire for dependence. When his inde-
pendence is respected and he can, therefore, have confidence
in adults, he goes to them with his sex problems; his social,
vocational, religious, and physical problems; and the endless
number of questions evoked by the whole business of grow-
ing up and making adjustments to society. This is a field
in which the nurse and the physician can be very helpful.
They are consulted frequently, but not nearly so frequently
as they should be.

Usually the struggle between independence and depend-
ence continues through adolescence and adulthood. While
the individual desires independence, he also wants to be
loved, which is dependence. At times, his independence
costs him dearly in terms of frustration, criticism, loss of
jobs, and disharmony in the home. These reactions indi-
cate that the parents did not give the individual security
during his childhood and that he never enjoyed that feeling
of approval which makes for self-confidence and the willing-
ness to accept help from others.

L. R., a man twenty-four years old, was one of these
individuals. Trouble began shortly after his marriage,
when he insisted upon dominating his wife and, rather than
accept her reasonable suggestions, often did things in ways
that he admitted were not efficient. "If I want to do
something," he said, "I'm going to do it. In my own
home I'm going to have my own way." When he was
asked if he did not feel like a small boy when he made
such statements, he admitted that this was true. "But,"

170 -

Adolescence

he said, "I was never allowed to do anything in my parents 5
home and now that I've got a home of my own Pm not
going to let that kind of thing get started."

In elaborating on this statement about his childhood, he
described a home in which his father had little authority
and his mother dominated the family. She had forced her
ideas upon the boy and set up rigid standards, without
giving him credit for doing anything right. The mother
selected the boy's clothes, failed to give him the spending
money that the family could well afford, refused to allow
him to play football, punished him if he fought, and kept
him in the house if he did not get the highest grades in
school. At the age of fifteen, he ran away from home and
went to live with an uncle in another city. As punishment,
the mother obliged him to stay there for a year. Although
he had never before admitted the fact to anyone, he con-
fessed to the physician who questioned him that during the
year away from home he had been very homesick. These
disclosures showed that the boy had been extremely depend-
ent on his mother. He had tried hard to please her but,
because she never approved of what he did, he had become
resentful. When he reached adolescence, he determined
not to be dominated by anyone and, although he fell in
love and was married, he could not tolerate the idea of being
dependent in any way on his wife. His home, he thought,
must be different from that of his parents.

Betty was another child who never received any praise
from her mother. On the contrary, she was unwanted,
unloved the object of constant criticism. Not surpris-
ingly, she became a behavior problem. When she refused
to be "broken," the mother beat her severely, and Betty

171 .

A Psychology of Growth

fought back by refusing to do anything unless she was
forced. At the age of twenty-two, she began to have pain
when she was away from home. She also, complained of
shortness of breath and nausea and had a dread of becom-
ing ill and vomiting in public. When she analyzed this
fear, she found that she dreaded being sick in public for
the reason that it might cause people to be sorry for her and
she didn't want sympathy from anyone. She said that
she wanted to be independent of everyone. Actually this
girl was very insecure. Because she felt a great resentment
toward the mother who never accepted or approved of her,
she tried to convince herself that she could live without
even sympathy from anyone.

Although the reactions of these two persons may appear
to be extreme, they are not uncommon. Many individuals
have similar, if less severe, reactions.

An important problem of the adolescent, then, concerns
the use to which he is going to put his independence, once
he has obtained it. Many individuals use it unwisely and
soon get into trouble. Usually the cause is not hard to
find. Youngsters who make serious mistakes are likely to
be those who for years were tied to mother's apron strings or
kept under father's fists, or both. Since they were not
permitted gradually to take on responsibilities proportion-
ate to their age and abilities, they never developed that self-
confidence which comes from learning how to do things;
they never became self-reliant. When they acquired inde-
pendence, they did not know what to do with it.

When adolescents go to adults for "advice," what they
really want is a good listener, someone in whom they have
confidence and to whom they can talk freely about their

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Adolescence

problems. The nurse and the physician, in this role of
counselor, can supply medical facts (being sure of their
information, of course, before passing it on); but they can
render even greater service by lending their ears, rather
than by giving their opinions. Though they may be able
to make some suggestions, their most valuable help comes
from permitting the patient to find the answers to his own
questions and from giving him only the backing that he
needs to translate his ideas into action.

The third problem of the adolescent has to do with
weaning. This process of becoming weaned from parents
is usually difficult and, in many cases, is never completed,
even in adulthood. Continued dependence on parents
may be the cause of many maladjustments, since a hetero-
sexual development is essential for success in life; that is,
every child must transfer his affection from his parents
(particularly the mother, in the case of the boy, and the
father, in the girl's case) to someone outside the family.

There are many reasons why boys and girls never become
emancipated from their parents. One is the insecurity that
results when apprehensive parents keep a child dependent
and refuse to allow him to grow up and take care of himself.
The youth who lacks security is always frightened; he often
believes the familiar adage, "Mother knows best," and the
crippling corollary, "I know very little."

The situation is illustrated by the case of Janice. She
entered nurse's training at the age of eighteen and, although
she was physically well and possessed high intelligence,
she was painfully homesick for many months and had great
difficulty with her work, both practical and academic.
Always apprehensive, she was so fearful of making a mistake

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A Psychology of Growth

that she did her work very slowly, used no initiative, never
recited or volunteered opinions. As a result, she was not
asked to participate in the activities of the other girls and
became a thoroughly maladjusted student nurse.

The story behind this story begins with a very strict,
neurotic mother, against whom Janice, unfortunately,
never rebelled. All through high school the girl conformed
absolutely to her mother's ideas. She never had friends who
did not meet the mother's approval, always wore the clothes
that her mother selected, always came home at exactly the
time her mother set, and altogether followed her mother's
wishes to the most minute detail. The father supported
his wife's ideas, but obviously had little to say about domes-
tic matters. Janice was greatly attached to him, always
used him as a standard by which to measure the boys she
knew, and was afraid to marry lest her husband should not
turn out to be like her father.

Coupled with her dependence and apprehension, Janice
felt extreme resentment toward her mother, although she
was too frightened to admit that fact even to herself. When
she left home to go into the hospital, where she was expected
to act and think for herself, the girl was lost. This type
of problem, which is very common among student nurses,
is more prevalent among girls than among boys.

Like Janice, many adolescents compare others with their
own parents. That is entirely normal, but if a boy or a
girl expects to marry someone who acts and thinks like
his or her mother or father, many difficulties may result.
Serious weaning problems occur in cases of extreme attach-
ment to parents. There is, for example, the very honest,
obedient, clean, polite ten-year-old boy who washes his ears,

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Adolescence

combs his hair, wears a blue-serge suit, takes his mother's
arm, tips his hat and says "How do you do?" He is at
once too greatly attached to his mother and too frightened
to do the things that normal boys enjoy. He is heading
for serious trouble when, at adolescence, his sex impulses
become very strong and sex wishes develop. These wishes
will then be directed toward that member of the opposite
sex of whom he thinks the most in this case, of course, the
mother. He may then continue to be very strait-laced and
proper, or he may break into open rebellion. His out-
breaks of temper are likely to reach alarming proportions,
because at adolescence a child is often violent. Parents
should be helped to understand the reason for this rebellion
and to recognize it as a necessary part of the child's develop-
ment. If he does not rebel, he is in danger of never becom-
ing weaned at all. When interviewed, children of this
kind express hatred of their parents in direct proportion to
their attachment.

Parents normally want to keep a child as long as possible.
In order to force them to realize that he is grown up and
determined to make decisions for himself, the adolescent
must rebel and treat his parents in a way that they consider
unkind. There is much truth in the old adage that the
boy who is not mean to his mother during adolescence will
be mean to his wife.

Probably the most common reason for the complaints of
wives and husbands is that each criticizes the other for not
behaving like mother or like father. The words of the
old song, "I Want a Girl Just Like the Girl Who Married
Dear Old Dad," are a popular expression of a profound
psychological truth. In the case of that individual who

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has never been weaned, this tendency to compare his wife
to his mother results in harsh criticism if the young woman
does not think, talk, dress, or keep house just as his mother
did. Similarly the wife may bring great unhappiness upon
herself and her husband if she expects him to be the counter-
part of her father. Many such adult problems stem from
adolescent difficulties.

The fourth serious problem in the life of the adolescent
has to do with his feelings of inadequacy and inferiority.
These feelings, of course, do not suddenly spring into being
with the approach of adolescence, but are the product of
improper training through all the preceding years. Chil-
dren may be told from fifty to one hundred twenty-five
times a day that they are bad and of no account without
it having any apparent effects at the time. Often the
results do not manifest themselves until the child has
reached preadolescence or adolescence itself; that is, until
he has arrived at that stage in his mental growth when he
becomes acutely conscious of others. Then the damage
that has been done produces behavior that is shocking to
the adults who unwittingly caused it.
. Such was the case with Nancy. She was a very intelli-
gent and attractive child. Her parents unquestionably
wanted her and approved of her, in general, but they set
up impossible standards of behavior for her. From their
ministerial ancestors they had received the idea that it is
extremely important to teach a child complete obedience
and consideration for others. They succeeded with Nancy
until she was nine and a half years old. At least, up to that
time she was very obedient and quiet; then, suddenly, she
began to have temper tantrums. When a physician who
had obtained her confidence asked why she became angry,

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Adolescence

she replied, "Because I hate myself." She felt that she
was thoroughly bad and gave two principal reasons for that
conviction: disobedience and disrespect.

Many boys and girls in high school have the same feeling
about themselves and react in a similar manner.

The individual who feels inferior responds in one of two
ways. Either he turns into a quiet, shut-in, a social or anti-
social person, who is very unhappy and develops many
resentments, or else he becomes aggressive, egocentric, all-
knowing. There is, of course, no such thing as a superiority
complex. Those unfortunates who give the impression
that they consider themselves superior are only covering
up their feelings of inferiority.

The minds of all adolescents are disturbed by the four
problems: sexual adjustment, independence (and its corol-
lary, dependence), weaning, and the inferiority complex.
These perplexities vary in degree with the development of
each individual from birth and with his training during
childhood, especially as it was affected by the attitudes of
parents, teachers, church leaders, and others concerned
with the guidance of children.

In addition to these universal problems, the adolescent
must cope with his individual difficulties, those anxieties
which have resulted from frustrations in infancy and those
other fears which he has acquired along the way. He must
now, furthermore, face the necessity for accepting his own
innate characteristics and those environmental circum-
stances which are unavoidable. He must learn how to live
with himself and with those external conditions over which
he has no control, however rebellious he may feel about
them.

Richard has to accept his delayed or slow development;

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A Psychology of Growth

George must reconcile himself to the probability that he
will never be tall; Mary has to face the fact that she is less
attractive than Susan; and Elizabeth, the knowledge that
she has poor motor coordination and no athletic ability.
Jack learns that he can never be a star football player and
Elsie finds that she is not a good actress. Adolescents are
much concerned about their growth and physical character-
istics. Failure to reach some desired goal creates a serious
problem.

