Child psychiatry is itself in its youth as a profession. During the first decades of the twentieth century, it emerged as a subspecialty of adult psychiatry even as that field was becoming established. Essential to the growth of child psychiatry was the acceptance by both the medical professions and society at large of the concept of childhood as a distinct period of human life, with characteristic stages from infancy through adolescence into young adulthood. Although there is some debate on the exact nature of concepts of childhood before the seventeenth century (1), by the nineteenth century, parents, educators, and legislators as well as the medical profession began to view children as in need of special protections and considerations in order to become healthy adults. The separation of childhood years as a focus of study and treatment accelerated near the end of the nineteenth century. Childhood (including adolescence) became an attractive subject of investigation, and many disciplines enlisted in the study of childhood’s special characteristics, needs, disabilities, and therapies. As in the case of general psychiatry, psychologists, pediatricians, educators, and social workers all contributed to the intellectual and scientific foundations of child psychiatry.

Whether the techniques and discoveries of the new field could be expected to mold the child as he or she developed, or if behavior and personality were largely fixed by heredity, has been a source of constant controversy for centuries. In the eighteenth century, John Locke argued that, at birth, the human mind was a blank slate. This idea, supposing as it did that there was no such thing as hereditary privilege, subverted aristocratic claims of divine right and had far-reaching political and social consequences—not the least of which was our own Declaration of Independence, based on the notion that “all men are created equal.” Belief in the power of environmental forces on individual development continued into the nineteenth century, though not without criticism. Severe mental illness, for example, was increasingly seen as hereditary and pretty much hopeless. Gregor Mendel’s discoveries lent experimental evidence to the idea that traits were heritable and to some degree predictable. How to affect heredity in order to improve society (eugenics) was a puzzle, but in time the political, social, and scientific ramifications of hereditarian ideas were as significant as Locke’s contrary faith in the malleability of the mind’s tabula rasa. The debate between proponents of biological determinism (nature) and supporters of environmental explanations (nurture) for normative as well as deviant behavior among children has been with us in one form or another since the beginning of the psychiatric profession.

Two broad channels of research have merged into the creation of child psychiatry: first, the investigation of normative child development, as in education and psychological maturation; and second, the investigation of emotional disturbance and forms of disability. In the area of normative development, the
leading figure in the United States at the end of the nineteenth century was G. Stanley Hall, a pioneer psychologist and educator (2). Hall engaged in a wide variety of investigations on behavior and psychological stages as part of what has been called the “child study movement.” One technique he adopted was to send out questionnaires to see what children at various ages had learned and what they appeared capable of learning. He was interested in activities of children and in the attitudes of their parents and teachers. The questionnaire method was not an accurate device but for the time represented progress toward a scientific basis of child development. The range of Hall’s topical syllabi, as he termed them in the journals Pedagogical Seminary and the American Journal of Psychology (which Hall founded), was extensive. Topics included “Anger,” “Some Common Traits and Habits,” “Thoughts and Feelings about Old Age,” “The Teaching Instinct,” and “Educational Ideals.” The syllabi were one to four pages each and distributed to appropriate target groups such as teachers or children. Those returned were tabulated and the statistics reported. Other educators also employed the questionnaire method; one was Margaret E. Schallenberger, who in 1894 published results of an interesting inquiry into moral judgment. Schallenberger suggested that at about nine years of age children shift from a morality of consequences to a morality of intentions, an anticipation of more recent work on the moral and mental development of children (3).

An important feature of the child study movement is the simple fact of affirming sequential development from infancy to adulthood. When normal development could be described, the stage was set for more accurate accounts of deviation from the normal, lags in development, and finding lacunae in the broad front of development. Hall believed that the stages of development recapitulated the evolution of mankind (that, for example, adolescence is the “heroic age” of chivalry and derring-do), and that the inevitable unfolding of this developmental sequence is the foundation of all child study (4).

Several developments in American society, especially the perceived need for lengthier education in a work world characterized by growing bureaucracy and the requirement for business literacy, indirectly stimulated this emphasis on childhood and adolescence. Thus, not surprisingly, the child study movement had its greatest impact among educators, not academic psychologists. Some have suggested this appeal to educators was due to the improved status accorded the teacher when attention was focused on the schoolchild. The rising enrollment and actual attendance at high schools and the significance attached to teaching the majority of children through mid-adolescence made understanding the norms of youth fundamental to education policy and practice. Hence, child study and other approaches to the rules of development were of direct value to educators. Meanwhile these studies were not only of practical value to society but also touched on the more abstract understanding of human nature.

A series of professionals who have offered advice on child rearing, including Hall’s student, Arnold Gesell, and Benjamin Spock, a student although not an adherent of Gesell’s, trace the beginnings of their careers to Hall. In addition, new youth groups were modeled after the kind of analysis Hall had made in his massive, two-volume study Adolescence, published in 1904 (5). The Boy and Girl Scout movement in the period around World War I were intended to harmonize with the child’s specific stages of development. Thus a stream of child development arose directed not at the disturbed or abnormal individual but toward the improvement and understanding of the average child growing up in American society. Again, the readers of this literature were commonly parents and teachers, rather than physicians or academicians.

