DIVISION VIII-MENTAL HYGIENE 'AL HYGIENE PROBLEMS OF NORMAL CHILDHOOD AND YOUTH THE ELEMENTARY SCHOOL AND THE INDIVIDUAL CHILD wing Richards, Associate in Psychiatry, Johns Hopkins University, Baltimore with hesitation that I venture upon remarks in the field of education. In the e, psychiatrists are accused of curious meddling in so many phases of human that even the modest statement of an observation or two not infrequently converted into dogmatic assertions and prescription for reform. In the second e facts responsible for my remarks at this time are not based upon a long or ge of experience. Accordingly, I trust that what I have to say will be regarded s a series of personal impressions, and not construed as an attempt to assume over the education of the young. laps there is no institution of our social organization where the individual can become lost in the group as in the elementary school. To be sure, we are surth books on the psychology of the child. We speak freely of the backward e nervous child, the incorrigible child, and yet it is theories regarding these hat we take up in actual discussion. In looking over some one hundred advers of private schools not long ago, I was impressed with the same type of fact. is "special attention" given to college preparation, to athletics, to health, to forts of home, to culture, etc., but only one school advertised "special 1 given to the individual child." I suppose the argument offered in defense the school training aims to be ample for the needs of every child. For , its courses of study have been so carefully prepared and standardized hild who repeats his grade once or twice must be backward; again, the boy berately turns aside from a clean bed and a well-ordered classroom to follow a 's wagon, or run with the gang on the street, must have the deep-seated ways of the incorrigible and delinquent to act in a way so contrary to the behavior lows. Are these children misfits in the school system because of some innate deficiency, such as retardation, neuropathic constitution, and viciousness? instances they are, but in many instances the repeating of grades, the temper s, the crying spells, the truancy, are symptoms of difficulties in adjustment rom a more superficial background. In the dispensary of the Henry Phipps ric Clinic of the Johns Hopkins Hospital we examined 143 children during the of September, October, and November, 1920. One hundred came directly or y from the schools of Baltimore and its suburbs. Of this number, 80 were for backwardness expressed by the repetition of grades and uncomplicated by ary troubles. Only 50 per cent of the latter showed actual retardation, accorde Binet-Simon tests. The poor record in class work made by the other 50 per associated with certain facts that can best be discussed by drawing your atten 351 ments of Surveys and Exhibits of the Russell Sage Foundation can be very helpful in this direction. Right here let us pause to pay tribute to Mr. Jenkins and his staff for that most helpful tool for librarians and social workers published by the Russell Sage Foundation. I refer to Social Workers' Guide to the Serial Publications of Representative Social Agencies, a checklist of the publications of 4,000 institutions and organizations arranged alphabetically and by subject. We wonder how we have managed to do without this tool for so long. The library should know the organizations of the town or city-the police department, the fire department, department of health, the charitable organizations, and any and all institutions which are for the purpose of human betterment-know what they are doing and find out by personal interview how the library may be of more service to them and more service directly to the neighborhood. The library should have on file bulletins concerning pending legislation, state and federal, which would be of interest to social workers; know what other towns or cities of approximately the same size are doing and pass the information on to the social worker. There is nothing that furnishes a greater incentive for work than to know that your town is being surpassed by another in a particular field of work. If there is any special survey being undertaken in the community, or if some problem is engaging a particular amount of attention, the library should collect from its shelves and other available places material bearing upon such topics and should notify the general public as well as the social workers that it is available. The librarian has an opportunity to meet young people who are interested in a general way in matters pertaining to community service and to acquaint them with the possibilities for definite training for social work and the field which is open to professional social workers. There should be on file in the library bulletins from all the schools of social work and from the universities which have added a department of social work. So far I have spoken only of the informational side of the library. There is the inspirational side which we must not forget. Social workers, probably more than workers in any other professions, come in contact with the sordid and seamy side of life and in hours of relaxation need to be lifted out of this state of mind. Too often we forget: There is no frigate like a book To take us lands away, Is it biography, travel, poetry, the essay, drama, fiction, or books on the great out-ofdoors you favor? Each and all may be had for the asking. You have but to step upon the magic carpet to be carried to all the world there is and some there never was. You will come back from these excursions stimulated and refreshed and better able to "carry on." Above all the library must be a human organization, interested in the human side of librarianship, and anxious to take its place in the community. If the library staff has not this spirit, no amount of money spent on equipment will ever make it a living factor in the lives of the community. For the secret of creating interest is to be found in being interested. It is the personal equation of the whole library staff that makes the books a living force, or not, in a community. Our libraries must reach out and give wider service. They must co-operate in all new fields of work. There is no such thing as standing still. The instant the forward movement ceases, death begins. Working together we can create conditions that make human progress inevitable. 