In the matter of intellectual and emotional characteris-
tics, adolescents have to face the same irrevocable truths
and learn to accept themselves as they are. Some have
special abilities and others have special defects. Some do
well in academic pursuits and others fail. The latter group
not only suffers disappointment but has to endure the scorn
of teachers and sometimes of parents. It is unfortunate
that during this period of rapid growth, when mental
efficiency may be low, adolescents are often faced with a
school curriculum that is most difficult. The struggle for
grades that will be acceptable to colleges, together with
strong individual competition, is a tax even on those who
do not have suppressed and exhausting fears and serious
problems of adjustment. Innumerable individual charac-
teristics contribute to the problem of making an adjustment
in society. Some of them are in the mind of each adolescent
and the anxieties that they create are great or small, depend-
ing on the patterns of response that the individual has
developed.

In the process of growing up, it is essential for each child
to feel that there is something that he can do well and that
there is some small niche in society for him. The security

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Adolescence

that he originally found in his parents and later in his school
is now enlarged to include the community, and finally rests
in himself. If he is to make a satisfactory adjustment, he
must have self-confidence and faith in his own ability to
meet new situations.

Mental growth is the measure of mental health in
adolescence, as it is at any age. By the time that a boy
(or a girl) reaches adolescence, he should have developed
much self-confidence and, as a result, the ability to take
the responsibility for his own conduct. He should be
responsible for his health habits and should be vitally con-
cerned about his physical development. He should be
responsible for his schoolwork, having begun to take on
that responsibility in the first grade. He should be able
to continue his socialization, and that process will not be
too difficult if he learned to play well with other boys and
girls during childhood. Now, as his contacts become wider,
he should know how to conduct himself in many social
situations; he should be responsible for getting home at a
reasonable hour (which is not necessarily the time set by
his parents), and should be able to avoid serious difficulties.
Parents can no longer supervise his social activities. If
they are wise, they have no wish to do so; if they have
brought the child up well, there is no need for the supervision.

The adolescent's social concepts and his attitudes toward
society are shaped by the current political philosophy of the
country in which he lives, the doctrines of the church in
which he was reared, and the standards of his home and
his community. Like the adult, the adolescent wants to
believe that he solves his problems by logical thinking and,
indeed, he makes a great effort to do so. Actually he

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A Psychology of Growth

devotes much time to an attempt to justify the prejudices
and ideas that have been handed down to him and to make
a comfortable adjustment to society. If he has been
brought up to be a "strong Republican Methodist," for
example, he may argue fervently to convince others that
his is the one true philosophy; but the more argumentative
he becomes, the more he shows himself to be uncertain
in his own mind. Should he be unable to convince him-
self of the truth of the concepts that his family has given
him, he may rebel and try to prove that his parents and
society are wrong and, perhaps, proclaim himself an atheist
mnd a communist. This struggle, which begins in ado-
lescence and continues throughout life, shows the effect of
the social-political concepts upon the individual and the
effect of the individual upon these concepts.

The rapid development of the adolescent often causes
trouble in school, particularly at the secondary level.
High-school boys and girls are sometimes overwhelmed by
very strong sex feelings and are likely to have difficulty with
the frustrated teacher who objects to behavior that results
from this development. With the adolescent's rapid physi-
ological or physical growth there are unquestionably in-
creased hormone secretions, and this change causes him to
become inattentive and, therefore, to do poor schoolwork.
Some boys and girls are unable to study thirty minutes
a day.

During the past twenty years, educators have given much
thought to the matter of curriculums for adolescents. As
children grow older and individual intellectual capacities
manifest themselves, there should be ample provision for
developing these. Some youngsters who have high intelli-

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Adolescence

gence, however, do not know how they want to use it;
others may have outstanding mechanical aptitude and no
capacity for academic pursuits; while still others will never
be able to follow any rigid school program. A high school,
therefore, needs a very broad curriculum, in order to keep
its requirements within the abilities of all its students and
thus develop their self-confidence and gradually replace
the security given by their parents with the confidence in
themselves that is essential to adults.

Some children make this adjustment very successfully,
others succeed temporarily, and all too many fail altogether.
The last mentioned are those individuals who are unable
to grow up and take on the responsibilities that society sets
up for the young adult. They respond to this maladjust-
ment in two ways by showing open rebellion or by de-
veloping neurotic manifestations and taking refuge in
illness. Those who rebel either refuse to do anything; that
is, they adopt a passive aggressive attitude, or else they
become openly aggressive and destructive. The latter
group makes up that large number of mentally ill youngsters
commonly designated as juvenile delinquents. The other
group is composed of those boys and girls who, hampered
by childhood insecurities and confronted with standards
that they were unable to meet, became emotionally dis-
turbed and acquired the many somatic complaints seen in
neurosis. They are very sensitive, apprehensive, uncertain,
and immature. Few studies have been made of this neu-
rotic group.

The following cases illustrate some of the complicated
problems of the adolescent.

Maxine was a large, not especially attractive girl. She

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A Psychology oj Growth

was eighteen and a half years old when she left college at the
end of her first year because she was not pledged to a
sorority, had failed in two subjects, and barely passed two
others. She complained that she could not sleep or study
and that she had abdominal distress and, two or three times
a month, colitis. These attacks, which lasted one or two
days, occurred before examinations and at those times when
the girl was invited to a sorority house. When she de-
scribed her symptoms in detail, Maxine said that she
"trembled inside." Her I.Q. was 130 and she had received
high grades in secondary school, even though she was
nervous.

This girl had been adopted at the age of two months.
Her mother was quiet and unresponsive; her father, a
preoccupied businessman, was critical of the child and
caused her to be afraid of him. Both parents insisted,
not altogether convincingly, that they had wanted a baby,
but admitted that they had never been close to Maxine.
She had heard her grandmother boast many times that it
was she who had selected the baby. From the time that
the girl was ten years old, therefore, she had been afraid
that her parents did not love her. The mother was socially
ambitious for Maxine and expected her to live up to high
standards. She, however, felt that she was inferior and
bad, although such was not the case and her parents were
proud of her attainments in high school. During her
adolescence she wanted independence but was afraid to
assert herself until her last year in high school. Then, she
said, she "nearly always lost the argument." When she
was tempted to use her own judgment, she was afraid of
being wrong and ended by following her mother's advice.

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Adolescence

Maxine matured at the age of twelve. She liked boys
and they were attracted to her, although she always felt
that she was not good looking. She recognized sex wishes,
but thought that they were bad and that a nice girl should
not have them.

When she went to college, she was frightened and very
insecure. She felt inferior to the sorority girls, was afraid
that they would not like her and that, if they did accept
her, she would not be able to make high enough grades for
admission. Soon after her arrival she was befriended by
an upperclassman who, she found later, was a homosexual.
Since she had never before been permitted to make deci-
sions, she was always afraid that she would do or say some-
thing wrong. In time, she was pledged to the sorority that
was her third choice, but poor grades prevented her from
joining. The serious problems in the mind of this insecure
girl were enough to prevent her from studying properly or
making an adjustment.

Other adolescent difficulties entered into the case of
George who, at the age of nineteen, was discharged from
the army as a neuropsychiatric. After one year in the
service, he had forty-two charges against him and was
referred to a psychiatrist.

Study of this problem showed that George's background
included three years of military training in high school and
a good academic record. When he entered the army, he
was eager to make good and had high hopes for promotion.
As months went by and promotions were not forthcoming,
however, he developed an attitude of indifference. Al-
though he never disobeyed orders, he was frequently late
at formations, drilled in a slovenly manner, and failed to

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A Psychology of Growth

follow individual assignments accurately or even to make
an effort to do so. During this time he slept badly, lost
weight, had crying spells, and became a problem in his
command.

When the psychiatrist asked George for his own explana-
tion of his trouble, he said that he presumed that he was
frightened and "couldn't take it." What he meant was
that the idea of war was in conflict with all his ideals.
The thought of hurting or killing was repugnant to him and
he felt that war was a terrible thing. In high school he had
taken military training because he liked the uniform, and
a wise drillmaster told him that he was one of his best
students.

George was the older of two brothers. He had wet the
bed up to the time he was five years old, but had presented
no discipline problems at home or in school. His parents
brought him up very carefully, stressing kindness and con-
sideration for others, and he was always a good boy. He
never stole, used bad words, or disobeyed; and when he
reached adolescence he became very idealistic. He was
fairly popular and did better than the average in sports.

- In his own opinion, however, George was always inferior
to other boys, owing, in part, to the fact that he was small.
By following his friends' lead, never crying or fighting, he
established a reputation for being amiable, a good sport,
and a thoroughly nice boy; but inside he was seething with
inferiority and resentment. Another element in the situa-
tion was George's fear of his father. Although he was never
punished, he knew that he had to do as, he was told and
obeyed without question.

In the army, George's failure to win promotion had less

184 .

Adolescence

effect upon him than his reaction to the philosophy of war,
which, he realized, was diametrically opposed to all the
teachings of his childhood. His ideals were shattered and
he became indifferent, frightened, and depressed.

George and Maxine are examples of adolescents who were
able to succeed in high school, in spite of the conditions
that later caused serious difficulties. Others break, during
the high-school period, when they rebel, develop serious
anxiety states, or fail completely, and often slip into that
large group of boys and girls known as juvenile delinquents.

REFERENCE

1. FRANK, LAWRENCE K., Journal of Pediatrics, vol. 19, April,
1941.

185

Chapter Twelve

Juvenile Delinquents

The term "juvenile delinquents" is applied to those
youngsters who are in conflict with the law. The term is
general and includes many types of problems. Many
environmental conditions have been blamed for delinquency,
usually on a basis of statistical findings. The greatest
progress in understanding delinquency has come from the
study of individual delinquents. These individuals are
usually mentally ill. The important practical question is
whether they can be cured by combined psychiatric and
social treatment.

JUVENILE delinquency is a general term applied to pre-
adolescent and adolescent boys and girls whose behavior
is in conflict with the law and causes them to become
court problems.

In the English-speaking countries the subject of juvenile
delinquency had been investigated seriously since the early
part of the seventeenth century. English investigators who
wrote the "Report of the Committee for Investigating the
Causes of the Alarming Increase of Juvenile Delinquency
in the Metropolis 55 * concluded that the principal causes
were "the improper conduct of parents; the want of edu-
cation; the want of suitable management; the violation of
the Sabbath and habits of gambling in public streets."
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Juvenile Delinquents

The intervening years have brought many other investi-
gations, but the majority of them, like the first one, have
been statistical studies, from which it is always difficult to
draw reliable conclusions. Some studies have convinced
the investigators that juvenile delinquency is the result of
environment; others, that it is due to an incurable con-
stitutional condition, that is, a defect or defects in each
individual delinquent from birth. These conclusions have
been affected by the fact that most serious cases of juvenile
delinquency that have come into court have not been
treated successfully, and the offenders have had to be placed
in custodial institutions. Like any condition in medicine
that does not yield to treatment, this had evoked many
diverse theories in regard to the cause and the method of
management.

