[1827] in Humor
HUMOR: THE ETIOLOGY & TREATMENT OF CHILDHOOD
daemon@ATHENA.MIT.EDU (abennett@MIT.EDU)
Fri Jan 17 12:54:54 1997
From: <abennett@MIT.EDU>
To: humor@MIT.EDU
Date: Fri, 17 Jan 1997 12:33:27 EST
Date: Thu, 16 Jan 1997 23:14:04 -0800
From: connie@interserve.com (Connie Kleinjans)
THE ETIOLOGY & TREATMENT OF CHILDHOOD
Jordan W. Smoller, University of Pennsylvania
Childhood is a syndrome which has only recently begun to receive serious
attention from clinicians. The syndrome itself, however, is not at all
recent. As early as the 8th century, the Persian historian Kidnom made
references to "short, noisy creatures," who may well have been what we now
call "children." The treatment of children, however, was unknown until
this century, when so-called "child psychologists" and "child
psychiatrists" became common. Despite this history of clinical neglect,
it has been estimated that well over half of all Americans alive today
have experienced childhood directly (Suess, 1983). In fact, the actual
numbers are probably much higher, since these data are based on
self-reports which may be subject to social desirability biases and
retrospective distortion. The growing acceptance of childhood as a
distinct phenomenon is reflected in the proposed inclusion of the syndrome
in the upcoming Diagnostic and Statistical Manual of Mental Disorders, 4th
edition, or DSM-IV, of the American Psychiatric Association (1990).
Clinicians are still in disagreement about the significant clinical
features of childhood, but the proposed DSM-IV will almost certainly
include the following core features:
1. Congenital onset
2. Dwarfism
3. Emotional liability and immaturity
4. Knowledge deficits
5. Legume anorexia
Clinical Features of Childhood
Although the focus of this paper is on the efficacy of conventional
treatment of childhood, the five clinical markers mentioned above merit
further discussion for those unfamiliar with this patient population.
CONGENITAL ONSET In one of the few existing literature reviews on
childhood, Temple-Black (1982) has noted that childhood is almost always
present at birth, although it may go undetected for years or even remain
subclinical indefinitely. This observation has led some investigators to
speculate on a biological contribution to childhood. As one psychologist
has put it, "we may soon be in a position to distinguish organic childhood
from functional childhood" (Rogers, 1979).
DWARFISM This is certainly the most familiar marker of childhood. It
is widely known that children are physically short relative to the
population at large. Indeed, common clinical wisdom suggests that the
treatment of the so-called "small child" (or "tot") is particularly
difficult. These children are known to exhibit infantile behavior and
display a startling lack of insight (Tom and Jerry, 1967).
EMOTIONAL LIABILITY AND IMMATURITY This aspect of childhood is often
the only basis for a clinician's diagnosis. As a result, many otherwise
normal adults are misdiagnosed as children and must suffer the unnecessary
social stigma of being labelled a "child" by professionals and friends
alike.
KNOWLEDGE DEFICITS While many children have IQ's with or even above
the norm, almost all will manifest knowledge deficits . . . Anyone who
has known a real child has experienced the frustration of trying to
discuss any topic that requires some general knowledge. Children seem to
have little knowledge about the world they live in. Politics, art, and
science -- children are largely ignorant of these. Perhaps it is because
of this ignorance, but the sad fact is that most children have few friends
who are not, themselves, children.
LEGUME ANOREXIA This last identifying feature is perhaps the most
unexpected. Folk wisdom is supported by empirical observation -- children
will rarely eat their vegetables (see Popeye, 1957, for review).
Causes of Childhood Now that we know what it is, what can we say
about the causes of childhood? Recent years have seen a flurry of theory
and speculation from a number of perspectives. Some of the most prominent
are reviewed below. Sociological Model Emile Durkind was perhaps the first
to speculate about sociological causes of childhood. He points out two
key observations about children: 1) the vast majority of children are
unemployed, and 2) children represent one of the least educated segments
of our society. In fact, it has been estimated that less than 20% of
children have had more than fourth grade education. Clearly, children
are an "out-group." Because of their intellectual handicap, children are
even denied the right to vote. From the sociologist's perspective,
treatment should be aimed at helping assimilate children into mainstream
society. Unfortunately, some victims are so incapacitated by their
childhood that they are simply not competent to work. One promising
rehabilitation program (Spanky and Alfalfa, 1978) has trained victims of
severe childhood to sell lemonade.
Biological Model The observation that childhood is usually present
from birth has led some to speculate on a biological contribution. An
early investigation by Flintstone and Jetson (1939) indicated that
childhood runs in families. Their survey of over 8,000 American families
revealed that over half contained more than one child. Further
investigation revealed that even most non-child family members had
experienced childhood at some point. Cross-cultural studies (e.g., Mowgli
& Din, 1950) indicate that family childhood is even more prevalent in the
Far East. For example, in Indian and Chinese families, as many as three
out of four family members may have childhood. Impressive evidence of a
genetic component of childhood comes from a large-scale twin study by
Brady and Partridge (1972). These authors studied over 106 pairs of
twins, looking at concordance rates for childhood. Among identical or
monozygotic twins, concordance was unusually high (0.92), i.e., when one
twin was diagnosed with childhood, the other twin was almost always a
child as well.