'hat ery ind 2 DIVISION VIII-MENTAL HYGIENE MENTAL HYGIENE PROBLEMS OF NORMAL CHILDHOOD AND YOUTH A. THE ELEMENTARY SCHOOL AND THE INDIVIDUAL CHILD Esther Loring Richards, Associate in Psychiatry, Johns Hopkins University, Baltimore It is with hesitation that I venture upon remarks in the field of education. In the first place, psychiatrists are accused of curious meddling in so many phases of human activity that even the modest statement of an observation or two not infrequently becomes converted into dogmatic assertions and prescription for reform. In the second place, the facts responsible for my remarks at this time are not based upon a long or wide range of experience. Accordingly, I trust that what I have to say will be regarded merely as a series of personal impressions, and not construed as an attempt to assume direction over the education of the young. Perhaps there is no institution of our social organization where the individual can so easily become lost in the group as in the elementary school. To be sure, we are surfeited with books on the psychology of the child. We speak freely of the backward child, the nervous child, the incorrigible child, and yet it is theories regarding these groups that we take up in actual discussion. In looking over some one hundred advertisements of private schools not long ago, I was impressed with the same type of fact. There was "special attention" given to college preparation, to athletics, to health, to the comforts of home, to culture, etc., but only one school advertised "special attention given to the individual child." I suppose the argument offered in defense is that the school training aims to be ample for the needs of every child. For example, its courses of study have been so carefully prepared and standardized that a child who repeats his grade once or twice must be backward; again, the boy who deliberately turns aside from a clean bed and a well-ordered classroom to follow a huckster's wagon, or run with the gang on the street, must have the deep-seated waywardness of the incorrigible and delinquent to act in a way so contrary to the behavior of his fellows. Are these children misfits in the school system because of some innate personal deficiency, such as retardation, neuropathic constitution, and viciousness? In some instances they are, but in many instances the repeating of grades, the temper outbursts, the crying spells, the truancy, are symptoms of difficulties in adjustment arising from a more superficial background. In the dispensary of the Henry Phipps Psychiatric Clinic of the Johns Hopkins Hospital we examined 143 children during the months of September, October, and November, 1920. One hundred came directly or indirectly from the schools of Baltimore and its suburbs. Of this number, 80 were referred for backwardness expressed by the repetition of grades and uncomplicated by disciplinary troubles. Only 50 per cent of the latter showed actual retardation, according to the Binet-Simon tests. The poor record in class work made by the other 50 per cent was associated with certain facts that can best be discussed by drawing your atten 351 is tha e pre gar an: mer ny the sei fe с tion to a bit of study along this line which has been carried on for several years as a sort of by-product of our psychiatric dispensary. In January, 1918, under the direction of Dr. Adolf Meyer, I undertook some work in one of the Baltimore schools (School No. 76), with pupils who were reported as difficult by parents and teachers. The venture was a piece of private research, quite divorced from any organized activity in the public school system. The school chosen had been the center of an investigation for the study of feeble-mindedness, which Dr. C. Macfie Campbell had made in this locality in 1914. My interest was in the nonfeebleminded, though I followed up the complaints as they were referred, without discrimination. Of the 46 children who came under observation, 35 were reported as having difficulty in keeping up with their grades in one or more subjects. In each of these cases where there was a suggestion of retardation, the Binet-Simon test was applied. As a result, 16 of the above-mentioned 35 were found to have a mental retardation of from three to six years. The academic troubles of the remaining 19 were associated with, if not the disguised expression of, such faulty psychobiological reactions as shyness, laziness, inattention, and vicious tendencies, sensitiveness to criticism, day-dreaming, hypochondriacal fears with resulting irregular attendance. The 11 remaining from the total 46 were referred for the more overt adaptive difficulties of temper tantrums, sullenness, crying spells, twitching, indifference, excitability, poor co-ordination with the hands, quarrelsomeness, etc. In reviewing the data accumulated, one fact stood out-in practically every case the peculiar characteristics for which the child was referred could be easily traced to their first appearance in the early