Many studies of large numbers of delinquents have
refuted the old idea that juvenile delinquency was inherited.
Spaulding and Healy's 2 study of several hundred cases in
Chicago failed to produce any evidence to show that it was
hereditary in nature, although they did conclude that some
children inherited physical or mental traits that might,
under special circumstances, become causative factors.

Goring 3 claimed that mental retardation was more fre-
quent in the criminal class than in the population as a
whole; but he based his conclusions on physicians' clinical
diagnoses, which are inaccurate. Using army intelligence
tests, Murchinson 4 and others have demonstrated that the
intelligence of the prison population is as high as that of
the general population. In other words, according to these
figures, the percentage of persons of superior intelligence
is as high in prisons as elsewhere and the percentage of

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A Psychology of Growth

prisoners with low intelligence is no greater than in the
general population. Italian criminologists attempted to
prove that juvenile offenders were victims of abnormalities
in the glands of internal secretion. Kretchmer 5 and other
Europeans tried to relate behavior to body build and
physical types. Neither of these hypotheses, however, has
been proved.

In most analyses of the environmental factors that might
produce juvenile delinquency, the broken home is given
first place. Shaw and McKay, 6 who made one of the
most careful studies, however, found that the ratio of broken
homes among juvenile delinquents to that among other
school children was 1.18 to 1. They concluded that
delinquency was less closely related to the formal break
in the home than to internal discord and conflict in the
family; and most psychiatrists agree with this conclusion if
parental rejection is added.

Investigators have made statistical studies of many other
possible factors, such as sibling position (chronological
position of the child in relation to brothers and sisters),
undesirable persons living in the same house, companions,
economic status of the family, religious influence, type of
community, urban and rural differences, regional dif-
ferences, inflation and depression, and many others. Al-
though all these factors throw statistical light on the prob-
lem, no one and no combination of them can satisfactorily
explain the cause of the behavior in individual cases. Two
publications that give a detailed report on our present
knowledge of these and other factors are "The Etiology of
Delinquency and Criminal Behavior," by \Valter G. Reck-
less, 7 and "Young Offenders, An Enquiry into Juvenile

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Juvenile Delinquents

Delinquency," by A. M. Carr-Saunders, Hermann Man-
heim, and E. C. Rhodes. 8

When juvenile delinquency is regarded as the inability
to make an adjustment to society, its seriousness is relative.
For example, in many neighborhoods, stealing and truancy
are normal. There the boy who steals enjoys the respect
of his fellows, while the lad who never breaks the law is the
one who becomes declasse. If extensive stealing is the
custom of the neighborhood, the average boy will steal,
since the desire to do so, which is normal in all children, is
now augmented by the natural reluctance of a young person
to defy custom and behave in a manner that sets him apart
from others. Some children, too, are very susceptible to
the influence of vicious or criminal elements in the home or
the neighborhood. The effects of suggestion and social
pressure are shown by the fact that most delinquents do
not work alone. The greatest number of delinquents may
be found in the areas showing the greatest disorganization;
that is, neighborhoods where there are industrial plants,
condemned buildings, a declining population. This does
not mean, however, that the environment per se is the cause
of the delinquencies. Individuals who live in these areas are
less capable of rearing children successfully and, therefore,
their boys and girls are more likely to encounter difficulties.

The first careful studies of individual cases of juvenile
delinquency were begun by Dr. William Healy when he
organized the Juvenile Psychopathic Institute in Chicago
in 1908. Since that time a large number of child-guidance
clinics and independent psychiatrists have studied the
individual delinquent.

Study of individual cases shows first of all that "delin-

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A Psychology of Growth

quency" is a very general term one that includes many
different forms of behavior. There are mentally retarded,
psychopathic, and sex delinquents; individuals whose
actions are due to compulsive behavior, to encephalitis, or
other forms of brain disease; and numerous other types of
delinquents. Persons who have studied individual cases
have generally concluded that they cannot be explained by
general theories.

Work with juvenile delinquents indicates that these are
youngsters who are emotionally disturbed. The primary
causes of their delinquency are their reactions to the stresses
and strains in their own minds, and these may be generated
anywhere in the city or in the country, on the boulevards
or in the slums, where discipline is strict or where it is lax,
in homes that have a strong church affiliation or in those
that have none at all. These and other general social
factors do not in themselves account for desirable or deplor-
able behavior of any kind, and juvenile delinquency is no
exception.

When we find a youth defying his parents and the laws
of his community to the point of committing acts that he
knows are prohibited, we are dealing with desperate
behavior, which must be motivated by serious emotional
difficulties. In his aggressive behavior the boy is expressing
some inner driving force that he himself neither under-
stands nor finds himself able to control.

For example, there was Edward, a fifteen-year-old boy
who was arrested for exposing himself to girls. He came
from a fine family in a good community and had been care-
fully brought up, as that expression is generally understood.
He was unable to give any reason for his behavior. He not

190

Juvenile Delinquents

only asserted that he had no interest in sex but also that he
believed sex wishes were wrong and that he attempted
desperately to force all such ideas out of his mind. This
extreme effort to dismiss normal feelings, which were
physiological in character and instinctive in nature, caused
him to develop a compulsion to the point where he could
not help exposing himself. Questioning revealed that this
boy had failed to receive intelligent sex instructions, but
had been taught all his life that everything about the subject
was wicked. With intelligent sex education and conse-
quent relief from impossible standards, his compulsion
disappeared.

Seventeen-year-old Irene was charged with sex delin-
quencies, which had been continuing for a year. She was
an only child, who had been adopted at the age of nine
months. Her parents, like those of the boy in the previous
case, were fine people who lived in a good neighborhood.
However, they had many disagreements, in the course of
which they used the child as a football. As she never
knew whether or not she was approved, she felt very in-
secure. At about the age of ten, she became something of
a social outcast. She had very few friends among girls of
her own age and said that she preferred older women.
Actually she was very dependent upon her mother but,
because she was not sure of her position in the family, she
was searching for a good mother substitute. The girl's
parents brought her up very strictly and, on the subject of
sex, she was more frightened than enlightened. She
described spells when she had very strong sex wishes
accompanied by an overwhelming sense of loneliness. At
those times she felt that she had to get out of the house and

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A ^Psychology of Growth

would go off with the first boy she met on the street. After
each episode she experienced an extreme sense of guilt and
felt that she should be severely punished.

In these two examples we find a boy and a girl whose
homes, parents, and environment as a whole would gen-
erally be classed as very desirable. Nevertheless, they
developed compulsive behavior that led both young people
to the juvenile court. Superficially their behavior might
appear to be very immature, the result of a lack of self-
restraint; or they might be described as indifferent to the
rules of society. A study of the two children, however,
disproves both of these explanations. They were not
immature or indifferent and each had a conscience a
more active conscience, in fact, than that of the average
individual; but internal strife was strong enough to break
down these barriers. What happened to them was as
inevitable as the result, say, of sealing the top and nozzle
of a teakettle filled with water and starting a fire under it.
Steam that cannot escape through normal channels must
break through some other way.

Both Edward and Irene were cured by psychotherapy.
This treatment is not always effective, however, even when
it is continued over a considerable period of time. In such
a case, the patient has to be placed in an institution.

Leonard, a sixteen-year-old delinquent, was arrested for
burglary after he had broken into a store, a school, and a
residence. Each time, he had stolen articles that he did
not especially want. In the last two places he had left
behind letters full of criticism, through which he was
traced and discovered to be the thief. This boy was the
oldest of four children. His father, who had been a prob-

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Juvenile Delinquents

lem in high school, had once been arrested for stealing a
bicycle. After his marriage, the father had become in-
dustrious but not notably successful. He worked long
hours, came home irritable, and gave his family little
consideration. Leonard was always afraid of him. Though
the boy's mother took the attitude that she had made her
bed and would continue to lie in it, she resented her hus-
band's lack of consideration and attention. Sometimes she
vented her displeasure on Leonard, who resembled his
father. Normally, however, she showed affection for her
children and Leonard reciprocated.

During his childhood the boy presented no special prob-
lems except that he wet the bed until he was five years old
and never got along very well with other children. His
serious problems arose during adolescence. At that time,
he felt inferior to other boys and attributed this to his
small stature. Although he wanted his mother's love and
experienced sex wishes directed toward her, he was embar-
rassed by her demonstrations of affection and felt disturbed
afterward. At the age of fifteen, he began to have homo-
sexual relations, which disturbed him greatly and caused
him to feel worthless. His schoolwork suffered and his
teachers criticized him for his inattention and what they
called his indifference.

Among the many adolescent problems behind Leonard's
behavior one of the most significant was his intense sense
of guilt. He felt that he was very bad and wanted to be
punished. In his burglaries he not only expressed resent-
ment but, by writing letters that would inevitably point to
him as the thief, he made sure that he would be caught. In
other words, he did not want the articles he stole but, by

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A Psychology of Growth

accepting censure and punishment for burglary, he obtained
relief from the sense of guilt that resulted from homo-
sexuality and his feeling toward his mother. Psychiatrists
who have analyzed many cases of juvenile delinquency
have usually traced misconduct to emotional distress. Why
some individuals react with the aggressive behavior of the
delinquent, while others become sensitive and shut in, is a
question that has not been fully explained. In many cases,
the boys and girls reflect the patterns that we noted in the
newborn infants; that is, some respond to insult by a passive
behavior, while others make violent outbursts. No definite
conclusion is warranted on the basis of the few cases that
have been analyzed from this point of view, but it suggests
a possible theory. Unquestionably the delinquent is very
often a child who was rejected from the time of birth and
was faced with impossible standards. He has resentments
and often appears to be indifferent. Usually he has an
intense sense of guilt. His emotional growth has been dis-
torted. He is ill and requires careful medical (psychiatric)
care.

Delinquents whose behavior does not bring them into
court are frequently sent to military school. Court cases
that do not yield to psychiatric or social treatment lead
to the reform school. Authorities recognize, however, that
these institutions do not cure the condition. Obviously,
discipline cannot correct behavior due to emotional con-
flicts over which the individual has no control. The reform
school is only a step on the path that leads to the peniten-
tiary. Much more efficacious treatment is afforded by
placing the delinquent in a boarding home and giving him

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Juvenile Delinquents

psychiatric care. In this way the youth is removed from
the ^environment where his difficulties arose and has the
benefit of treatment by a skilled, trained worker, who is
often able to give him new emotional outlets and to help
him form interests that enable him to relieve his anxieties.

Another group of adolescents whose plight is equally
serious from a medical point of view has received far less
attention than the juvenile delinquent. It is made up
of those whose emotional conflicts form anxieties to which
they respond by becoming shut in and by developing neu-
rotic corftplaints.

Frank belonged to this group. When he was examined
at the age of seventeen, he was a junior in high school doing
passing work. He did not enter into the social program
of the school, had no friends, and spent much time listening
to the radio or aimlessly wandering around town. At home
he said little and was irritated when his parents attempted
to talk to him or when they urged him to attend social
events. He complained of vague headaches, for which no
physical basis could be found.

