Book review: The introduction of child psychiatry in Norway – a witness report

Michael 2006;3:92–5.

Sommerschild H, Moe E. (eds.) Da barnepsykiatrien kom til Norge. Beretninger ved noen som var med. Oslo: Universitetsforlaget, 2005. 379 pp. ISBN 82–15–00619–1.

The build-up of child psychiatry as a clinical and academic discipline in Norway is mostly a post-World-War-II process, and in this book the story about it is told by two of the persons central in the development, the child psychiatrist Hilchen Sommerschild and the clinical psychologist Einar Moe. Both of these senior scholars played instrumental roles in the field during many years, and so the book has to be seen as a «witness report», fitting well into the emerging genre of historical literature which provides facts and information for later discussions, interpretations and surveys. The greater part of the book is written by the two editors, and the rest by collaborators and other colleagues.

Please allow this reviewer to clarify his special background for commenting on this book: In the interesting introductory part of the book, sketching the background for the development of child psychiatry in Norway, the authors among other things describe how intelligence tests, as part of the process, came into use in Norwegian schools, intended to be a tool for tailoring teaching and caring support for the individual pupils, however soon being turned into a sorting system for administrative purposes. In the autumn of 1944, at the age of six, the author of these lines was subject to an intelligence test and was swiftly expelled from school because of few answers and a deviant behaviour. I still remember what happened: Half way in the test, consisting of filling in boxes and similar corny stuff, which I perceived as utterly stupid, I worded my opinions about the test and the people presenting it loudly and explicitly and ran away. That made it: Out! Although I quite soon was taken in again, my attitudes towards child psychologists, child psychiatrists, school teachers and the like are still influenced by this incident. However, when reading the book by Sommerschild and Moe, I maintain that this fact is no bias, but a reason for reading with special interest.

The first parts of the book take the reader back to the 18the century, when the new child raising principles presented by Johann Heinrich Pestalozzi (1746–1827) were launched. Institutions aimed at taking care of needy children in his spirit were gradually built up many places, also in Norway. It is refreshing to read that also the authors Sommerschild and Moe question the statement held by the influential French social historian Philippe Ariès (1914–1984) about the historically recent «discovery» of childhood. Parents and children have probably had feelings and worries, even if the historians did not believe in them, and such eternal concerns are what the new attitudes towards the child were about. However, some human institutions replacing family care and intended to give unfortunate children a home, easily could take on a sort of concentration camp hardship, depending on the local leaders, and so they also did.

The development of child psychiatry is closely related to the development of psychoanalysis and the theories on mental dependence of childhood experiences set up by Sigmund Freud (1856–1939). Psychoanalysis early manifested itself as a forceful tool to explore human mind and to treat mental disorders. To treat adult patients this way required medical training, whilst taking children under psychoanalytic cure was free and therefore also taken up by others. A dramatic event, showing for all the dangers of releasing subdued sentiments through psychoanalysis happened when the philosophically trained psychoanalyst Hermine Hug-Hellmuth (1871–1924) was killed by a then 18 year old long time patient.

The early international history was filled with conflicts between different «schools» in theory and practice. A special attention should be paid to the two different directions pursued by the followers of Anna Freud (1895–1982) and of Melanie Klein (1882–1960). Klein’s interest was concentrated on the unconscious mental life of the child, while Freud highlighted motherhood and social life. Norwegian child psychiatry came to develop in the Freudian tradition. A somewhat odd addition to that was the astonishing influence exerted by the eccentric Austrian analyst Wilhelm Reich (1897–1957) who in the years 1934–1939 settled in Norway.

Although built up on biographies of important persons, the general introductory chapters give a broad and interesting survey. The book also touches on clinical examination methods, e.g. is the chapter of the use of a sand box and the observation of children who plays in it, fascinating reading.

On the Norwegian stage local pioneers were active, and they are duly portrayed, such as Helga Eng (1875–1966) and Åse Gruda Skard (1905–1985). However, the really outstanding person for Norwegian child psychiatry was the physician Nic Waal (1905–1960), born Caroline Schweigaard Nicolaysen. Lengthy parts of the book deal with how Nic Waal dominated the further development, gathering people around her like in a royal court. She was obviously beloved and admired, almost like a religious leader; seemingly democratic, yet obviously increasingly authoritative, nevertheless humbly adored by pupils who already were or later became visible and influential members of the Norwegian medical establishment. Also after her sudden death development can be seen as her legacy. She was even honoured with a postage stamp in 2005.

In Norway, the foundation of child psychiatry was closely related to provoking left wing politics and elitist bourgeoisie radicalism, not least because of the orientation by the circles around Nic Waal. The deeply socialistic later General Director of Health in Norway 1938–1972, Karl Evang (1902–1981) was her student days’ fiancée, and her later marriage to the avant-garde novelist Sigurd Hoel (1890–1960) put herself and her professional work on the cultural agenda. Besides that, some of the other people occupied with the new discipline and clinical field of child psychiatry also had personal interrelationships and an eccentric life-style which caught public attention. Private and professional life in the group was more mixed up than society was used to.

The description of the build-up of institutions for child psychiatry in Oslo and in other places in Norway is interesting, but perhaps of more appeal to the internal professional circles than are the general parts of the book, which address a broader readership.

The book tells the story as it was perceived by the actors themselves. In this way it has to be regarded as a «white paper», and it has its values, virtues and flaws as such. The adherence to the «white paper» category is underlined by the cover, which is white, yet astonishingly decorated by a photograph depicting small girls’ feet, a somewhat misleading metaphor for the topic, as outraging boys often were the most visible group in child psychiatry.

As a «white paper», the book tells about something that has more resemblance to the ventures of a movement, to the achievements of missionaries, of enthusiasts who have defeated counterparts and obstacles for the sake of their cause: building up a discipline against odds and practicalities. A historian would then ask for the positions and arguments held by the other side, by the opponents, by those the enthusiasts had to convince. The shortages here are the weaker part of the book, but when it presents itself as a «white paper», the objection is not relevant. The rest of the story has to be written by someone else. This quest for context is especially important because the external reader might wonder: Why was a clinical field like child psychiatry so provoking in society, why not fields like hygiene or microbiology, where, despite that conflicts here e.g. already had been presented by Henrik Ibsen (1828–1906) in «An Enemy of the People» (1882), the evolving body of knowledge should imply even larger potentials for stirring up society. Therefore, this reader had liked to learn something more about the build-up of child psychiatry and its reception in other countries for comparison. However, the topic is these days covered by increasing interest in the field of public health history and has lately been on the programme on several conferences.

The parable referred to in the text, on how the old Greek goddess and daughter of Asklepios, Panakeia, gained in popularity because her treatment of the sick gave more immediate results than did the efforts by her sister Hygieia who worked long-sightedly with disease prevention, is relevant and appropriate in child psychiatry and could have been interpreted even broader and more deeply.

As a «white paper» from Norway the book has its definite place in the source literature. An index of persons had added to the accessibility of the contents, especially because the approach is biographic.

My conclusion: This is an important, well-written work of lasting value in Norwegian medical history. The book deserves to catch attention and should be read with interest also by those who were not expelled from school due to some arrogant child psychologists (who will never be forgotten by this reviewer) more than sixty years ago.

Øivind Larsen

Institute of general practice and community medicine

University of Oslo 1130 Blindern,

N-0318 Oslo, Norway