Best regards, Andrew Stewart
Begin forwarded message: > From: H-Net Staff via H-REVIEW <[email protected]> > Date: April 29, 2021 at 4:52:32 AM EDT > To: [email protected] > Cc: H-Net Staff <[email protected]> > Subject: H-Net Review [H-Disability]: Wilson on Doroshow, 'Emotionally > Disturbed: A History of Caring for America's Troubled Children' > Reply-To: [email protected] > > Deborah Blythe Doroshow. Emotionally Disturbed: A History of Caring > for America's Troubled Children. Chicago University of Chicago > Press, 2019. ix + 335 pp. $45.00 (cloth), ISBN 978-0-226-62143-2. > > Reviewed by Daniel J. Wilson (Muhlenberg College) > Published on H-Disability (April, 2021) > Commissioned by Iain C. Hutchison > > _Emotionally Disturbed_ is a history of the treatment of emotionally > and behaviorally disturbed children in the mid-twentieth-century > United States. "Emotionally disturbed" emerged as a new diagnostic > category in the 1930s and 1940s to describe children who were not > mentally ill or intellectually impaired, but who exhibited abnormal > emotional states and behavioral patterns. Psychiatrists, > psychologists, and social workers developed residential treatment > centers (RTCs) to house these children for months, or sometimes > years, while they administered treatment. RTCs were developed and > advertised as more humane alternatives to the large, grim, state > mental asylums and institutions to which such children had typically > been sent. RTCs and the therapeutic strategies that accompanied their > establishment prevailed into the 1960s when the movement for > deinstitutionalization and changing therapeutic theories and > practices led to their abandonment. Although they never served more > than a small percentage of children needing care and treatment, > Deborah Blythe Doroshow argues that they represented a sincere effort > to improve the care of emotionally disturbed youth and to prepare > them to rejoin their families and society. While acknowledging their > good intentions, Doroshow is also attentive to the significant > weaknesses and flaws of this approach to treating this population. > > RTCs arose out of the mental hygiene movement of the 1920s and the > child guidance clinics developed to treat troubled children. > Residential treatment centers were created to treat children who > required more than outpatient care and as an alternative to either > reform schools or large-scale mental institutions. "RTC > professionals," Doroshow argues, "were forced to seek out novel > therapeutic approaches and professional structures to treat this > newly identified seriously troubled group of children" (p. 3). These > professionals "identified a new kind of person: the emotionally > disturbed child" (p. 4). She believes that "the creation of spaces > and the creation of new types of people were codependent; the > identification of a population of emotionally disturbed children was > necessary for the creation of RTCs, and the development of RTCs was > critical to the understanding of who the disturbed child was and how > he or she might best be helped" (p. 4). > > Emotional disturbance as a diagnostic category with its associated > treatment regime and locale arose during the post-World War II > American quest to return to normality following two decades of > economic depression and conflict. Emotionally troubled youth with > their abnormal behaviors were seriously at odds with expected norms, > and the RTCs were an effort to treat these children so they could > behave appropriately and normally. As Doroshow puts it, "at RTCs, > treating emotional troubles and building normal children were > inextricably intertwined" (p. 4). For RTC professionals, normal > children were "moderate" in their behavior and came from normal homes > with two normal parents. Emotionally disturbed children exhibited > extreme behaviors and often came from broken or abnormal homes and > families. These professionals believed that it was often necessary to > remove troubled children from abnormal situations to treat their > disturbances and restore their emotional balance and behaviors to > something approaching normal. > > RTCs varied considerably in size and quality. Some were small, > treating perhaps a dozen children, while others might house several > hundred. Some RTCs were housed within larger institutions such as > Bellevue Hospital in New York or the Menninger Clinic in Topeka, > Kansas. Others were free-standing and independent. Most were unlocked > and established as alternatives to the large, locked institutions and > asylums characteristic of the early twentieth century. They were > typically constructed and outfitted to resemble the normal home to > which the children were expected to return. Many had small > residential cottages overseen by house mothers or house parents. > These places sought to establish a therapeutic milieu in which the > children both lived and were treated. Psychologists, social workers, > and sometimes psychiatrists spent their days observing and working > with their patients in the therapeutic milieu. Understanding the > basis for the child's acting out, and working with him or her to > modify their behaviors rather than punishing them for misbehaving, > was at the core of the RTCs approach. RTCs were expensive to operate > and could handle only a small percentage of emotionally troubled > children and adolescents. Many were private patients whose parents > could afford the cost. The typical patient was white and middle or > upper class, although a few of the RTCs made an effort to admit black > children and those from poorer families. > > Doroshow traces the development of RTCs from their origins in the > 1930s and 1940s. She discusses how a pioneering spirit animated many > of the original advocates for RTCs and the ways in which they > developed the new category of emotionally disturbed children. She > also describes how and why they believed the origin of these > disturbances could be traced to family pathologies. Other chapters > focus on the individual therapies used with children, the casework > with parents, and the therapeutic milieu that characterized RTCs. > Advocates considered the therapeutic milieu a distinctive and > original contribution in the treatment of this population. The > therapeutic milieu "was to be warm, welcoming, and permissive, a > noninstitutional institution differentiating RTCs from punitive, > custodial institutions for children, such as training schools. Most > importantly, the milieu would foster normality" (p. 7). The > therapeutic milieu was designed to "resemble typical, white, > middle-class American homes so that the children living there would > have corrective experiences to erase the effects of their > pathological ones at home" (p. 7). Every activity and interaction > with the professional staff was "aimed at shaping normal children who > represented moderation" in their emotional states and behaviors (p. > 7). > > Later chapters trace the decline and abandonment of RTCs in the 1960s > and 1970s. Doroshow discusses "how RTCs found themselves on shaky > ground in the face of increased costs, reduced funding, growing > anti-institutional sentiment, and the community health movement" (p. > 7). Some RTCs closed and others transformed themselves into > "multiservice organizations offering a spectrum of services," from > residential to outpatient and day care options (p. 7). By the late > 1970s, Doroshow finds, "residential treatment as an optimistic, > progressive treatment option for the emotionally disturbed child was > relegated to the margins of mental health care" (p. 8). In its place > was a hodgepodge of professionals and agencies that parents had to > negotiate to try to secure care for their troubled child. > > Doroshow provides a thorough account of the rise and fall of > residential treatment centers focused on the perspective of the > professionals who developed, championed, and ran these therapeutic > institutions. She provides some insight into how treatment in RTCs > was experienced by the children housed and treated in them. However, > children's voices form only a small part of her study. This is due in > part to a lack of sources; few first-person accounts of a stay in a > RTC exist. More troubling, Doroshow quotes numerous generally > positive comments and observations from resident children in official > RTC publications. These comments needed more interrogation given that > official publications were unlikely to publish any critical comments > from their patient populations. > > The book would also have been stronger had Doroshow more critically > examined the standard of normality employed by RTC professionals in > evaluating family life and the emotional status of their patients. > Doroshow is undoubtedly correct in describing the professionals' > adherence to standards of normality in post-World War II America, but > from a disability perspective that is a problematic stance, > especially when normality equated only to white, middle-class > families with two normal parents and normal children. Doroshow's > account would have been stronger had she explored more fully the cost > to the children and their families of expecting them to conform to a > single norm and treating them with a view to fostering that norm > emotionally and behaviorally. > > My concerns notwithstanding, _Emotionally Disturbed_ is a valuable > account of how many professionals sought to provide effective > treatment and more humane care for troubled children in > mid-twentieth-century America. Readers will come away with a good > sense of the positive, even progressive, intentions and techniques > that lay behind the movement for RTCs. They will also become > acquainted with how RTCs functioned, their successes and failures, > and why they were abandoned in the 1960s and 1970s as therapeutic > theory changed, funding declined, and deinstitutionalization for > mentally, intellectually, and behaviorally troubled children gained > ground. Although RTCs had their flaws, we should not condemn them too > harshly; they were a good-faith effort to help seriously emotionally > disturbed children, and nothing that has replaced them has been an > unqualified success. > > Citation: Daniel J. Wilson. Review of Doroshow, Deborah Blythe, > _Emotionally Disturbed: A History of Caring for America's Troubled > Children_. H-Disability, H-Net Reviews. April, 2021. > URL: https://www.h-net.org/reviews/showrev.php?id=56403 > > This work is licensed under a Creative Commons > Attribution-Noncommercial-No Derivative Works 3.0 United States > License. > > -=-=-=-=-=-=-=-=-=-=-=- Groups.io Links: You receive all messages sent to this group. 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