Like the majority of such patients, Frank was not very
communicative with the physician at first and usually
asserted that there was nothing wrong with him. As the
physician won his confidence, however, he described strong
feelings of inferiority and inadequacy and the fear that he
experienced when he had to talk to anyone or when he was
called upon to recite in school. He felt that he was not
liked and finally concluded that no one had ever liked him.
He displayed some interest in mechanics and had con-
siderable aptitude; his father was helpful in encouraging

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A Psychology of Growth

him to set up a workshop at home. During his senior year,
when he had this added interest, he worked hard and
gained admission to an engineering school.

Although he was now able to discuss many problems and
to gain an insight into his difficulties, he still kept apart
from others after he entered college. In his second year
he formed a few friendships and had dates with girls, but
on those occasions he was so nervous that, he said, "my
hands shook if I even tried to drink a coke." However,
he was determined to understand his fears and was able to
make appreciable progress.

During his two years in the army, Frank did fairly well.
He was still unsure of himself and became boastful and
egocentric, in an effort to compensate for his feeling of
inferiority. It is significant that he did not develop battle
fatigue. He readily admitted that in conflict he knew
extreme fear and trembled so greatly that he had difficulty
in performing the operations assigned to him. When he
was injured, he experienced a feeling of great relief at the
prospect of being relieved of further duty. Probably the
reason why he did not develop battle fatigue was that he
had a considerable insight into the origin of his fears and
realized that there were many other soldiers as frightened
as he was.

After five years of intermittent treatment, he has become
outwardly a sociable, friendly individual, but his mind is
not at ease. He still feels that he is not liked, although he
knows that this is not true. His present pattern of behavior
will probably follow him through life. If he continues to
be successful, he will build up more self-confidence; if he
fails, he will become more uncomfortable.

Reactions such as Frank's, which are not uncommon

Juvenile Delinquents

among boys, appear still more frequently in girls. They
account for that large group of high-school girls and women
who are nervous. The anxieties that often give rise to
somatic complaints, such as abdominal distress, colitis,
rapid heart, and weakness are due to the insecurity, resent-
ment, fear, and sense of guilt that have been present from
birth. These produce fixed habits of response during
adolescence and finally bring about the suppressed and
exhausting anxieties of adulthood.

REFERENCES

1. "Report of the Committee for Investigating the Causes

of the Alarming Increase in Juvenile Delinquency in
the Metropolis," printed by J. F. Done, St. Johns
Square, London, 1816.

2. SPAULDING, EDITH R., and WILLIAM HEALY, "Inheri-

tance as a Factor in Criminality," Physical Basis of
Crime: a Symposium; papers and discussions before
the 38th annual meeting of the American Academy of
Medicine, Minneapolis, June, 1913, p. 19, Am-
erican Academy of Medicine Press, Easton, Pa., 1914.

3. GORING, CHARLES, "The English Convict," p. 263, H. M.

Stationery Office, London, 1913.

4. MURCHINSON, CARL, "Criminal Intelligence," p. 43,

Clark University Press, Worcester, Mass.

5. KRETGHMER, E., "Physique and Character," translated

by J. H. Sprots, Harcourt, Brace and Company, Inc.,
New York, 1925.

6. SHAW, CLIFFORD, and HENRY D. McKAY, "Social

Factors in Juvenile Delinquency," Report on the
Causes of Crime, National Commission on Law En-
forcement and Observance, No. 13, vol. II, p. 276,
Washington, D.C., 1913.

197 .

A Psychology of Growth

7. RECKLESS, WALTER G, "The Etiology of Delinquency

and Criminal Behavior," Social Service Research
Council, 230 Park Avenue, New York.

8. CARR-SAUNDERS, A. M., HERMANN MANHEIM, and E. C.

RHODES, "Young Offenders, An Enquiry into Juve-
nile Delinquency," The Macmillan Company, New
York, and University Press (John Wilson & Son,
Inc.), Cambridge, Mass.

BOOKS ON SEX EDUCATION

For Children

STRAIN, FRANCES B., "Being Born," The Macmillan Com-
pany, New York, 1936.

STRAIN, FRANCES B., "Love at the Threshold," D. Appleton-
Century Company, Inc., New York.

LEVINE, MILTON L., and JEAN H. SELIGMAN, "The Wonder
of Life," Simon and Schuster, Inc., New York.

DE SCHWEINITZ, KARL, "Growing Up," The Macmillan
Company, New York, 1928.

For Adults

XEVY, JOHN, and RUTH MONROE, "The Happy Family,"
Alfred A. Knopf, New York, 1935.

STONE, ABRAHAM, and HANNAH MAYER STONE, "A Mar-
riage Manual, "Simon and Schuster, Inc., New York.

SWIFT, EDITH HALE, "Step by Step in Sex Education,"
The Macmillan Company, New York.

STRAIN, FRANCES B., "New Patterns in Sex Teaching," D.
Appleton-Century Company, Inc., New York, 1934.

HAMILTON, G. V., "A Research in Marriage," Albert and
Charles Boni, Inc., New York.

* 198

Chapter Thirteen

Adults

An adult is an individual who can meet new and dif-
ficult situations in life and make an adjustment to them.
At this point it is well to review growth and development
from birth. Adults like to work but also go back to their
childhood for a certain amount of play. All adults have
rational fears and hates; also irrational fears and irra-
tional hates. Adults desire to rear a family, to work, and
to create. Many symptoms are produced by the effect of
intense feelings upon the Physiological processes via the
sympathetic nervous system.

Neurosis is an exaggeration of normal emotions. Neu-
rotic individuals are controlled by their unconscious anx-
ieties: fears, hates, sense of guilt. They are unable to
grow up and act like adults. To them everything is ter-
rible. There is no line of deviation between the normal
and the neurotic individual. Anyone may "break" if
conditions are too difficult.

"Psychopathic personality" is the name given to the
state of a group of immature individuals who have little
or no sense of right and wrong. These individuals are
often troublesome.

An alcoholic is an individual who cannot stop drinking,
after he has had one or two drinks, until he makes himself
completely dependent. Some individuals develop obsessions

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A Psychology of Growth

that they recognize as irrational but are still unable to
control. This behavior often becomes compulsive.

Sexual impulses may be distorted. Exhibitionism,
sadism, fetishism, and so on, are examples. In these
individuals there is a suppression of normal sex wishes
and such distortion of sex impulses that they no longer have
the biological function of propagation.

Psychoses are forms of mental illness in which the
patients lose contact with reality. The manic-depressive
condition and dementia praecox are the most serious forms
of mental illness.

ADULTHOOD may be defined in many ways, but from the
point of view of this study we might describe an adult
as an individual who has grown up and so fitted himself for
life that he can adjust to new and difficult situations. When
misfortune comes, he can take it in stride. This standard,
to be sure, is purely relative, since there is no person who
may not become emotionally disturbed and "break" if his
difficulties become sufficiently serious. Some individuals,
however, have a lower breaking point than others.

In order to understand these differences, let us look back
at the steps in the development of an adult. Each indi-
vidual is one infinitesimal unit in the life of all mankind.
Since he is only a link in a very long chain, a living replica
of his ancestors for countless generations, he is ancient
even at the moment of birth. His life, like that of every
other living thing, is a growth process. This process begins
with conception and continues to senility. Growth is most
rapid before birth, but follows at a swift pace through

200

Adults

infancy and accelerates again during adolescence. It may
proceed continuously or it may be interrupted, either before
or after birth, by toxic or poisonous agents Or disease. It
may also continue for a time and then reverse itself, as in
the deteriorating diseases. After birth, suitable environ-
ment may encourage growth; unsuitable environment may
arrest or stunt it or cause regression. Growth is stimulated
by growth energy that is, vitality with which the indi-
vidual is endowed from the time of conception. The
amount of growth energy varies with the individual.

Everyone is born with potentialities for the development
of growth patterns that determine his physical stature,
intellectual capacity, and emotional responses. He may
also have certain inherent abilities and handicaps. En-
vironment will affect these elements to some degree but will
not change them. Growth occurs in a definite, orderly
sequence, which varies among individuals only in regard
to rate and extent. In other words, each individual follows
a universal sequence of growth changes, but does so at his
own rate of speed and can attain only the size and capa-
bilities inherent in himself.

A normal infant has at birth a well-developed and func-
tioning mechanism that regulates vegetative, physiologic,
and metabolic processes and emotional responses. He has
his own rhythmic pattern of sleeping, waking, and desiring
food. The type and degree of his emotional response,
which we call temperament, is also individual. He re-
sponds in terms of satisfaction and complacency or of fear
and hate.

The newborn infant is completely dependent and his
behavior is controlled by his feelings. Yet from the moment

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A Psychology of Growth

of birth he must meet the biological demands of his growing
organism and the requirements of a complicated society.
As his central nervous system develops and he gains experi-
ence, he begins to learn how to meet various situations and
with frequent repetition his responses become habits.
Growth and learning come from within the individual and
the learning process is lifelong.

Every infant has certain fundamental physical, intel-
lectual, and emotional needs, which his environment must
supply if he is to attain maximum growth. When his needs
are satisfied, he gains self-confidence, which makes for con-
structive aggression and enables him to learn about him-
self and his world. As he grows older he forms habits of
responsibility, becomes independent, self-reliant, and able
to cope with the inevitable problems that arise in hu-
man society.

The child's mental needs are (1) security, which comes
from the assurance that he is wanted and accepted as he is;
(2) opportunity to grow up naturally at his own pace
that is, freedom from standards inappropriate to his age
and capacity. In this regard, the most important environ-
mental factor is the attitude of the child's parents. His
security or insecurity will be based on the fact that his
parents love him wholeheartedly or with reservations, or
actually hate him; on their ability or failure to make him
feel that everything is all right and that he is acceptable to
them, or by their tendency to see in him problems that are
in their own minds. His second need will or will not be
supplied, depending upon whether the parents establish
standards to which the child is capable of measuring up or
whether, because of their own prejudices, insecurities,

202.

Adults

fatigue, or lack of knowledge, they demand too great
achievement; whether they help him to feel useful or thwart
his efforts through overprotection or underprotection.
When the environment places too many difficulties in the
way of the individual, his growth is stunted or distorted or
he regresses to a less mature level at which he feels more
comfortable. Thus the child whose needs have been sup-
plied is able to meet adversity with confidence and to make
an adjustment. On the other hand, the insecure and
thwarted child or adult lacks self-confidence and reacts
with either overcompliance or ovcrdefiance.

In the course of the baby's first two or three years, he is
interested primarily in his own physiologic processes and
in learning to use his body. He begins to walk, talk, and
coordinate his eyes and hands while walking and running.
Next he becomes curious about concrete objects and about
his surroundings. All his investigations are fun; these
learning processes are pure play.

