Children at psychiatric risk / edited by E. James Anthony and Cyrille Koupernik.

Date:
[1974]
Catalogue details

Licence: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)

Credit: Children at psychiatric risk / edited by E. James Anthony and Cyrille Koupernik. Source: Wellcome Collection.

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    Normality in the Assessment of Risk 13 To distinguish between the physiological and the pathological in medicine is generally not easy [1]. For example, an inflammatory reaction is normal in certain conditions of physical insult, and its absence would give cause for alarm. The association of insult and inflammation, on the other hand, does define a pathological fact. In speaking of normality and illness in this context one is making certain about the life process and its transience or permanence. In psychiatry, similarly, Goldstein [4] has stated that to behave sanely is to behave in an orderly manner, but that recovery may be marked by the establishment of a new order. In dealing with mental pathology, one should respect these neo-organizations that do not necessarily correspond to the norms of the particular culture to which the child and his family belong. For instance, as regards the specific learning disturbances already mentioned, the practice of reeducation should not lead to a demand that the child conform to normal as defined by performance on standard developmental tests. These examples, which could be multiplied, indicate that the predicament of not being well, whether applying to the child or to his family, may be harmfully overextended. It would include both those who are not normal and those who are not happy. In fact, the need to seek professional help is determined more and more by social and cultural factors, for example, the level of sophistication of referring agencies, rather than by any actual potential in the patients for change. All this points to the danger latent in a purely nosological and descriptive point of view based on the traditional medical model. No description, whether symptomatic or syndromatic, is qualified to define the normal child simply by the absence of these so-called morbid entities. The diagnosis of health should not be based solely on the absence of ill-health. The Contribution of Psychoanalysis Psychoanalysis has made an essential contribution to this problem. According to Freud, the experiences of early relationships and early conflict are responsible for organizing the mental functions, and pathological conditions are not attributable simply to regressions or to nonorganizations arising from the early life conditions and the structures that define them. Instead, it is postulated that every
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