J. Louise Despert, “Schizophrenia in Children,” 1938

Louise Despert, “Schizophrenia in Children,” Psychiatric Quarterly 12, no. 2 (April 1938):366-71.

Complete original source available here.

In addition to Despert’s efforts to refine clinicians’ understanding of symptom chronologies, frequencies, and patterns, one can see in her description of childhood schizophrenia the enduring interest in the types of families that produced severely disturbed children. Her characterization of parents’ personalities—the dominant mother and submissive father—would become a psychoanalytic staple in the decades that followed.

J. Louise Despert (courtesy of Cornell University Medical College and the National Library of Medicine)

Schizophrenia in children is probably not so rare as it has long been thought…. To our way of thinking, studies of child schizophrenia should be limited to individuals of less than thirteen years. The present report deals with a series of 29 children admitted at the New York State Psychiatric Institute from 1930 to 1937 and who have been followed for periods varying from one and one-half to six years.

Nine children (8 boys, 1 girl) were less than seven years old on admission….

Since it would be impossible in this brief report to go into clinical details, we shall confine ourselves to defining schizophrenia—a disease process in which the loss of affective contact with reality is coincident with or determined by the appearance of autistic thinking and accompanied by specific phenomena of regression and dissociation….

There were three types of onset: 1. Acute onset; 2. Insidious onset; 3. Insidious onset followed by an acute episode….

From the point of view of evolution of the disease, the patients can be divided into three groups as follows: 1. Among the seven cases of the first group (acute onset), six evolved rapidly toward deterioration and in the seventh the progression of symptoms was followed by partial resolution and relative adaptation to reality at an ideo-affective level inferior to the normal. 2. In the second group of 16 cases (insidious onset) three cases evolved rapidly toward deterioration, 12 had a chronic course without exacerbation, but with ultimate lowering of the ideo-affective level and finally one case had a chronic course with one exacerbation. 3. In the third group of six cases (insidious onset followed by an acute episode leading to admission) there were two who showed remission with subsequent relative adaptation; three progressed, not toward deterioration, but toward a marked lowering of the ideo-affective level, and finally the last case evolved rapidly toward deterioration.

To illustrate, the brief description of a clinical case taken from the first group is here given. A boy, an only child, brought up in a fairly comfortable family, closely attached to his nurse maid, develops normally until the age of three and one-half years. The family antecedents are negative. The mother is an aggressive, oversolicitous, American-born Jewish woman who dominates her husband. The child was three and one-half years old when the financial status of the father suddenly collapsed. The child lost his most important affective contact in the person of his nurse maid….. During the next few days, his loss of contact with reality became more and more marked. His speech became inarticulate, he became sleepless, waking up suddenly with unexplained laughing spells….

About two months after admission, he had a typical catatonic episode; attitudinizing, rigid postures kept during periods of 15 to 20 minutes, mutism and incontinence…. [T]he schizophrenic characteristics have persisted with alternating periods of rigidity, mutism, active hallucinatory reactions, catatonic excitement and destructiveness and finally complete autism. He was at the Psychiatric Institute for about three years, and toward the end of his stay he developed severe compulsions…. At two years this child had a capacity above normal to retain words and use them in a mechanical way, (he could recite over one hundred nursery rhymes)….

[A]ttempts at self-mutilation were noted in four children; by self-strangulation, diving down head first from radiators and other high points, tearing the flesh with the nails, etc…. Mutism is a capital symptom of schizophrenia in the younger children….

From the point of view of family antecedents, it is noted that the children in the second group (insidious onset and chronic evolution) show a heavy hereditary taint….

Personality studies of the parents bring out an important point. In 19 of the 29 cases the parents are of a definite type, the mother aggressive, overanxious, oversolicitous, while the father plays a very subdued role…. First, the children admitted under the age of seven are in the proportion of eight boys to one girl…. Second, of the 29 cases, 19 have Hebrew parents (14 Russian) on both sides. It is possible that their family structure, matriarchial rather than patriarchial, explains the predominance of the mother’s role in the early development of these children….

In conclusion, we believe that schizophrenia in children is not so rare as formerly believed…. It is possible that they are brought to the attention of the qualified psychiatrist only at the stage in which they appear to be feebleminded rather than psychotic.

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