During childhood, the boy and the girl are most interested
in their developing bodies and their newly acquired freedom
after the dependence of infancy. They want to learn and
they want to do things, but they are selfish and self-centered.
Unlike the infant, who is impatient and must have his wants
satisfied immediately, the child can wait a short time
(though not without difficulty) for the fulfillment of his
wishes. Since he does not have to take care of himself,
his activities are still of a playful nature. Maturation,
however, causes him to feel that he is grown up and needs
a place in society. For that reason his learning processes
are directed toward a vocation.

In order to have mental health, it is not necessary for the

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A Psychology oj Growth

individual to reach any peak of perfection,, but only to
realize his own potentialities, however limited these may
be, and to have acquired the ability to make necessary
adjustments. An adult who is well mentally works and
plays, laughs and cries, loves and hates, experiences fear
and self-confidence, does some things with ease, does others
with difficulty, but above all is possessed of sufficient self-
confidence and understanding of himself, enough habits of
responsibility to stand on his own feet and meet new
situations without breaking down.

It is the rate of change rather than the change itself that
determines the ease with which an individual can make an
adjustment; the more rapid the changes, the greater the
problem of adjustment. Because of the rapid social and
economic changes that have occurred in the past fifty years
this period has presented an unusual test for mental health.

Adulthood is a continuation of the growth process.
Physically, the maximum growth is usually reached within
the first twenty to twenty-two years; the maximum intellec-
tual capacity, which is determined by the individual's
maximum mental age, is usually acquired when he is
between the chronological ages of thirteen and twenty-two.
However, mental growth as a whole (this includes emotional
development) can continue until an individual reaches
senility; that is, until his brain begins to deteriorate from
inadequate blood supply or for other reasons. This pro-
longed mental growth depends upon the ability of the
person to learn to profit by mistakes and continue to develop
self-confidence and skill in solving the problems that life
presents. The sum of the habits of response that he has
been forming since birth make up his personality.

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Adults

These responses are affected (1) by the amount of vitality,
the potentialities, and traits with which he was born; and
(2) by environment. The individual's inborn and un-
changeable characteristics are strength, general intelli-
gence, special abilities (such as aptitude for music or art),
motor coordination (which gives rise to mechanical skill),
alertness and speed of response, and special defects (for
example, weakness, clumsiness, limited intelligence, total
or partial tone deafness, and poor visual memory, which
causes reading difficulties). In addition, his responses
normally include both justifiable and irrational fears and
hates. The latter are emotions that are not warranted by
the occasion that arouses them, as is illustrated by the
person who always fears the worst and the one who, in
addition, has a temper tantrum when he does not get his
own way. Environment has the effect of stunting or
furthering growth; it determines the individual's confidence
or anxiety, prejudices, beliefs, and general philosophy of
life. By the time he has reached adulthood, the effects of
these influences have so crystalized into personality patterns
that his reactions to situations have become readily pre-
dictable. In other words, although adults like to think
that their behavior is reasonable and logical, it is actually
controlled by these well-developed patterns without refer-
ence to reason or insight. When these trends are guided
by irrational fears and resentments, they form the basis
for typical neurotic behavior.

No adult grows up so completely that he does not go back
to childhood and enjoy a certain amount of play, such as
golf, tennis, or card games. These activities and other
diversions are nonetheless beneficial because they are play;

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A Psychology of Growth

since they provide rest and relaxation, they are valuable
from the standpoint of health. Similarly, motion pictures,
prize fights, and other recreations provide outlets for pent-
up resentments and unsatisfied wish fulfillments and thus
improve mental health. Some persons need these activities
more than others. The individual who has no athletic
ability derives pleasure from the success of one player or
team of which he has become a partisan; the individual who
cannot fight releases a great deal of resentment when his
favorite beats an opponent. Anyone can identify him-
or herself with the hero or heroine of a play and find satis-
faction in watching the story unfold on the screen. Proof
that there is a need for these emotional outlets is amply
furnished by million-dollar prize fights and the extent of
the motion-picture industry.

Other characteristics of the adult are his desire to rear a
family and to work and create. Incidentally, his work may
benefit others as well as himself. The fact that he does
it for his personal satisfaction, however, does not detract
from his usefulness and value to society.

Although some adults work with satisfaction and com-
placency most of the time, all have certain illogical sub-
conscious prejudices, which influence their judgment. For
example, a very good businessman who hired many girls
did not realize until it was pointed out to him that his
selection was greatly affected by his predilection for red
hair. Another man was prejudiced against girls who used
lipstick because his mother, to whom he was very much
attached, had never rouged her lips. People frequently
judge others on the basis of a single characteristic. An
individual who does not like obesity will consider a fat
> 206

Adults

woman very inferior, regardless of her other character-
istics. The president of one corporation distrusted any
person who did not look him straight in the eye while
they were talking together. A very intelligent woman who
learned that for years her husband had been unfaithful was
worried only because he lied to her about minor details
when he made his confession. All adults, even those who
have mental health, possess ideas of this kind. They repre-
sent unconscious childhood impressions that continue to
exert their influence during adult life.

Sally, who was very well liked, incited ten associates to
give up their jobs because of the conduct of a foreman who
had reprimanded her. Analysis of the situation showed that
the trouble began when one girl employee drew pictures of
a fat and a thin cat and wrote Sally's name under the
former. Sally, an extremely sensitive girl who was particu-
larly disturbed about her obesity, became very angry and
made many complaints about the girl who drew the
pictures, ending with a demand that the foreman dis-
charge her. He had found this girl to be a very efficient
worker and, having no knowledge of the reasons underlying
Sally's demand, he not only refused to do what she asked
but also charged her with being a troublemaker. Sally, in
turn, persuaded her friends to quit. When the nature of
the trouble was made clear to all concerned, ruffled feelings
were soothed and everybody went back to work. This
incident illustrates the manner in which group behavior
can be influenced by one individual's sensitiveness about
himself. It shows the necessity for supervisors, whether
they are foremen, nurses, or others, to look for the attitudes,
either logical or illogical, that influence behavior.

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A Psychology of Growth

All adult minds are furnished not only with attitudes
but also with various convictions and, possibly, superstitions.
The convictions, which may be religious, political, or social
in nature, are usually unconscious attempts to satisfy child-
hood anxieties remaining in the adult mind or to justify
ideas that the individual received as a child but was unable
to understand. Superstitions are beliefs that control the
individual's behavior even though he cannot explain them
logically.

Thus the child is indeed father of the man. From him
the man inherits all the resentments, anxieties, and ways of
responding that he acquired in his early years. The adult
represses his unpleasant experiences that is, forces them
out of his consciousness but they remain in his unconscious
mind and influence his feelings and actions even to the
extent of causing him to behave in a manner contrary to
the dictates of his conscious mind. This is shown, for
instance, in the conduct of a person who finds it difficult or
impossible to do certain things because he is frightened, even
though he knows that there is no danger. Another ex-
ample is the behavior of the individual who loses his temper,
in spite of the fact that he realizes that his anger is illogical
and will keep him from accomplishing what he most wants
to do.

The effect of emotions upon physiological processes and
the relationship of these influences on disease processes
makes up psychosomatic medicine.

As has been pointed out by physiologists, notably
Cannon, 1 emotions are expressed along the neurons of the
autonomic nervous system. The cranial autonomies nor-
mally control digestion, heart, sex, and other organs and

208

Adults

functions of the body. Where there is pain, fear, or rage,
however, the sympathetics take over and drastic changes in
function of the organs take place. Notably gastric and
sex functions are markedly suppressed and there is a dis-
charge of adrenin and an increase in blood sugar. When
adrenin is injected in both normal and abnormal individ-
uals, there is precordial and epigastric palpitation, diffuse
arterial throbbing, oppression in the chest, trembling, chilli-
ness, dryness of the mouth, fear, malaise, and weakness.
The heart beats more rapidly, arterioles are contracted,
bronchioles are dilated, and blood pressure is raised. These
changes are explained upon an evolutionary basis as prepa-
ration of .the animal for fighting defense.

At least one writer, Klemperer, points out the importance
of spasm of the coronary vessels in coronary disease. He
feels that this spasm produces localized anemia of the
muscle and weakening of the wall of the blood vessel, so
that small hemorrhages occur from which inflammatory
processes develop. All cardiologists feel that intense emo-
tions are a factor in coronary disease. For detailed dis-
cussions of this important factor read "Emotion and Bodily
Changes" by Flanders H. Dunbar. 2 Internists agree that
the effects of intense emotions are a factor in gastric ulcer.

These physiological reactions to intense emotions are
present in both normal and abnormal individuals. Those
who have intense irrational emotions are affected to a pro-
portionally greater degree. In many patients the symptoms
from these physiological reactions are sufficient to cause
illness without organic disease. Gastric disturbances, some
forms of colitis, and cardiac neurosis are common examples.

When fears and resentments dominate an individual's

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A Psychology of Growth

personality and prevent him from gaining sufficient satis-
faction in life, he is said to be "nervous" or neurotic.
Because his childhood and his environment were never
solved, he is constantly impelled to indulge in behavior that
gives him a needed satisfaction. He experiences the same
feelings that he had during his childhood, and when difficult
situations confront him he reacts in terms of youthful fears,
resentments, and a sense of guilt. Unable to assume the
role of a self-reliant adult, he goes back to an earlier, more
dependent status. This process is known as regression.
Mental ill-health, then, is a return to an immature level of
growth. It varies from the temporary and partial to the
complete return to childhood; that is, from the milder forms
of neurosis to the vegetative state that appears in the end
stages of dementia praecox. Neurotics make up the largest
group of those persons who are mentally ill.

Neuroses often begin with lack of parental approval at
birth. Frequently this attitude is coupled wih the imposi-
tion of standards too high for the child to meet. Conse-
quently, he becomes frightened and resentful of his own
parents. As he grows up and his conscience develops, he is
oppressed by a strong sense of inferiority. He resents his
lot and is frightened of his own thoughts and feelings. The
observer sees him as a person who complains a great deal,
exaggerates symptoms of illness, and has temper tantrums.
Even though he recognizes that his behavior is often illogi-
cal, he cannot alter it because he is impelled by fears over
which he has no control.

It is not necessary to go far to find an example of the
neurotic who lives in his childhood and is governed by early
anxieties. There was Mr. A, for example, a capable busi-

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Adults

nessman who was always afraid in the dark. Analysis of
his fear revealed that it had originated in his childhood, at
which time he had been very much afraid of his father.
When he was in a dark room he imagined that a man was
going to hit him. In describing this assailant, he said the
man was "my father with whiskers like the devil's." Mr. A
was frightened, also, when he was interviewing clients. If
someone disagreed with him, he experienced the same sen-
sations that he had known when his father struck him and
said, "What the hell is the matter with you?" In a recur-
ring dream, which had begun in his childhood, he was falling
from a high point in a tall building and his father was look-
ing at him from a window of each floor that he passed.

A student nurse, who had been doing very good work,
began to have great difficulty in her classes when a resident
physician, for some reason, got into the habit of baiting her.
As a child she had been subjected to much criticism by her
parents and had come to the point where she was always
afraid that she might make a mistake. When criticism
was unjust, she became so disturbed that her work suffered,
until finally she had difficulty in speaking and began to
show other forms of infantile behavior.

