EMOTIONAL DISORDERS OF CHILDHOOD
JUNE M. BURGER,
(BHJ. Vol. LXII, 3/1974)
Socially we live in an age of paradox. There is growing emotional isolation among people crowded together in high density housing schemes. There are depressing trends of depersonalization in education, however well meant. There are conflicting demands of individual freedom in large social organizations, notably industry, not to mention the National Health Service.
We must therefore consider the link between the broader social theme and the causation, diagnosis and treatment of emotional disorders. The convenient medical line between physiology and pathology cannot be transposed on to the opinions and traditions on which societies are built. Physiologically a stimulus can be applied, for example, to the sole of the foot and the subject responds pathologically when the big toes goes up and the others fan out. But socially there is no Babinski reflex. When is depression a normal response to circumstance and when is it pathological? Where should one draw the line between constructive anxiety that may key a patient up to solve his or her problems, and the destructive squirrel’s cage of the acute anxiety state?
These thoughts have been presented as we turn to the problems as they affect the growing child, for it is necessary to our understanding that as doctors we continually ask ourselves the questions:
What do we mean by emotional? What do we mean by disturbed?
It is sometimes helpful to have a working classification although some of the following conditions may overlap or there can be multiple pathology. Broadly speaking, four groups are defined.
Disturbances due to:
1 Psychiatric conditions
2 Mental retardation
4 The socially disadvantaged
1. Psychiatric Conditions
Autism has been well documented in the recent past following the observations of Dr. Mildred CREAKE and others, although it does seem to be a rather alarmingly increasing condition. The child is utterly withdrawn into itself. It fails to speak normally. It has bizarre obsessions and avoids the use of the word “I”. It usually presents between the age of 18 months and three years and if it does present after age of three years one has to include the possibility of a progressive neurological degeneration.
Juvenile psychosis presents from about the age of eight—a different condition altogether. There are compulsions and frank hallucinations and there may be accompanying depression and anxiety. It is not clear whether this complex is related to the delirious and toxic states of childhood. Overt schizophrenia does not seem to appear before puberty. I saw a boy only this week who is now regarded as a juvenile psychotic and he became ill when he was ten.
Neurosis—always interesting, for these children can be either withdrawn or outgoing, with accompanying learning problems and bedwetting.
The parental influence is often a factor in disturbed children who reflect the underlying emotional tensions in the home, and is particularly relevant in those children who cannot sleep.
2 The Mentally Retarded
The spastic or palsied child imprisoned in his sensory experience who knows no melody of movement.
The hydrocephalic child who is irritable, oversensitive and often inattentive, dreamy, aloof and living in a world of fantasy.
The microcephalic child very outgoing, helpful and willing to serve and do the things that others plan.
The post-encephalitic syndrome includes children with petit-mal and epilepsy; they all come into this and these children can be extremely destructive and hyperkinetic. They can be very severely retarded and interestingly enough their behavior depends on the age at which their illness began. The 0-5 age group have, as I have described, the restlessness and overactivity with severe retardation. From school age their intellectual capacity and general development is less impaired but they have moral disturbances leading to severe delinquency. In adulthood the opposite picture to that of early infancy shows itself in Parkinsonism. I have brought this up because when you are dealing with children you must think in terms of their developmental stages and the post-encephalitic syndrome is a good illustration of this.
Mongolism or Down’s syndrome as I prefer to call it—the phenomenon of the late 19th century onwards, classically described by Langdon Down long before chromosomes were thought of, exhibits the charming, unintellectual, mischievous child, an all-social being so often the medicine for other disturbed children.
Finally, in this group, those children with biochemical imbalance, who are becoming more obvious with refined techniques, notably phenylketonuria, show their disturbance from early infancy onwards.
3 The dyslexic child, another interesting group of whom we are becoming increasingly aware, is said to include 4 per cent of all children. The accepted definition is “a language disorder in children who despite classroom experience fail to attain language skills of reading and writing commensurate with their abilities”.
To the school, a seemingly intelligent child begins to lag behind in reading and writing. The child becomes aware that something is wrong and may start clowning in class to seek attention. At home, with his family, there may be outbursts of temper with school phobia, and to the G.P. he may present as a case of stress.
1. Finally, the socially disadvantaged child whose problems have been brought to our notice by the work of Britain’s National Child Development Study which has been financed by both private and public funds. It is a survey of 15,000 children born between 3-9 March in 1958 who have been followed up with great care. The findings show that 6 per cent of all children are socially disadvantaged. The criteria are that they are badly housed, living below the poverty line, usually with only one parent and often one of more than five children. At school they are often regarded as maladjusted, they are short in stature for their age, four times more of them have hearing problems than the average child, five times more of them are likely to be away from school for long periods because of ill-health or their emotional problems. A very salutary fact is that whereas the Junior Probation Service is used by 1 in 300 children, in this group 1 in 11 are on probation. They swallow up a tremendous amount of the resources of the social services, they are very costly and they are, in fact, as has been written, “born to fail”.
