Concept
Hospitalism
The physical and psychological deterioration of infants kept for long periods in institutions where they are fed and physically cared for but have no stable, affectionate relation with a mother or a substitute. Paediatricians used the word from the late nineteenth century for the harm done by long stays in hospitals and foundling homes, which they generally put down to infection and poor hygiene. In 1945 René Spitz recast it as a psychiatric syndrome caused by total emotional deprivation in the first year of life: a steep fall in developmental level, withdrawal, retarded growth, susceptibility to illness and high mortality, damage he considered largely irreversible. He set it against anaclitic depression, the partial and reversible form. His studies, and the methodological objections raised against them, fed the post-war debate on maternal deprivation.
Development
1945
reworked by René Spitz
The term was a paediatric one from the end of the nineteenth century; in his 1945 paper Spitz reformulated its causes, tracing the deterioration of institutionalised infants to the absence of a mother rather than to infection.
In Hospitalism: An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood (1945)
1955
critiqued by Samuel R. Pinneau
Pinneau's 1955 review challenged the evidence Spitz offered for hospitalism.
In The Infantile Disorders of Hospitalism and Anaclitic Depression (1955)
Relations
- 1945 reworked by René Spitz
The term was a paediatric one from the end of the nineteenth century; in his 1945 paper Spitz reformulated its causes, tracing the deterioration of institutionalised infants to the absence of a mother rather than to infection.
- 1955 critiqued by Samuel R. Pinneau
Pinneau's 1955 review challenged the evidence Spitz offered for hospitalism.
- gave rise to Maternal deprivation
Spitz and Wolf's interpretation of hospitalism fed into Bowlby's post-war theory of maternal deprivation, and the notion of hospitalism was later widened to severe and lasting maternal deprivation in general.
Works
- 1945
Hospitalism: An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood
In this paper, the first of two inquiries into the genesis of psychiatric conditions in early childhood, René Spitz compares two groups of infants. One lived in a foundling home, where the infants were fed and kept clean but had almost no sustained contact with a caregiver. The other lived in a prison nursery and were cared for by their own mothers. Measured with the Viennese baby tests, the developmental quotient of the foundling-home infants fell sharply and they showed the signs of hospitalism, while the nursery infants developed normally. Spitz attributes the difference to the absence of maternal care. He thereby recasts hospitalism, whose cause had been sought in infection and hygiene, as a psychiatric condition produced by emotional deprivation in the first year of life.
- 1951
Maternal Care and Mental Health
Maternal Care and Mental Health is the report John Bowlby wrote for the World Health Organization in 1950–51 as its contribution to a United Nations study of homeless children: children orphaned or separated from their families and cared for in institutions, foster homes or other group care within their own countries. Drawing on visits to France, the Netherlands, Sweden, Switzerland, the United Kingdom and the United States, and on the clinical and research literature of child psychiatry and child guidance, Bowlby argues that what the infant and young child needs for mental health is "a warm, intimate, and continuous relationship" with the mother or a permanent mother-substitute, one in which both find satisfaction. The lack of such a relationship he calls maternal deprivation. It is partial when a child lives with a mother unable to give loving care, or is looked after by someone other than the mother; it is almost complete when, as in many institutions, residential nurseries and hospitals, no one person cares for the child in a personal way. Part I reviews three kinds of evidence. The first is direct observation of children in institutions, hospitals and foster homes (Spitz and Wolf, Goldfarb, Burlingham and Anna Freud, Roudinesco and Appell, and others). The second is retrospective study of disturbed and delinquent adolescents and adults, including Bowlby's own study of juvenile thieves with an "affectionless" character. The third is follow-up studies. Bowlby grants that few of these studies are conclusive alone, but finds that together they agree well enough to establish that prolonged deprivation in early childhood can do grave and lasting harm to character. He explains this by analogy with the critical periods of embryology, and in the terms of psychoanalytic ego psychology: until the child internalizes the functions of ego and superego, the mother performs them, so deprivation during the phases in which a relationship is formed and sustained arrests their growth. Part II turns to prevention. Children tend to fare better even in poor homes than in good institutions, and deprived children tend to become parents who deprive their own children. The first aim must therefore be to keep families together with economic, social and psychiatric help. After that the report recommends early adoption for the children of unmarried mothers, supervised foster care, and small family-like group homes rather than large institutions. It also asks for humane hospital practices, such as admitting mothers with young children and encouraging frequent visits. The report closes by urging governments to accept that mother-love matters as much to mental health as vitamins and proteins do to physical health, and to act without waiting for complete evidence.
- 1955
The Infantile Disorders of Hospitalism and Anaclitic Depression
A methodological critique of René Spitz's reports on hospitalism and anaclitic depression. Pinneau re-examines the samples, the developmental tests and the published figures and argues that the data do not establish that maternal deprivation caused the decline Spitz described, pointing to gaps and inconsistencies in the reporting and to other factors that could account for the findings. It was printed together with Spitz's 'Reply to Dr. Pinneau' and a rejoinder by Pinneau.
See also
People
References
- Hospitalism: An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood1945Evidence for a relation
- The Infantile Disorders of Hospitalism and Anaclitic Depression1955Evidence for a relation
- Maternal Care and Mental Health1951Evidence for a relation