Conscious or semiconscious fears and anxieties frequently
produce somatic symptoms, such as abdominal distress,
choking spells, rapid heart, and others. These symptoms,
in turn, frighten the sufferer still more, and he thinks, in
panic, that he has cancer, heart disease, or some other ail-
ment of which he is going to die. It should be borne in
mind that such symptoms are very real to the patient and
should not be ridiculed or laughed off as pure imagination.
The patient is extremely uncomfortable and no less ill

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A Psychology of Growth

than one who has some organic disease. He is as. badly
in need of medical in this case, psychiatric treatment as
any sick person.

There is no sharp line separating the mentally well
individual from the neurotic. All persons have some illogi-
cal or irrational emotions. It is when those Demotions
control the individual's behavior that he is considered
neurotic and even this criterion is not absolute. In general,
the neurotic is the person in whom the mental qualities of
the normal individual are exaggerated and who over-
responds to circumstances.

Of all forms of mental ill-health, neurosis is the most
amenable to psychiatric help. The first step consists in
letting the patient know that he cannot help being what he
is or doing what he docs. In that case he need not feel
ashamed of his fears and hates or guilty because of them.
Neither should he worry about somatic symptoms that are
not organic but the product of his fears. Since it is harm-
ful for the patient to repress his emotional problems, the
next step in his treatment is an examination of his fears,
hates, and sense of guilt, with a view to discovering their
origin. As the child, cowering in the dark, throws off his
fears when someone turns on the light and shows him that
the supposed burglar was only a flapping window shade,
so the neurotic is freed of many fears when he is helped to
see that his anxiety is a relic of his childhood with no current
validity. If his present uncertainty is due to an old fear of
his father, for example, and he realizes that when he is
governed by this fear he is simply continuing to live in his
childhood, he is better able to analyze and improve his
present situation.
212

Adults

Other irrational anxieties and resentments likewise
become less disturbing when the patient understands that
they are reactions that were conditioned by childhood
insecurities. We have seen that fear of hate is one of the
serious anxieties in the mind of the neurotic. It can be
diminished when he finds out that he cannot help hating
one person or another and that neither love nor hate is
100 per cent pure, but that both may be evoked simul-
taneously by one individual. The neurotic may lose his
intense sense of guilt if he can be made to understand that
he loved his father or his mother or some other close relative
at the same time that he hated this person, but that his love
was probably stronger than his hatred.

In caring for a neurotic it is helpful for the nurse, who
should first understand herself, to avoid putting a personal
construction upon the patient's resentments and complaints.
The ill temper that he vents on her or the hospital is prob-
ably only an expression of his fear. Irrational fears, which
are present in the mind of every patient, are more pro-
nounced in the neurotic than in the normal person and
more common in the hospital than in any other place.
Furthermore, it is safe to assume that the patient, particu-
larly the one who is going to have an operation, is afraid of
dying. The hospital routine is probably unfamiliar and
the patient may have difficulty in adjusting to it. A bed
patient is especially sensitive about exposing himself, using
bedpans, and operation gowns, and undergoing various
forms of treatment. The skilled nurse is sympathetic,
whatever the patient's behavior. She does not side either
with the hospital or with the patient, but makes him feel
that she understands his attitude. She shows an interest

213

A Psychology of Growth

in him and solicitude for his feelings as well as his welfare.
This she can do only if she is objective and does not permit
her personality difficulties to affect her point of view.

It usually relieves a patient to be able to talk about his
problems. The nurse cannot solve them, but she can do
good by listening sympathetically. In fact, that nurse helps
most who listens most. She does not help her patient by
discussing other patients or her own problems.

PSYCHOPATHIC PERSONALITY

When we use the terms "constitutional psychopathic
state," "emotional insufficiency, 35 "psychopathic personal-
ity, 33 "moral imbecility," and "moral insanity, 3 ' we have in
mind one troublesome and often unapproachable group of
individuals. The person who falls into this category is one
who knows the difference between right and wrong but is
unable to act accordingly. He attempts to reach his own
goals with no consideration for others and with complete
indifference to the regulations of society. He may ignore
all sensible plans and intentions, become a truant or a
periodic drinker, and develop a tendency to reckless spend-
ing. Like a child who cannot wait for the fulfillment of his
wishes, the psychopath must have what he wants at once,
no matter what the cost. Because of his childish impul-
siveness, he usually fails to achieve his purposes, and this
frustration makes him still more aggressive and indifferent
to social codes. He will become pathological in his lying,
try violent avenues of escape, and develop ideas of persecu-
tion. Being unable to meet social demands, he may
attempt to change society and become an agitator or a

- 214

Adults

fanatic. If he has qualities of leadership, he may carry
others along into antisocial endeavors.

This individual's behavior is not due to lack of intelli-
gence but to insufficient emotional growth. He may have
good ideas, converse well, be good-natured, sociable, and
cheerful. As a rule, he is also vain and arrogant and
conveys the impression that he has a high opinion of his
own ability and is sure of himself. At other times, however,
he is morose, irritable, and defiant, and has temper out-
bursts. He never admits that he is wrong.

The psychopath, then, is an individual who has been
unable to grow up and take on responsibility for his be-
havior. His irrational actions can best be explained by
comparison with the impulsive, insecure, frustrated child.
Both feel that they are not approved but cannot understand
the reason for their unhappiness. They therefore try to
prove that they are indifferent and find their only satis-
faction in retaliating foe their injuries by causing trouble.
The psychopath's behavior is immature and compulsive.

ALCOHOLISM

Alcoholism may be associated with a neurotic, psycho-
pathic personality or with other forms of mental ill-health.
It is compulsive behavior and may be regarded as a symp-
tom of regression toward infancy. This is shown by the
fact that, after taking one or two drinks, the alcoholic is
unable to stop until he is completely drunk, at which time,
like the infant, he is absolutely dependent and needs to have
someone take care of him. The case histories of alcoholics
commonly include extremely severe fathers and mothers
who were prone to overprotect their children.

215

A Psychology of Growth

A typical case was presented by John, who, at the age
of twenty-one, was examined by a physician because of
alcoholism of two years' duration. This young man de-
scribed alcoholism very well in reply to the question of what
he would do with a given amount of money if permitted to
spend it at will. His answer was that he would go down
town and decide to have one drink. After he had taken
one, he would be unable to stop drinking until he had
spent all his money except the sum that he habitually paid
a taxi driver to take him home. The next day he would
wake up in bed with his mother sitting beside him. From
past experience, John knew that he would have no recol-
lection of saving the necessary money or hiring the cab,
and that he would have no interest in anyone during the
time he was intoxicated. Here was a patient, therefore,
who felt compelled to drink, disclaimed any understanding
of his behavior or memory of his actions while drunk, hired
someone to take him to his mother, and depended upon her
to care for him as she had done when he was an infant.

John's father was an efficient businessman, who employed
ruthless methods in his commercial affairs and carried them
into his home. He was a stern disciplinarian and never
supplied the boy with anything except what would meet
his purely material needs. The mother, feeling that her
husband was too severe, overindulged the boy and pro-
tected him from his father. As a result, John had never
been able to behave consistently like an adult; periodically
he had to go back to his infancy.

OBSESSION AND COMPULSION

Some individuals develop obsessions, which they recog-
nize as irrational but are still unable to control. There
. 216 .

Adults

was a young woman, for example, who had the idea that
she would kill her baby; another who was sure that she
would scream and run out into the street naked; and a man
who was convinced that he would insult women. These
persons were actually very conservative and their behavior
was most considerate and proper. Obsessions represent the
opposite of actual behavior.

In time, however, persons who have such obsessions often
develop compulsive behavior. This is illustrated by the
conduct of a man whose obsession was the fear of harming
someone. At night he took two hours to assure himself
that everything was safe in his household. He locked the
doors and windows, then went back repeatedly to make sure
that they were secure. He also slammed the refrigerator
door and closed the matchbox again and again, tried the
faucets fifty to a hundred times, used blotting paper to test
them for leaks, and felt the bottom of the sink and the
lavatory, to be certain that they were dry. During this
procedure, he perspired heavily and criticized himself for
his foolish behavior.

This man was very quiet, considerate, and honest. For
twelve years he had punched the time clock daily at exactly
eleven minutes before he was due on the job. He was a
perfectionist and always did far more work than was
required of him. Inquiry revealed, however, that this
behavior was diametrically opposed to his underlying feel-
ings toward people. As a child, he had undergone great
hardships. After the death of his mother when he was
three years old, his alcoholic father had beaten and other-
wise abused him. As a result of these experiences, he had
grown up feeling intense resentment.

. 217 .

A Psychology of Growth

SEXUAL ABERRATIONS

Sexual impulses may be distorted in many different ways.
Exhibitionism, as we have seen, is one form of distortion.
Others are sadism, the wish to give the partner pain; and
masochism, the wish to be hurt. Some individuals cannot
accept certain forms of affection unless they are accom-
panied by pain. A sixteen-year-old girl, for example, did
not enjoy being kissed unless, at the same time, the man
stamped on her feet or kicked her legs. One young woman
could not accept sex relations unless her husband slapped
her, as if he were forcing her to submit to him. Some
persons derive sexual satisfaction from seeing others naked
or from watching them have sexual intercourse. Sex
impulses may be directed toward others of the same sex
(homosexuality) or be satisfied by the use of the mouth
(sex perversion). Other aberrations are paedophilia, zoo-
philia, and fetishism that is, sexual desire directed,
respectively, toward small children, toward animals, or
toward parts of the body or articles of clothing. Paedo-
philia combined with sadism is illustrated by the case of a
fifteen-year-old boy who got satisfaction from undressing
a small girl and hitting her over the head with a switch.
Fetishism was exemplified by an eighteen-year-old boy who
felt sexual excitement when he saw a man wearing sus-
penders. 'In cases of sexual aberration, there is a sup-
pression of normal sex wishes and such distortion of sex
impulses that they no longer have the biological function of
propagation.

MANIC-DEPRESSIVE

A person is said to be psychotic when he develops irra-
tional behavior to the point where he no longer has control
218 -

Adults

of his actions or insight into them and, therefore, completely
loses contact with his environment. The two most com-
mon functional psychoses that is, those which have no
organic basis are the manic-depressive type and schizo-
phrenia, or dementia praecox.

The manic individual throws off all self-restraint. He is
extremely restless, talks incessantly without inhibition, and
continues this way for days, until he reaches the point of
exhaustion. At other times, he may have periods of
depression, when his conscience troubles him; he feels that
he is bad and worthless and ought to kill himself. Some
depressed patients are overwhelmed by anxiety and a sense
of guilt and go into a panic. They are emotionally ill, their
ideas about themselves are irrational, and they attribute
their condition to minor misfortunes or unpleasant situ-
ations. One such man blamed the OPA for his serious
depression; another associated his condition with the pur-
chase of an unsatisfactory used car; and a woman thought
that her trouble was due to her sister's refusal to believe
certain facts about their father.

