Louise Despert, “Thinking and Motility Disorder in a Schizophrenic Child,” Psychiatric Quarterly 15, no. 3 (1941):522-36.
Complete original source available here.
This case study of childhood schizophrenia is interesting in part because the subject is a girl. From the earliest observations of autistic-like behavior, clinicians and researchers have noticed a gender gap favoring boys. Despert’s comments about Joan, born in 1933, highlight the significance that clinicians attributed to emotional (“affective”) development in complex cases that also involved challenges in linguistic, cognitive, motor, and social growth. The case study also emphasizes a theme that was central to the theory of psychogenesis: the mother who deprived her young child of affection and emotional attachment.
J. Louise Despert (courtesy of Cornell University Medical College and the National Library of Medicine)
This eight-year-old Jewish girl, an only child in a family of low economic status, was seen for the first time at the age of four years, one month. She was then admitted to the New York State Psychiatric Institute because of inability to play with other children, assaultiveness, tantrums and “spells” of one year’s duration….
Family History. The paternal grandparents were said to have been withdrawn, indifferent individuals, more interested in Communism than in their home life…. The father, a drug salesman, is 35 years old. At seven years of age he lost one eye in an accident, following which he became seclusive, and has shunned people through his life….
The mother, 35 years old, intelligent, aggressive, helps her husband in business…. As regards the patient, the mother has been overanxious, overprotective and openly sadistic….
Personal History. The child, Joan L., was born in Chicago on January 22, 1933, after three years of marriage with no other pregnancies reported. The child was unwanted and unplanned for…. [T]he mother says, “I was so afraid to have a baby it broke my spirit a great deal,” although she also insists that the child became “precious” as a result of this shock. She appears to have become obsessed with the “idea of perfect health,” reading many books on the subject….
At three years, her language development presented some peculiarity in the sense that she used very few words for communication with parents or children, but that she actually knew many words, with a preference for difficult ones. There was considerable pressure on the part of the mother in her drive for perfection….
It is at this time (three years) that she began to have tantrums….
At the Institute, she was described as very aggressive and destructive. She talked a great deal in a rapid, singsong, lisping, babyish fashion which was difficult to understand…. She wet and soiled, was in constant activity, rocking back and forth, rubbing her legs up and down, sucking the hem of her dress, had frequent tantrums, and was destructive in play sessions…. A psychometric examination gave her an I.Q. of 98 on the 1916 Revision of the Stanford-Binet Scale and 100 in the Minnesota Preschool Non-Verbal Test. During this first stay at the Psychiatric Institute, Joan continued to be very active and aggressive and showed a conspicuous indifference to physical pain…. Compulsive behavior was marked….
[Joan was discharged and readmitted after five months. She was now four years and nine months old.]
On the ward, she was assaultive toward other children. Outside of this aggression, she was practically in a world of her own and did not mingle with the children…. Her speech at this time was almost unintelligible and showed further deterioration. Neologisms were numerous; and her language, to a large extent, was made up of a jumble of meaningless syllables interspersed with plainly audible and well-articulated words….
Insulin shock therapy was suggested by the writer at the time of readmission; but the mother refused to sign the release for it…. [T]he mother did not allow her to remain, because of alleged mistreatments reported by the child.
Since Joan’s discharge from the New York State Psychiatric Institute, the writer has seen her at irregular intervals…. A year and one-half after discharge, at the age of six years, two months, the I.Q. was 68 with a mental age of four years, two months…. Echolalia was marked….
The mother reported that throughout the period following the discharge, she had taken Joan’s problem in hand. She now understood the child’s “emotional complex” and used a method which brought good results: namely, beating the child, which caused her to cry…. The child was admitted to school at seven and one-half years of age. She continued aggressive toward children and seclusive…. She does not mingle with children, and does not seem to know what to do with toys…. At present, he behavior is quieter; she is passive, preoccupied, uninterested. At times, she appears hallucinated….
Affectivity. There are marked disturbances of affective contact as seen in the withdrawal, and the alternation of alert and excited behavior with stuporous behavior….
Motility. The excited motor behavior has been described. There are primitive, purposeless movements of hand, arms, legs, as well as head. The motor behavior presents the same character of dissociation which has been seen in the thinking and affective spheres, with considerable variety in patterns and purposelessness of activity….
Etiology
Etiological factors are not wanting in this case…. The history shows a marked familial tainting…. Both parents have neurotic characteristics, the mother’s being more prominent. In the case of the mother, the neurotic symptoms are so severe as to have warped her attitudes strongly in handling the child…. The mother’s aggressive and sadistic attitudes have had a significant repercussion on the failure of this child to adjust to the world of reality. It can be said that Joan’s mother has created for her child an early pathological environment from which almost all other influences were excluded. Her rejection of the child made it impossible for her to create the atmosphere of affection which is an essential requirement of an infant’s life. The marked ambivalence of the mother is reflected in the child’s own ambivalence toward the outside world. The external world—which for the average child is to a large extent one of play and gratification—becomes full of frustrations for this girl; and her withdrawal from the external world is a reaction to such frustrations. The role played by the father is more obscure….
Summary and Conclusions
…In the case of an adult, the symptoms noted in this child would be acknowledged as characteristic of schizophrenia. They are: specific thinking and perceptual disorder, mental deterioration, specific language and speech disturbances, dissociation of affect, alternation between excitement and semi-stuporous states, negativism, impulsive behavior, and primitive motor behavior. The evolution of the syndrome is also characteristic. The onset is placed at three years of age….
Severe behavior disorders, associated with regressive characteristics, are not uncommon in young children with acute emotional disturbances. However, in the absence of affective dissociation, the diagnosis of schizophrenia cannot be made, however severe the behavior disorder….
Affective dissociation in the young child can be diagnosed only with some difficulty, owing to the present lack of knowledge of early intellectual function and the relation of emotional factors to symbolic structure at various developmental levels. Because of this lack of knowledge, intellectual and perceptual defect is usually evaluated through comparison with the schizophrenic adult, whereas it should be evaluated in terms of deviations from the normal child of similar developmental level….