Occupying the thoughts of many people in authority is this cycle of deprivation and how to break it.
So much of the child’s ability to cope with stress, physical — from illness — or psychological — from his environment —, depends on his temperament. And I have found it very helpful in understanding children with emotiuonal problems to think of them in terms of the four temperaments because so often their behavior is an exaggerated form of their natural temperament. At the same time it helps in leading to the homœopathic remedy, particularly with the mental symptoms. We are not taught in medical school the old Greek concepts of the temperaments, yet they remain relevant today.
From age 5-7 the commonest is the sanguine, a bright, chatty, cheerful, friendly child, eager to please, whose curiosity and interest are readily aroused but whose attention is fleeting and whose interest is shallow. They have attention-seeking behavior. A disturbed child of sanguine temperament is reminiscent of a mildly brain damaged hyperkinetic child although his educational needs are quite different. Physically they are lightly built, active and graceful, with fair colouring. One thinks here of Pulsatilla and its related remedies.
Secondly, the phlegmatic children, who lack initiative in changing anything in their surroundings or themselves. They can accurately produce anything factual, but are incapable of making a spontaneous creative contribution. They can accurately produce anything factual, but are incapable of making a spontaneous creative contribution. They are often inert and non-participating. There is often `a lack of response to punishment. Some crave food and can become obese - but once their interest is aroused they can become true leaders because their temperament makes them steady and reliable. Here we think in terms of a homœopathic remedy such as Calcarea and Sulphur.
Thirdly, the melancholic children, an unfortunate term for they are not depressed, but take life the hard way. They can be clairvoyant, they brood over and ponder things, they can become withdrawn and upset if faced with an unexpected challenge. On the whole they are thin and narrow-chested. The remedies Phosphorus and Silicea come to mind.
Finally, the choleric child, rare, but once seen never forgotten. They have a fiery look in their eye, and they have terrible tantrums. Outburst of rage are interspersed with bubbling activity but afterwards the child is shaken and contrite. These outbursts must be distinguished from the aggressive outbursts of some anti-social depressed and deprived children. Nux vomica fits this temperament.
In reading through Dr.BORLAND’s Children Types it struck me that there is a degree of compatibility of the remedies with the temperaments, and the grouping of his remedies.
The treatment of children who are emotionally disturbed is not easy, homœopathically or otherwise. I will give you a few examples of children who have come my way and with whom we have had some success using homopathic remedies. Several of them have come from other hospitals accompanied by mountains of paper. It is a good mental exercise to go through the case notes that follow the children from doctor to doctor and to realize that other people also have difficulties in assessment and treatment. So let us not be too despondent at our own efforts.
Case History 1
Martin aged 5. Diagnosis: Autism
Second of two children, he had been in two schools when first seen in February 1973. Extremely fortunate in his parents who said he was unable to communicate with others and very highly strung. His highly obsessional behavior was first noticed when he was four. He became aggressive when he first went to nursery school, which excluded him, and then he was excluded from a second one because the teacher could not tolerate his attitude towards the other children.
He was a strange little boy who would not go to bed at night until all his clothes were ready and tidy on a stool. He must always have a clean white shirt, although he could not say so it had to be put there. He was obsessed by matches and frightfully fussy about his food. He would hoover the carpet obsessionally all morning until he had been in every corner, and covered every square inch of it. He would do the same thing in mowing the lawn. His language was highly idiosyncrateic, rather like a delayed echolalia, very strange. Obviously, he could not cope in a normal school and because of his failure was referred by the local authorities to the Nowcomen Clinic or Guy’s Hospital. The very full and helpful report from the psychologist characteristically reported that he avoided looking at her although once or twice he did climb on to her lap and say over and over again the same words. His chronological age of 5 years 11 months corresponded to a mental age of 4 years 8 months. The recommendation from Guy’s was that he would never be contained in a normal school and would have to go to an Educationally Subnormal School. This was a difficult decision for the parents as his father is, infact, a school master, and they decided to send him to a small private school known to the Divisional Medical Officer of Health as having reputation for being good with “difficult” children. Guy’s recommended Ritalin for two months in the summer holidays during which time he had no homœopathic medicine.
The important thing was to help him over the hurdle of the first day at his new school so that he would not come out screaming or having punched up all the other children.
He was given Argent. nit. 200 two doses on the day before and one dose on the morning that he went. His mother, having expected almost daily to be telephoned to say “take him home”, went along rather tentatively after three weeks, and was told he was “settling in fine”. So far he has survived one term and is making good progress all round.