PARANOID INDIVIDUALS

The paranoid individual is one who has an irrational
conviction that others are trying to harm him. His delu-
sions are wholly without foundation in fact and represent
only distorted ideas in his own mind. His suspicions may
take the form of a conviction that someone is trying to poison
him, to take away his money, or to injure him socially,
One man conceived the idea that a newspaper advertise-
ment was attacking his character. He burned the paper
and refused for weeks to look at another. Such an indi-
vidual may also have exaggerated ideas about himself and

219

A Psychology of Growth

come to believe that he is Napoleon or Caesar or some other
famous person in history.

Paranoiacs feel that they were treated unfairly when they
were growing up, and this may be true. They are often
the black sheep of their families. As such, they were dis-
liked and discriminated against in the home. Convinced
that they were not getting a square deal, they became
negativistic and were subjected to even more criticism.
Thus they developed strong feelings of inferiority and, at
the same time, came to believe that others were taking
advantage of them. The conviction that they are very
superior is compensation for their feelings of inferiority
and inadequacy.

The true paranoiac remains alert and troublesome
throughout his life. Those who deteriorate mentally are
suffering from paranoid praecox. They slowly lose interest
in other people, grow slovenly in appearance, and show
little concern about their surroundings. This process
covers a period of many years.

DEMENTIA PRAECOX (SCHIZOPHRENIA)

The most serious mental illness is dementia praecox.
The patient develops unsystematized delusions and the
most bizarre hallucinations (false perceptions), which seem
to have no basis in fact or logic. He completely loses
contact with his environment and lives in a dream world,
in which his personality disintegrates and his behavior
becomes entirely abnormal.

As a rule, this illness takes definite form in adolescence.
Study of early cases has provided some information regard-
ing the origin of the disorder. In the beginning, a patient

220 -

Adults

may explain that his mind is in two parts. One part, for
example, says "Be good," while the other part says "Be
bad." Later the patient may resolve this conflict by
hearing voices that tell him what to do, or he may imagine
that someone is pursuing him. These hallucinations and
delusions may force him to try to escape, and he will then
become a tramp and go from one place to another. Ab-
sorbed in his mental aberrations, he rapidly loses interest
in his surroundings and a slow but inexorable deterioration
sets in.

The group of dementia-praecox patients known as cata-
tonic is characterized by extreme negativism. For ex-
ample, an individual will refuse to change his position and,
holding his muscles rigid, will resist every effort to move
him. When he is told to do one thing, he is inclined to
do the opposite. Such patients usually have catatonic
episodes and are more cooperative between attacks.

The most serious form of this disorder is called hebe-
phrenic dementia praecox. Individuals who suffer from
it develop the most irrational of delusions, such as that of
a man who was convinced that he had no heart, despite
the fact that he admitted it was impossible to live without
one. These patients deteriorate more rapidly than the
others and offer the poorest prognosis. They regress to a
lower level than that of the newborn infant, because they
do not even respond emotionally. Ultimately they reach
a vegetative level, at which they have no control of any of
their faculties and are unable to take responsibility even
for toilet habits.

Such mental deterioration represents the antithesis of
that mental growth which is the objective of parents,

- 221

A Psychology of Growth

nurses, and physicians. Although they cannot alter a
child's innate characteristics, they can ease the inevitable
tensions that lead to mental and emotional distortion and,
with proper care, they can help him to achieve his max-
imum development.

REFERENCES

1. CANNON, WALTER B., "Bodily Changes in Pain, Hun-

ger, Fear and Rage," D. Appleton-Century Company,
Inc., 1929.

2. DUNBAR, FLANDERS H., "Emotions and Bodily Changes,"

Columbia University Press, New York, 1938.

222

List of Visual Aids

The following list of visual aids can be used to supple-
ment some of the material in this book. These films can
be obtained from the producer or distributor listed with
each title. (The addresses of these producers and dis-
tributors are given at the end of the bibliography.) In
many cases these films can also be obtained from your
local film library or local film distributor; also, many
universities have large film libraries from which these
films can be borrowed.

The running time (min) and whether it is silent (si)
or sound (sd) are listed with each title. All those not
listed as color (C) are black and white. All motion pic-
tures are 16mm.

Each film has been listed once in connection with the
chapter to which it is most applicable. However, in many
cases the film might be used advantageously in connection
with other chapters.

CHAPTER ONE THE FOUNDATION OF MENTAL HEALTH

Life Begins (EBF GOmin sd) . Demonstrates individual
growth patterns in different children; how children react
to standardized test situations.

Infant Behavior: Early Stages (EBF lOmin sd) . Shows
the activities and responses of an infant seated in a small
chair; compares same infant at different stages.

Infant Behavior: Later Stages (EBF lOmin sd) . Dem-
onstrates increasing ability of infant to use hands in
manipulating objects.

223

List of Visual Aids

Posture and Locomotion (EBF lOmin sd) . Deals with
the stages by which an infant advances from a helpless
state to the stage where he is able to change position and
posture at will; presents a study of these phases of child's
development from age eight to eighty weeks, thirteen age
levels are portrayed.

From Creeping to Walking (EBF lOmin sd) . Illus-
trates the correlation of abilities; continues the study
begun in Posture and Locomotion.

Baby's Day at Twelve Weeks (EBF lOmin sd) Fol-
lows an infant through his domestic day from time of
awakening until final feeding at night; offers an inter-
pretation of the significance of his various reactions.

Thirty-six Weeks Behavior (EBF lOmin sd) . Com-
pares behavior now with that of infant at twelve weeks;
comments upon responses to the ministrations of father
and mother; first successful creeping efforts are observed.

Forty-eight Weeks Behavior (EBF lOmin sd) . Por-
trays wholesome methods of child care; emphasis is placed
upon psychological implications and the educational sig-
nificance of the infant's everyday experiences.

Behavior Patters at One Year (EBF lOmin sd) . At-
tempts to clarify some of the principles which govern the
learning process; discusses the possibilities and limitations
of training infants from twenty-four to forty-eight weeks;
also discusses relationships between age, growth, and learn-
ing, laws which determine learning and several learning
problems.

Early Social Behavior (EBF lOmin sd) . Shows mani-
festations of infant personality in a variety of social set-
tings.

Stages of Child Growth (EBF 20min sd) . Dr. Charlotte
Buhler of Vienna demonstrates methods for giving ac-

224

List of Visual Aids

complishment tests for infants and children of preschool
age.

The Study of Infant Behavior (B&H 20min sd) . Dr.
Gessell's cinematographic record of reactions of infants
in standardized situations.

Normal Child Development (Rutgers 15min si C) .
Genetic study of preschool child; responses to tests.

Reaching Prehensive Behavior of Infant (Warden
& Gilbert 15min si) . Development of hand-eye coordina-
tion.

Reaction of Infant to Pinprick (Warden & Gilbert
15min si) . Individuation of responses illustrated.

Reflex Behavior of Newborn Infant (Warden & Gil-
bert 7 min si) . Illustrates Moro reflex, suspension grasp,
crawling, stepping, and swimming.

Some Basic Differences in Newborn Infants during the
Laying-in Period (NYU 23min si) . Actual records of
children from moment of birth; shows importance of
mother's emotional adjustment to child for total develop-
ment.

Modern Motherhood (Marvin 15min si). Develop-
ment of emotional life of child during first year.

CHAPTER Two THE TWO-YEAR-OLD

Now I Am Two (Dept. of Labor 30min si) . Story of
a two-year-old's meals, play, and sleep.

This Is Robert (NYU SOmin sd) . Traces the develop-
ment of an aggressive, "difficult" child from two years to
seven years; shows reasons for aggressiveness and corrective
procedures.

A Child Went Forth (NYU 20min sd) . Pictures two- to

225

List of Visual Aids

seven-year-olds in a nursery camp; shows wide scope of
activities and sympathetic guidance.

Bending the Twig (Ideal 15min si) . Training the
child in correct health and hygiene habits.

Play's the Thing (Dept. of Labor 15min si). How to
make play equipment: toys and muscle coordination.

Finger Painting (NYU 20min sd) . Demonstrates the
use of plastic materials by young children; portrays dif-
ferences that underlie personality patterns.

CHAPTER THREE ADJUSTING TO ENVIRONMENT

Psychological Implications of Behavior during Clinical
Visit (NYU 20min si) . Shows how important clues to
a child's emotional attitudes can be seen from its overt
behavior during clinical visit; contrasts behavior of sev-
eral children awaiting examination, during physical and
dental examinations, during I.Q. testing, and at play.

Balloons: Aggression and Destructive Games (NYU
20min sd) . Demonstrates special techniques in the diag-
nosis of normal personality of children; compares a nor-
maly aggressive, destructive boy with a suppressed normal
boy.

Frustration Play Techniques (NYU SOmin sd) . Shows
blocking games; frustration and hostility games; study
of ego development and demarcation of self in young chil-
dren.

Conflict Situations in Childhood (CFC 15min si) . De-
scribes the experimental and clinical techniques of Kurt
Levin, an outstanding psychologist, in the study of be-
havior.

Not One Word (PSC 15min si). This is a study of
jealousy. A subject with striking motor ability is com-

226 -

List of Visual Aids

pared with a subject of average ability, using numerous
standardized mechanical tests.

CHAPTER FOUR INTELLIGENCE

Measurement of Intelligence (CFC 15min sd) . De-
monstrates administration of the Stanford-Binet scale to a
thirteen-year-old boy.

Testing the /.Q. (Warden 8c Gilbert 13min si) . Shows
administration of Form L to a five-year-old child; nature
of test materials; scoring standards and calculation of the

I.Q.

CHAPTER FIVE MENTAL DEFICIENCY

Clinical Types of Mental Defectives (PSC 30min si C) .
Presents splendid illustrations of the main institutional
types of mental deficiency.

Performance Testing (Minn 34 min si) . Shows use of
standard performance tests in examining both normal and
feeble-minded children.

Institutional Training (Minn 15min si) . Depicts activ-
ities of school and kindergarten at Faribault School for
Feeble-minded.

Institutional Care of the Feeble-minded (Vineland
15min si) . Modern institutional care of mental defectives
is shown at Vineland Training School.

The Feeble-minded (Minn 60min si) . Treats subject
of feeble-mindedness from standpoint of pathology; men-
tions possible organic conditions causing feeble-minded-
ness; shows difference between morons, imbeciles, and
idiots; describes eight major pathology groups.

Behavior of the Feeble-minded (Stoelting lOmin si).
Contrasts performance of two normal and two feeble-

227

List of Visual Aids

minded subjects on the Healy and Fernald block-assembly
test.

Deficiency in Finger Schema Agnosia and Acalculia
(PSC llmin si). Describes deficiencies in counting and
localizing the fingers by some feeble-minded boys.

The Differentiation of Aphasia from Mental Deficiency in
Children (Mitrano 12min si). Compares aphasic child
with a feeble-minded youngster; shows discrepancies be-
tween verbal and manipulation tests and language de-
velopment and social competence.

