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grasp the essential problem, and any attempt at rapid training is doomed to failure.
It may be useful to consider the type of problem concerned in a little more detail.
13. During his early years a child and his mother are to be regarded as a unit. It is
only very gradually that he grows out of the environment provided by her and becomes
relatively independent. The lack or interruption of an intimate and warm relationship
with the mother encourages the development of a child's ordinary anxieties to a pathological
degree and these anxieties have been found to underlie a great variety of mental
ill-health in later life. Thus the child's mental development and mental health can be
affected, not only by premature separation, but also by the nature of the general
emotional environment provided, first by his mother and later also by his father and
others in the family. Thus he can become deeply upset by experiences such as frank
rejection, a covert rejecting attitude underlying his parent's love, by a parent's excessive
demand for love and reassurance from him, or by a parent's need for vicarious satisfaction
from his difficult behaviour which he or she consciously condemns.
14. In most cases the parents are not fully aware of the nature of these disturbances
in their relationship with their children, and the reason for this is commonly that the
disturbances have their roots in the parents' own childhood, especially in their relationships
with their own parents, brothers and sisters. For instance, a parent who has
developed hostility or jealousy towards one of her own parents or siblings may,
unwittingly vent her feelings on one of her children who happens to remind her of
the original object of her feelings. Equally, a parent who has grown up to feel guilty
in regard to some personal failing may see such failing in her child and seek by rather
violent measures to correct it, or may even turn from the child in horror. Thus problems
of behaviour which do not exist in the child are imagined, and the importance of those
which do exist exaggerated and thereby exacerbated.
15. In cases of this kind, advice, often given in excess, is seldom found to be of any
value. On the other hand, if the right kind of help can be given quickly, the problem
can be dealt with in its early stages before a vicious circle has had time to develop.
At present insufficient skilled help is given and sooner or later a very difficult problem
is referred to a child guidance clinic. These clinics have in the past been conceived as
providing a preventive service, but this has never in reality been the case. It may be
that the therapeutic work done in them often prevents even greater problems arising
in adolescence and adult life but on the whole child guidance clinics today are inundated
with severe problems of many years' standing.
The present position in the maternity and child welfare services of the Counity
16. Although it is true that in child guidance work carried out in the Council's
clinics and elsewhere the average age of children referred has materially decreased in
recent years and that in some clinics appreciable numbers of pre-school age children
are nowadays receiving treatment, a radical improvement can only be achieved if the
public health staff working in child welfare centres are themselves encouraged to take
a live interest in mental health problems and to concern themselves actively with
preventive mental health work.
17. The conception that preventive mental health has a place in the maternity and
child welfare service is, of course, by no means new. Psychiatrists working in child
guidance clinics which have in the past dealt mainly with children of school age have
become increasingly conscious of the inevitability of failure in a large proportion of
their cases, simply because they were not seen sufficiently early. In London, two child
guidance clinics have been established in child welfare centres for periods of 9 and 8
years respectively, and children of pre-school age have been directly referred to them
by the centre doctors. The Council's first comprehensive health centre at Woodberry
Down, opened in 1952, also includes a child guidance clinic.
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