Medication: for forceps delivery with foetal distress: Arnica 10M, 1 dose, followed by: for his obsessional behaviour: Silica 200, 3 powders, four months later; this has recently been repeated; for his agitation and fears: Arsen.album 10M iii, prescribed at his first visit.
Case History 2. Sara aged 3. Post-encephalitic with some degree of autism. Youngest of three children. Normal delivery.
Presented as an extremely restless child, a dreadful sleeper and non-communicative. Aged 5 months had severe Fever and Diarrhoea which left her with myoclonic jerks. She was extensively investigated at Great Ormond Street Children’s Hospital and all underlying sinister pathology eliminated. EEG showed hypsarrhythmia. Treated with 40 units ACTH daily for three weeks, gradually reducing over a period of six months. Also given Pyridoxin, Nitrazepam and Phenytoin 150 mg. daily which unfortunately caused ataxia. By April 1972, on Mogadon 10 mg. daily, again with no relief.
June 1973, attended The Royal London Homœopathic Out Patient Clinic. Given Chamomilla 200 q.i.d. Two weeks later was reported to be sleeping better.
August: head banging and self injury reasserted themselves. Given Tuberculinum bovinum 200, i.
Aconite 30 i, nocte, was no help.
Plumbum 200 iii given.
September: had quietened down appreciably after Plumbum, and attacks of hypsarrhythmia decreasing.
October: having Salaam attacks, about 4 daily.
During this time Chamomilla 200 q.i.d. was being given.
November: Chamomilla withdrawn slowly and her attacks increased in frequency and intensity.
Some eye contact slowly being established and knows her name. Her mother at the last consulation said she always felt Sara was allergic to milk. Aethusa 200 b.d. for one week has been prescribed and we await the outcome with interest. It is almost impossible to find the constitutional remedy here for although she looks a normal child her hyperkinesis is such that she can create havoc in the Clinic room in five minutes. Nevertheless, we are struggling, together with her valiant parents, to find clues.
Case History 3. Celia. Aged 5. Post-encephalitic syndrome. Born prematurely in University College Hospital, had meningitis when she was 3 weeks old and is now severely retarded following her neonatal meningitis. She can have as many as 3 major fits in one day and uncountable spasms.
Phenobarbitone, Mogadon and ACTH have not helped. At age 5, unable to walk or talk.
April 1973: came to O.P.D. at the Hospital. Remedies given:
Arnica 10M, 1 dose
Streptococcin nosode 30 iii
Cicuta 200 iii
Finally, Bryophyllum 5 per cent. t.d.s.
August: reported to be calmer and more serene, with all-round improvement such that her mother feels she is more contactable and talking an interest in her food. Currently prescribed with Bryophyllum t.d.s., Cuprum met. 200 iii, and Artemisia vulgaris 6 t.d.s.
Case History 4. Stephen. Diagnosis: Post measles retardation.
1971, aged 2 years, brought to the Royal London Homœopathic Hospital because he was said to be mentally retarded following measles at age of 9 months. 1st child.
Medication: Morbillinum 30 iii
By the end of the year Natrum muriaticum was emerging as his remedy. Given: Nat. mur. 30 iii.
January 1972: Aged 3 years 3 months, he was learning to talk. Bedwetting remained a problem.
September 1972: His personality was changing and there was a general improvement, but there was still a long way to go.
He was terrified of noise. Given: Borax 6 t.d.s.
November 1972: More attentive and dry.
January 1973: Became excessively jealous.
Given: Lachesis 10M iii
March 1973: Improving.
June 1973: Given: Morbillinum CM iii
Lachesis 10M iii
Silica 200 i
August 1973: Given: Natrum mur. 10M iii
September 1973: Much less violent and can dress himself.
October 1973: Settling in at primary school and will sit still for a story.
Now aged 5 years and is trying to read and knows his numbers but mirror writes.
Case History 5. Deborah. Aged 6. Diagnosis: Parental influence.
July 1973: Attended Royal London Homœopathic Hospital. Eldest of 2 children, with the complaint of incessant crying, outbursts of temper and difficult to control.
The father and mother had separated three times and divorce proceedings were pending.
A highly intelligent child who had fed herself at 6 months. Aged 18 months was seen at a child guidance clinic for abnormal behavior. At school there was no problem and she was an advanced reader. At home she was very argumentative and threw things. Her general health was good except for nose bleeds and occasional sleep-walking. She was deeply connected to her mother; for example, when her mother had a period Deborah had tummy-ache.
On examination she was very fair, blue-eyed and sensitive. The maternal grandfather had had tuberculosis.
Remedies Tuberculinum bovinum 30 i
Phosphorus 12 b.d. for one month.
