Parents need help, but not in the current American under-standing of the phrase. They may need it from the same people, but they need a different kind. I appeal for a breakdown of the separation between parents and the psychiatric profession. At present it is common practice for a child to receive psycho-therapy for months, sometimes years, without its mother or father having any direct conversation with the child’s psychiatrist. Especially is this true in large clinics, where the social worker exists as a kind of mediator (or buffer) between psychiatrist and parent. It is thought best that the parent, even of a small child, know nothing of what goes on in those privileged sessions, and the only way she may hear what the expert actually thinks of her child’s case is if he is kind enough to speak to her if she passes him in the hall. Yet there is so much that she must learn that he could teach her.
How can parents learn? They can read, and they can watch and listen. Yet they find out fast that psychiatrists do not like them to read; display of the slightest knowledge of their child’s problem suggests exactly that cold intellectuality which many professionals expect to find. Even after I met psychiatrists who trusted me enough not to veto professional literature, they did not encourage reading, or suggest what it would help me to look at in this vast field with which I was almost completely unfamiliar. Even from my random reading I learned something-here was a child astonishingly like Elly, there a technique that seemed worth trying. How much more might I have learned from an intelligently selected bibliography, especially if I had been able to discuss what I read with a professional?
And if I learned from reading, how much more might I have learned from watching? Let parents into the therapy rooms and the special schools. The difficulties are obvious, but they can be overcome. An observer’s presence may disrupt the therapy, and children — especially other people’s children — cannot be made into guinea pigs. Fair enough. Use microphones then, and one-way glass. An untrained observer will not understand what she sees. Convert, then, the session with social worker or therapist into a question-and-answer training period. If the mother’s reactions need analysis, they will be better understood, by both her trainer and herself, in the mutually experienced context of the therapy room than when shakily reconstructed from memories and dreams. But the parent’s personality may be totally unsuited to this kind of work. Of course — in many cases it is bound to be so. But the radically unsuitable are less likely to wish for such training. If they should, they can be excluded after they have proved themselves so.
Severe mental illness in children is far too widespread for it to be possible to provide intensive professional treatment for every case. The answer must be to train nonprofessionals[17] — unless there is to be no answer at all. Above all, it must be to train parents to do with skill and effectiveness what they have got to do anyway. Mothers (and fathers who have time) will make ready pupils, as people do when they are learning what they have immediate need of. And it may happen that their training will pay social dividends beyond their own particular cases; such parents, if the time comes when their own child’s need is no longer paramount, may make use of what they have learned in helping others. The professionals may find that they have unwittingly created a corps of valuable assistants who will amply repay the time and effort that have gone into their training.
I have spoken so far of the special advantages of parents of abnormal children — those they possess by the very nature of their position, and how they might be enhanced by sympathetic training. I must not overlook, however, another advantage — not a special one, this one, but so commonplace that it is easy to forget it entirely or to doubt its relevance. This is the homely expertise already possessed by parents of normal children. I have often thought of the Institute psychiatrist’s musing words — ‘It’s hard — it’s very hard — even to bring up normal children.’ It is hard, perhaps, but it is something that millions of people have done. When viewed from the vantage point of the expert, conscious of the vast field of parental error, it may indeed seem miraculous that children ever grow up undamaged. Yet most of them do. Parents must not sell themselves short. Let them be conscious not only of how little they know, but how much. [18]
Without guidance, through Elly’s worst years, I brought up Elly as I had brought up my normal children, with no more knowledge of psychology than Dr Spock affords an unpractised mother. Perhaps I should not imply that that knowledge is a little thing, for Dr Spock is the premier example of a psychiatrist who is loving, wise, and good. His book was written for ordinary parents of normal children — it is not a handbook for the nurture of psychotics. Yet it is astonishing how much that one has learned from living with normal children is applicable also to the disturbed and defective.
I have come to see mental health and illness, soundness and defect, not as the separate entities the words seem to describe, but as a continuum. The needs of the defective and the sick are more imperious than those of the well, but they are not different in kind. Sick children need to be accepted, supported, comforted, corrected — like well ones. Above all, like all children — like all people — they need to be respected. Good parents have no magic key to dealing with children beyond this almost foolishly simple one: to try to imagine each situation from the child’s point of view. Some people do it by instinct, but it is a technique that one can learn — to turn in upon oneself at need and ask, ‘What would I feel like if?'
But the child is ill, its thought processes are incomplete, distorted? So are we ill, by turns and chances, and we are no strangers to distortion and incompleteness. Indeed since our children tend to be like us, we may have a special insight, based on our own self-knowledge. Our memories of our own childhood will guide us as we try to understand our children’s.
I remember a little girl, seven years old, shy to the point of incapacity and so tense that every social situation was liable to flood her in helpless nausea. I remember a father less known in daily familiarity than in arbitrary incursions and descents bringing with them fear and distrust the child could not acknowledge, since children learn only that it is customary to love one’s father. I remember a weekend of crisis so acute that the doctor had been called — the little girl had been able to keep nothing down for two days and the doctor and her mother had agreed that she should not be forced to eat, in hopes that the tension would abate of itself. I do not forget the unwonted apparition of the father in the kitchen, tall, handsome, intense. He would get the child to eat, these people knew nothing, it was all a matter of the right approach. He would make it with his own hands — a simple, tasty meal served in attractive circumstances. They would see that she would eat for him.
17
For an impressive account of the achievement of untrained ‘teacher-moms’ working with severely disturbed children in an ordinary public-school situation, see Sol Nictern and George Donahue,
18
A trained psychologist, writing in a highly specialized professional journal, solemnly records his anger when his new jacket was soiled by a small autistic patient, and explains that he chose an old one for the next session. Any mother of young children could have instructed him in this elementary principle.