ABOUT THIS BOOK

Before the 1940s, children in the United States with severe emotional difficulties would have had few options for care. The first option was usually a child guidance clinic within the community, but they might also have been placed in a state mental hospital or asylum, an institution for the so-called feebleminded, or a training school for delinquent children. Starting in the 1930s, however, more specialized institutions began to open all over the country. Staff members at these residential treatment centers shared a commitment to helping children who could not be managed at home. They adopted an integrated approach to treatment, employing talk therapy, schooling, and other activities in the context of a therapeutic environment.

Emotionally Disturbed is the first work to examine not only the history of residential treatment but also the history of seriously mentally ill children in the United States. As residential treatment centers emerged as new spaces with a fresh therapeutic perspective, a new kind of person became visible—the emotionally disturbed child. Residential treatment centers and the people who worked there built physical and conceptual structures that identified a population of children who were alike in distinctive ways. Emotional disturbance became a diagnosis, a policy problem, and a statement about the troubled state of postwar society. But in the late twentieth century, Americans went from pouring private and public funds into the care of troubled children to abandoning them almost completely. Charting the decline of residential treatment centers in favor of domestic care–based models in the 1980s and 1990s, this history is a must-read for those wishing to understand how our current child mental health system came to be.

AUTHOR BIOGRAPHY

Deborah Blythe Doroshow is a clinical fellow in hematology and oncology and an affiliate in the Section of the History of Medicine at the Yale University School of Medicine.

REVIEWS

"Emotionally Disturbed is a clearly written and meticulously researched account of residential treatment centers, a largely forgotten strategy for addressing the needs of children with mental illness. This book will remind those who work with, live with, and love such children how a combination of ingenuity, resources, and focused care greatly improved the lives of those whom society had left behind."

— Barron H. Lerner, MD, PhD, author of The Good Doctor: A Father, A Son, and the Evolution of Medical Ethics

"Doroshow's work exemplifies a new generation of historians bent on reinterpreting the history of American psychiatry from a fresh, twenty-first-century perspective. Artfully researched and beautifully written, Emotionally Disturbed explores a little-known aspect of twentieth-century mental health care: the efforts to devise new therapeutic options for 'leftover' children, that is, children and youth so troubled that neither their families nor existing institutions would care for them. Doroshow's work deepens our understanding of the past and present challenges of caring for this very important, very vulnerable group of Americans."

— Nancy Tomes, Stony Brook University

"Meticulously researched and well-written . . . . A welcome contribution to the history of medicine. Highly recommended."

— CHOICE

"The book does a masterful job of explaining how this new category of mental illness came into being and how it related to the emerging field of child psychiatry, as well as to broader changes in psychiatric theory and practice itself."

— Nursing Clio

"Doroshow holds up residential treatment centres not as a perfect model for treatment, but as a riveting example of how we might create change. Her narrative inspires us to examine the cultural ideals quietly shaping our understanding of ourselves and our children. We might not use the word 'normal' these days, but undoubtedly new ideals infuse our understanding of our children and ourselves. What are they? How do they affect even our most progressive approaches to treating children who struggle? Doroshow’s book ultimately represents a case for more history as thorough and sensitive as her own."

— The Lancet

"This is a valuable and interesting book, as Doroshow squarely places the current crisis in youth and adolescent mental health in historical perspective. Government officials, doctors, educational bureaucrats and mental health professionals generally ignore her spot-on push for a continuum of services for those children in dire need of help."

— Social History of Medicine

"Successfully put[s] a human face on emotional disturbance."

— Canadian Bulletin of Medical History

"Part historian and part advocate, Doroshow convincingly advocates for a reexamination of the lessons to be learned from residential care as treatment for emotional disturbance that marked the time of optimism. . . . A needed addition to our understanding of the ways Americans have defined the problems of children who challenged social expectations, children who seemed to fall outside the norm. The book’s insights into the history of the child as the object of psychiatric concern confirm the value of seeing twentieth-century psychiatry not as a monolithic entity, but rather as a system designed for and influenced by age, class, race, and gender differences."

— Journal of the History of Medicine and Allied Sciences

"Clearly written and rich in detail, her book opens not only a window on a little-known chapter in the history of US child psychiatry, but also points to lasting questions and challenges for child mental health care today. . . . Emotionally Disturbed is not only a carefully crafted historical narrative but also a thoughtful reflection about the broader values that should guide social policy."

— Gesnerus

"[An] informative history . . . . Doroshow considers her topic from several angles, weaving together the perspectives of RTC professionals, staff, parents, and even the children themselves into a compelling historical picture. . . . Drawing upon prodigious research, Emotionally Disturbed offers both a detailed overview and a fair assessment of the residential treatment movement. While Doroshow clearly admires the dedication and creativity of its advocates, she is also realistic about their shortcomings. The inclusion of perspectives from parents and children enriches our understanding of residential treatment as a lived experience. . . . Scholars from a range of disciplines with an interest in twentieth-century childhood will find a great deal to learn and appreciate in this fine study."

— Journal of the History of Childhood and Youth

"Doroshow's work stands as a strong pillar of support for psychiatric reform of today’s mental health institutions. This book should be recommended to all historians of medicine due to its dualistic approach, educating those unfamiliar with US paediatric mental health systems as well as expanding the knowledge of advanced scholars with its many detailed case discussions, anecdotes, and insights. We would recommend it as a source of reference for anyone wishing to study the history of post-war American paediatric psychiatric care."

— History of Psychiatry

"A valuable account of how many professionals sought to provide effective treatment and more humane care for troubled children in mid-twentieth-century America.

— H-Disability

TABLE OF CONTENTS

List of Illustrations

Introduction

One     O Pioneers!

Interlude: The Road to Residential

Two     Disturbed Children, Disturbing Children

Three   Playing by Ear

Interlude: Therapeutics in Residential Treatment

Four     The Special Relationship

Five     A New Home

Six       Building the Normal Child

Interlude: Homeward Bound

Seven The Breakdown of Emotional Disturbance

Eight   Discarded Children: The Last Thirty Years in Child Mental Health

Epilogue
Acknowledgments
Key to Archives and Manuscripts
Notes
Index

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