years of school (kindergarten, first and second grades). In the majority of cases also, the unhealthy habits of adaptation began in the home, and were carried into and through the school life, handicapping the efforts of teacher and child to get together on the business of early training in the classroom; and the commonest result of this handicapping was the repetition of grades. Accordingly, it seemed best to devote some time to the first grade with special reference to examining the problem of backwardness at its source. By way of experiment, 18 children were selected from the first grade for special study. Their ages ranged from six to ten, and their years of repeating the first grade from one to three. These children were studied from the standpoint of the story of the home, the story of the school, and the story of the child himself, as recorded under the headings of complaint, school history, habit data, personality traits, and a rough estimate of physical status as obtained from the health records, weight curve, and brief examination. Aside from the Binet-Simon tests no special technique was used, either in the examination of the children or the sifting of facts. The Binet-Simon findings were as follows in 2 cases the actual age and tested age were exactly the same; in 7 cases there was a difference of only one year between the actual age and tested age; in 7 cases there was a difference of two years between the actual age and the tested age; one case objected so violently to examination that it was thought best not to push matters, and one case showed a difference of three years between the actual age and the tested age. It was felt that the difference of one to two years between the actual age and the tested age of 14 of these children represented no real backwardness, but was the expression of various factors in the background, development, early training, and personality traits of the individual children themselves. That these were the facts The details of this study, covering some fifteen months' duration, were published in Mental Hygiene for April, 1920. responsible for the lodging in the first grade seemed more feasible than deficient mental equipment. Turning from the facts of standardization to those of physical condition and living arrangements, there was nothing striking in the story of these little people. There was one mouth breather, and one child with definite eye strain, and two tuberculosis suspects. Several children appeared pale and undernourished, and only two weight curves were below the normal. The habit data were characteristic of this industrial sectioncomparatively late bedtime, with two, often three sleeping in a bed, a diet of coffee, buns, and soup, movies two nights a week. Unideal as these conditions are, it must be remembered that they have not proved a serious hindrance to the school progress of hundreds of other boys and girls. The school records of the members of this group varied little, one from the other. There was the same amount of language difficulty and uneven attendance that is found in the average classes throughout the school, so that here again as in matters of health and living arrangements, one had to beware of overemphasis on obstacles that are commonplace in this community setting. The stories of each child were remarkably similar. John Jones had entered the first grade at six or eight years of age, acquitted himself with a "Poor," and was rolled on to another first grade teacher at the end of a half-year with all the moss of reputation for "dumbness" that he had acquired in first grade sojourns elsewhere. Not infrequently John Jones and I were introduced by the teacher before the whole class with the remark, "I'm glad you've come to examine John. He can't seem to learn a thing. I don't know what's the matter with him. John Jones! stand up and let the doctor see you." Naturally the mental attitude of a child who has been passed from one teacher to another for a year or two without promotion is a very interesting study. Some of these children were calloused to ridicule, teasing, and loud rebukes, both at school and at home. Ambition and the spirit of rivalry had gone. They were bored timeservers in the classroom, often organizing mild revolutions when the teacher's attention was diverted for a moment. Others covered up a sense of shame at not being promoted by various reactions attributed to their being "high strung and nervous." They were exceedingly "touchy" over the slightest criticism or teasing, bursting into tears or explosions of cursing at the most trivial provocation. Still others seemed to have sunk into an uncommunicative state, never volunteering a remark and rarely answering a question, but quietly amusing themselves in a way to escape contact with the environment as much as possible. The general characteristics of the group and the personal traits of its individual members were so interwoven that in many instances it was impossible to say how much of the child's behavior was due to temperamental idiosyncrasies, and how much was a defense mechanism developed to meet the school existence. Each child had his own story of shyness, obstinancy, sensitiveness, fear, laziness, etc., which undoubtedly played a large rôle in his failure to make a good start in school. Following the gathering of data on the foregoing it was arranged with the principal of School No. 76, Miss Persis K. Miller, u Mers be put under the supervision of a teacher who had the time, patience Could be done with the 18 candidates for reconstructive therapy given us by Dr. West, Superintendent of Baltimore Sche 1920. January, 1921, she reported that 10 second-grade work, 7 were making satisfact |