August: Reported to be very much better. No outbursts and no crying. Her mother had been able to go out alone and when she returned Deborah had washed up!
Case History 6. Mildred, aged 14. Diagnosis: Neurosis.
May 1972: Came to The Royal London Homœopathic Hospital complaining of headaches, sleeplessness, listlessness and depression. Various remedies were given, but by January it was obvious we were getting nowhere. It was felt there was more to the history than it was possible to obtain in front of Mildred and in a busy Out Patients Clinic. Her father was a clergyman and her mother a teacher. I asked her father to write down anything he thought was relevant and might help us in understanding, and subsequently lead to the remedy. A précis of his letter follows:
Aged 22 months, admitted to a children’s hospital for bronchoscopy following ingestion of grit. When visited found lying on her face with a frame under her middle so her head was lower.
Developed gastro-intestinal infection in hospital and 14 days later was discharged.
On her return home she refused to sleep alone and would not allow her parents out of her sight.
Aged 8, 1967, had a severe nervous breakdown, was frantically sleepless and had to be restrained from running out of the house at night. Away from school for five weeks under sedation. Precipitating factors could have been the return of her sister to boarding school and the impending marriage of her brother, of whom she was very fond.
1970: Moved to London.
1971: Another episode of sleeplessness with a marked reluctance to go to bed and then difficult to rouse.
This history led us to the remedies Arnica 10M i, and Phosphorus 12 b.d. for one month.
March 1973: (one month later) very much better.
April: Remains well. No complaints.
August 1973: A very good school report. Sleeping very well.
A salutary lesson on the importance of taking a full history.
Case History 7. Alex, aged 14 years. Diagnosis: A socially disadvantaged girl. The fifth of seven children. Her next eldest sister had suffered from depression and been given ECT at age 12 and had subsequently had a nervous breakdown following the birth of an illegitimate child when 14 years old. The mother, a well-meaning soul, had tried to commit suicide, and the father drank and had left the family. Poor housing.
June 1973: Alex was brought to Out Patients Clinic complaining of nose bleeds, sudden vomiting and depression.
In a monosyllabic way it transpired that she was very excitable, would scream when corrected, but could be a good story teller. She adored her sister’s baby and loved animals. She flushed easily and was terrified of thunder.
Remedy: Phosphorus 12 b.d. for 1 month.
July: Reported to be much better and would talk to the people next door.
September: (brought her sister for treatment). Her own improvement maintained.
Now desperately wanting a job although down to attend an Educationally sub-normal school. As aged 15, some correspondence ongoing with educational authorities.
One feels reasonably confident that this girl can be maintained on her constitutional remedy to help her with her problems emotionally, but environmentally much more is needed here.
With the exception of Martin, who came to the practice, all these children have been seen during the general Paediatric Out Patient sessions at The Royal London Homœopathic Hospital. They have had to rub shoulders with children with ear-ache, enlarged tonsils and many with the Asthma-eczema complex (we seem to be bombarded with these at the moment), and this in itself is no bad thing. Our facilities are quite simple and reasonably relaxed.
Ladies and gentlemen, I am well aware that this is the last paper of the Chester Congress and it also happens to be Sunday morning. Without wishing to preach a sermon, nevertheless I crave your indulgence a while longer for it happens to be a hobby of mine to read poetry and yesterday, while thinking about the enjoyable evening and the good company at the dinner, I chanced upon these lines by the 17th century poet Thomas Traherne. They seem to be appropriate for the ending of this 1973 British Homœopathic Congress:
Mankind is sick, the World distemper’d lies,
Opprest with Sins and Miseries.
Their Sins are Woes; a long corrupted Train
Of Poyson, drawn from Adam’s vein,
Stains all his Seed, and all his Kin
Are one Disease of Life within.
They all torment themselves!
The World’s one Bedlam, or a greater Cave
Of Mad-men, that do alwaies rave.
The Wise and Good like kind Physicians are,
That strive to heal them by their Care.
They Physick and their Learning calmly use,
Although the Patient them abuse
For since the Sickness is (they find)
A sad Distemper of the Mind;
All railings they impute,
All injuries, unto the sore Disease,
They are expressly come to ease!
If we would to the World’s distemper’d Mind
Impute the Rage which there we find,
We might, even in the midst of all our Foes,
Enjoy and feel a sweet Repose.
Might pity all the Griefs we see,
Anointing every Malady
With precious Oyl and Balm;
And while ourselves are Calm, our Art improve To rescue them, and show our Love.
From Poems, Centuries and Three Thanksgivings By Thomas Traherne. Ed. Anne Ridler. Published by Oxford University Press in 1966.
(A paper read to the British Homoeopathic congress at Chester on 18 November 1973.)