Psychological Models A considerable number of psychologically-based
theories of the development of childhood exist. They are too numerous to
review here. Among the more familiar models are Seligman's "learned
childishness" model. According to this model, individuals who are treated
like children eventually give up and become children. As a counterpoint
to such theories, some experts have claimed that childhood does not really
exist. Szasz (1980) has called "childhood" an expedient label. In
seeking conformity, we handicap those whom we find unruly or too short to
deal with by labelling them "children."
Treatment of Childhood Efforts to treat childhood are as old as the
syndrome itself. Only in modern times, however, have humane and systematic
treatment protocols been applied. In part, this increased attention to
the problem may be due to the sheer number of individuals suffering from
childhood. Government statistics (DHHS) reveal that there are more
children alive today than at any time in our history. To paraphrase P.T.
Barnum: "There's a child born every minute." The overwhelming number
of children has made government intervention inevitable. The nineteenth
century saw the institution of what remains the largest single program for
the treatment of childhood -- so-called "public schools." Under this
colossal program, individuals are placed into treatment groups based on
the severity of their condition. For example, those most severely
afflicted may be placed in a "kindergarten" program. Patients at this
level are typically short, unruly, emotionally immature, and
intellectually deficient. Given this type of individual, therapy is
essentially one of patient management and of helping the child master
basic skills (e.g. finger-painting). Unfortunately, the "school" system
has been largely ineffective. Not only is the program a massive tax
burden, but it has failed even to slow down the rising incidence of
childhood. Faced with this failure and the growing epidemic of
childhood, mental health professionals are devoting increasing attention
to the treatment of childhood. Given a theoretical framework by Freud's
landmark treatises on childhood, child psychiatrists and psychologists
claimed great successes in their clinical interventions. By the 1950's,
however, the clinicians' optimism had waned. Even after years of costly
analysis, many victims remained children.
The following case (taken from Gumbie & Pokey 1957) is typical. Billy J.,
age 8, was brought to treatment by his parents. Billy's affliction was
painfully obvious. He stood only 4'3" high and weighed a scant 70 lbs.,
despite the fact that he ate voraciously. Billy presented a variety of
troubling symptoms. His voice was noticeably high for a man. He
displayed legume anorexia, and, according to his parents, often refused to
bathe. His intellectual functioning was also below normal -- he had
little general knowledge and could barely write a structured sentence.
Social skills were also deficient. He often spoke inappropriately and
exhibited "whining behavior." His sexual experience was non-existent.
Indeed, Billy considered women "icky." His parents reported that his
condition had been present from birth, improving gradually after he was
placed in a school at age 5. The diagnosis was "primary childhood."
After years of painstaking treatment, Billy improved gradually. At age
11, his height and weight have increased, his social skills are broader,
and he is now functional enough to hold down a "paper route." After
years of this kind of frustration, startling new evidence has come to
light which suggests that the prognosis in cases of childhood may not be
all gloom. A critical review by Fudd (1972) noted that studies of the
childhood syndrome tend to lack careful follow-up. Acting on this
observation, Moe, Larrie, and Kirly (1974) began a large-scale
longitudinal study. These investigators studied two groups. The first
group consisted of 34 children currently engaged in a long-term
conventional treatment program. The second was a group of 42 children
receiving no treatment. All subjects had been diagnosed as children at
least 4 years previously, with a mean duration of childhood of 6.4 years.
At the end of one year, the results confirmed the clinical wisdom that
childhood is a refractory disorder -- virtually all symptoms persisted and
the treatment group was only slightly better off than the controls. The
results, however, of a careful 10-year follow-up were startling. The
investigators (Moe, Larrie, Kirly , & Shemp, 1984) assessed the original
cohort on a variety of measures. General knowledge and emotional maturity
were assessed with standard measures. Height was assessed by the "metric
system" (see Ruler, 1923), and legume appetite by the Vegetable Appetite
Test (VAT) designed by Popeye (1968). Moe et al. found that subjects
improved uniformly on all measures. Indeed, in most cases, the subjects
appeared to be symptom-free. Moe et al. report a spontaneous remission
rate of 95%, a finding which is certain to revolutionize the clinical
approach to childhood. These recent results suggests that the prognosis
for victims of childhood may not be so bad as we have feared. We must
not, however, become too complacent. Despite its apparently high
spontaneous remission rate, childhood remains one of the most serious and
rapidly growing disorders facing mental health professional today. And,
beyond the psychological pain it brings, childhood has recently been
linked to a number of physical disorders. Twenty years ago, Howdi, Doodi,
and Beauzeau (1965) demonstrated a six-fold increased risk of chicken pox,
measles, and mumps among children as compared with normal controls. Later,
Barby and Kenn (1971) linked childhood to an elevated risk of
accidents--compared with normal adults, victims of childhood were much
more likely to scrape their knees, lose their teeth, and fall off their
bikes.
Clearly, much more research is needed before we can give any real hope to
the millions of victims wracked by this insidious disorder.