CHAPTER Six THE SCHOOL CHILD

Motor Aptitude Tests and Assembly Work (PSC 15min
si) . Demonstrates use of seven tests of motor aptitude
with subjects possessing mediocre and exceptional abili-
ties; compares assembly work.

Guidance Problem for School and Home (Columbia
20min sd) . Case of a boy who has poor social adjustment;
the attitude of his parents; and the role of his teacher.

Guidance in the Public Schools (EBF 20min sd) .
Shows some of the problems of organizing and administer-
ing guidance in public schools.

School (NYU 20m in sd) . Shows the work of a school
pledged to develop self-reliance and good citizenship
through self-government involving individual and group
planning and executing, using the fifth-grade class as an
example.

CHAPTER EIGHT CAUSES OF BEHAVIOR PROBLEMS

Experimentally Produced Neurotic Behavior in Rats
(PSC 15min si) . Shows how rats develop abnormal
(neurotic) behavior patterns when placed in frustrating
situations.

228

List of Visual Aids

Cradle Song (NYU lOmin sd) . Reveals the damages
of possessive devotion to child; leads to a discussion of
wjiy adults overprotect children and become overdepend-
ent on the love of children.

La Maternelle (NYU 20min sd) . Story of a neglected
child and her attempts at compensation, revealing physical
tensions that may develop in a maladjusted child.

CHAPTER TWELVE JUVENILE DELINQUENTS

As the Twig Is Bent (NYU lOmin sd) . The effect of
good and bad home environment on the children of
today; practical suggestions to parents on how to deal
with many current youth problems.

Children of the City (NYU 30min sd) . Shows how the
problem of juvenile delinquency is approached through
the child's home environment, using three cases of theft
as an example.

Juvenile Delinquents (MOT 9min sd) . Indicates the
causes of crime and the development of juvenile delin-
quency; suggests measures which will reduce criminal de-
linquency.

A Criminal Is Born (TFC 21min sd) . Shows the case
history of three boys who develop criminal tendencies due
to inadequate home life.

CHAPTER THIRTEEN ADULTS

Behavior in Hypnotic Regression (PSC 15min si) .
Shows young woman in a deep hypnotic trance who is
told she is a little girl again and experiencing her first
memories; she behaves like a three-year-old, like a child
starting school, and like other levels of growth.

Narcosynthesis (PSC 20min si) . Shows use of drugs as
aid in psychotherapy.

- 229 .

List of Visual Aids

Prefrontal Lobotomy in Chronic Schizophrenia (PSC
19min si) . Illustrates the improvement that can be ob-
tained in chronic schizophrenia by presenting four cases.

Athetoid Gestures in a Deteriorating Parergasic Schiz-
ophrenic (PSC 6min si) . Demonstrates contrasting
schizophrenic motility disorders.

A Parergasic Reaction (Schizophrenia) in a Person of
Low Intelligence (PSC 16min sd) . Shows stereotypic
grimaces and speech vagueness, etc.; comparative study
of motility disorders.

Catatonic Behavior in a Deteriorated Parergasic (Schizo-
phrenic) Patient (PSC 8min si) . Shows posture, hyper-
trophied neck muscles, and ritualistic and stereotypic
methods of eating.

Symptoms in Schizophrenia (PSC 15min si). Reviews
common symptoms of schizophrenia as they are exhibited
by patients in the average mental hospital.

GENERAL

A Better Tomorrow (NYU 20min sd) . Story of chil-
dren beginning with a preschool class through high school
with emphasis on proper schools and training for different
temperaments, intelligence, and abilities.

SOURCES OF FILMS LISTED ABOVE

BfcH Bell & Howell Company, 1801 Laichmont Ave.,
Chicago.

CFC- College Film Center, 84 E. Randolph St., Chi-
cago 1.

Columbia Pictures Corp., 729 Seventh Ave., New York 19.

Department of Labor, Children's Bureau, Washington,
D. C.

230

List of Visual Aids

EBF - Encyclopedia Britannica Films, 20 N. Wacker Dr.,
Chicago 6.

Ideal Pictures Corp., 28 E. Eighth St., Chicago 5.

Marvin, Donn, Ossining, New York.

Minn University of Minnesota, Bureau of Visual In-
struction, Minneapolis 14, Minn.

Mitrano, A. J., 15 Glenbrook Ave., Park Hill, Yonkers,
N.Y.

MOT - March of Time, 369 Lexington Ave., New
York 17.

NYU New York University, Film Library, Washington
Square, New York 3.

PSC Pennsylvania State College, Psychological Cinema
Register, State College, Pa.

Rutgers Films, Rutgers University, Box 78, New Bruns-
wick, N. J.

Stocking, C. H. Company, 424 N. Homan Ave., Chicago.

TFC - Teaching Film Custodians, 25 W. 45th St., New
York 18.

Vineland Training School, Vineland, N. J.

Warden & Gilbert, Psychological Laboratory, Columbia
University, New York.

231 -

Index

Accidents, physical, 37
Adolescence, anxiety during, 162,
182

biological significance of, 166

description of, 158

emotional growth in, 165

glandular changes in, 160

growth changes of, 159

independence during, 169

inferiority during, 176

physical changes in, 159

problem in mind of, 167

school problems of, 178

sex problems of, 167

social concepts of, 179

weaning during, 173
Adoption, 59
Adults, 199

described, 200, 204, 206

position in time, 200
Affection, 1, 3, 15, 16
Aggression, 8, 23, 24
Aldrich, C. A., 2, 10, 19
Ancestry, 1, 2
Anorexia nervosa, 155
Anxiety states, in adults, 208, 213

in preadolescence, 150

Bakwin, Harry, 63

Behavior problems, causes of, 108

enuresis, 119

food, 128

of spoiled children, 138

stammering, 133

Bender, Lauretta, 87, 91
Bernfield, Siegfried, 109, 118
Beverly, Bert I., 40
Biological demands, 202
Blanton, Smiley and Gray, Margaret,

136, 146

Brill, A. A., 40,90,91, 144
Brothers and sisters, 31

Cannon, Walter B., 208, 222
Carr-Saunders, A. M., 189, 198
Chinese, attitude of, 27
Chronological age, 46, 50
College requirements, 178, 183
Color sense, 20
Comic books, 88
Crying in infancy, 10, 16

Delinquency, 72

(See also Adolescence)
Dementia praecox, 219, 220
Destructiveness, 3
Deutsch, Helene, 19
Discipline, 19, 22, 25, 26

Education, health, 80, 91
progressive, 81, 82

Encephalitis, 67

Enuresis, 119
treatment of, 126

Environment, 8, 202, 205

Exhibitionism, 190

Falling, sense of, 10

233

Index

Fears, 7, 8, 24, 25

causes of, 92, 93, 96

described, 92

of illness, 97

medical, 97, 98, 100

treatment of, 95
Fernald, Grace, 63, 70
Food, 1, 13, 14, 21, 30, 80

(See also Hunger)
Force, 24, 25
Frank, Lawrence, 185
Frohlich's syndrome, 161

Germany, discipline in, 28
Gesell, Arnold, 14, 19, 43, 49, 61
Growth, potentialities of, 1, 7, 9, 11,
19, 47, 83, 108, 200, 202

Habit, 7, 21, 24, 35
Hahn, Eugene, 133, 146
Healey, William, 187, 189
Hospitals, 19

Hubbard, Elizabeth, 82, 91
Hunger, 10, 13, 14, 80
Hypothyroidism, 161

Imitation, 26
Independence, 85, 169
Individuality, 1,6, 11, 83
Infancy, frustrations of, 177
Infant, 1,4,7,8, 10,14, 18,201
Inferiority complex, 176
Insecurity, 173

Intelligence, 8, 11, 19, 41, 42, 44, 64,
84, 164, 180, 204

quotients of, 46, 47, 50

tests of, 11, 44, 50
Interests, 26

234

Japan, discipline in, 28

Jealousy, 31, 111

Juvenile delinquency, 186
causes of, 187
exhibitionism, 190

Laughing, 21
Learning, 24
Levy, David, 32, 142, 146
Lurie, Reginald, 87, 91

Manic-depressive psychosis, 218
Mearns, Hughes, 82, 91
Mechanical ability, 11
Menninger, Karl, 8, 19
Mental deficiency, 64

attitude toward, 68-70

causes of, 66, 67

incidence of, 72

relationship of, to delinquency,
72, 73

training, 76

Mental health, 1, 7, 28, 74, 179, 203
Merrill, Maud, 44
Moro reflex, 10
Mother substitute, 16, 18
Motion pictures, 87, 90, 206
Murchuson, Carl, 187, 197
Musical ability, 11, 52

Needs in growth, 4, 6, 7, 12, 14, 25,

29, 83, 179, 181, 202
Nurse as counselor, 173
Nursery school, 34

Obedience, 27
Orton, Samuel, 52, 63

Index

Paranoid individuals, 219
Parents, 1, 2, 8, 9, 12, 16, 26, 28,
' 61, 69, 108, 111, 114, 116, 202
Play, 19, 25, 27, 32, 33, 38, 39

adulthood in, 205

room for, 27
Praise, 25
Preadolescence, 88, 143, 147

anxieties of, 150

boys, 148

girls, 150
Prejudice, 206
Prize fights, 206
Psychosis, 218
Psychosomatic medicine, 4

Radio, 87

Reading difficulties, 52
Reckless, Walter C., 188, 198
Reflexes, 10, 11
Reichcnberg, Wally, 73, 78
Relationship to others, 18, 20
Resentment, 7, 8, 25, 28
Responsibility, 21
Rhythm, 1, 14, 15

School nurse, 79, 81

School problems, 53, 156, 139

during adolescence, 180, 181
School teachers, 26, 81, 75
Security, 1, 6, 13, 15, 18, 31, 34, 75,

89, 178, 181, 202
Self-preservation, 7, 9, 34
Self-propogation, 7
Self-reliance, 7, 22, 36, 179, 202
Sex education, 168, 180

books on, 198

Sexual aberrations, 218

Shaw, Clifford and McKay, Henry,

188, 197

Shimberg, Myra, 73, 78
Sibling rivalry (see Jealousy)
Simon-Binet, 4
Smiling, 11

Social concepts, 7, 9, 179
Somatic medicine, 208
Spaulding, Edith R., 187, 197
Special abilities, 178
Speech, 19, 20
Spelling difficulties, 52
Spoiling, 16, 95, 138
Stammering, 133

Standards, 1, 7, 9, 24, 87, 108, 202
Stealing, 142
Superstition, 208

Talent, 2

Terman, Louis, 44, 63
Temperament, 1, 12, 22
Thumb sucking, 10, 14, 29
Toilet habits, 1, 17,21,29
Tredgold, A.F., 78
Two-year-old, 20

Visual disturbances, 153, 155
Vitality, 1, 205

War, problems of, to adolescents,

184

games of, 86, 148
Washburn, Carleton, 83, 85, 91
Wile, Ira, 5, 68, 78
Williams, Frankwood, 101. 106

235

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