In the late nineteenth century, child development study began to focus on deviancy, coinciding with a trend in both popular and scientific thought that had its origins in darwinian concepts of evolutionary “progress”—the idea that both healthy development and pathology were based on genetics, and that reproduction among individuals thought to be the most fit would contribute to the betterment of mankind. Of course, Hall and similar researchers were interested in both normality and pathology, so a sharp demarcation cannot be drawn between the two areas of research, but centers increasingly established themselves as primarily concerned with juvenile delinquency, with the retarded, or with a study of emotional stresses or hereditary “defects” that might account for mental disorder.

A cluster of beginnings important to the history of child psychiatry started in 1896 and continued until 1924. In 1896, at the University of Pennsylvania, Lightner Witmer instituted a clinic chiefly devoted to the mentally retarded child; in 1909, William Healy established the Juvenile Psychopathic Institute in Chicago, which advised the juvenile court on the diagnoses of offenders; and in 1924 the American Orthopsychiatric Association (AOA) was established, which brought together the disciplines comprising psychiatric diagnosis and treatment of children with the professionals involved in child guidance: psychiatrists, psychologists, social workers, and the judiciary (6,7). These three events symbolize the broad advance in the understanding and treatment of psychiatrically ill and mentally retarded children, which has continued to the present.

This was the period during which ideas now known as eugenics became prevalent in both scientific inquiries and popular culture, and powerful forces promoted reform of all sorts of social ills that were supposed to have deleterious effects on future generations of Americans. The drive to suppress alcohol consumption was just one aspect of this reformist atmosphere, but perhaps the one with the most profound effect on attitudes toward children and the consequences of parental behavior. Whether or not alcohol consumption affected the health of the developing fetus—or even its genetic structure—and thus the mental development of the child was a subject of heated controversy. Intense fear of the personal and social effects of alcohol pervaded society, and the belief in a safe threshold of alcohol use faded under an onslaught of real and pseudoscience, emotional public campaigns and single-issue politics. Even the smallest amount of alcohol was thought dangerous, for it did at least a little damage and could lead to further drinking and start the experimenter down the road to alcoholism.

Ordinary science, the kind found in peer-reviewed journals, supported the concern over alcohol, especially when a fetus or young children were involved. Researchers studied animals and found that alcohol had a deleterious effect on offspring of mice, rats, and guinea pigs. These studies indicated that alcohol could damage not only the fetus, especially in its early stages of development, but could permanently change the individual’s genetics, so that damage in one generation would be transmitted to later generations. One scientist who provided this worrisome information was Dr. Charles Stockard, Professor of Anatomy at Cornell Medical School. In 1916 he reported his conclusion, after a study of guinea pigs, that:

Stockard’s research was taken up by persons dealing with humans and quickly applied. A New York pediatrician wrote the next year on “Disease conditions in older babies that can be attributed to prenatal influences.” Stockard’s work and that of other laboratory workers and the observations quoted from clinicians would suggest that “cases of retarded development in older children, nervous and irritable conditions, epilepsy, and the various forms of infantilism and idiocy, are in many cases the result of alcoholism in one or both of the parents before conception or possibly of alcoholism in the grandparents or great-grandparents” (9).

A 1905 survey of school children in New York City showed that 53% of children of drinking parents were “dullards,” while only 10% of 13,523 children of abstainers were “dullards” (10). A 1916 study of families showed that alcoholism in a given generation was followed “in the next two to three generations by epilepsy, imbecility, stillbirth, infant death, chorea and tremor” (11).

A contrary position was presented, most notably by the biometrician Karl Pearson, who studied schoolchildren and their parents, among other subjects, and concluded that parental alcohol use was not linked to defects in their offspring (12). Needless to say, the vast majority of writers on the subject attacked him, and even John Maynard Keynes wrote a refutation of Pearson’s methods in the Journal of the Royal Statistical Society (13).

A second doubter was Henry H. Goddard, the renowned Director of Research at the Vineland Training School in New Jersey. Strongly disagreeing that alcoholism was a cause of feeblemindedness, he was surprised “that anyone could have reasoned so falsely” (14). Goddard found that the retardation observed in the families he studied could be accounted for by heredity and accidents, including disease in the child and mother. Goddard had made a famous study of the Kallikak family, a large group of related persons who were marked by retardation, antisocial behavior and poverty (15). He concluded that here too the cause was heredity that perpetuated feeblemindedness over several generations. His research bolstered the Supreme Court decision in 1927 that permitted sterilization of the mentally defective because, as Supreme Court Justice Oliver Wendell Holmes remarked, “Three generations of imbeciles are enough” (16).

The general attitude of writers on alcohol in the era just before national prohibition was summed up by Dr. Alfred Gordon, Professor of Physiology at Jefferson Medical School, when, in 1911, he warned that alcoholism “leads to a degeneration not only of the individual, but also of the species, to depopulation; it is dangerous to society as it produces a slow and progressive deterioration of the individual and an intellectual and physical sterility of the race (17)…”

This is echoed in a social scientist’s warning from 1913:

Coincidentally with Goddard’s work at Vineland, Witmer, at the University of Pennsylvania, and Walter Fernald, in Boston, concentrated on the problems of the mentally deficient. One of the earliest goals of these pioneers was to be able to measure degrees of mental deficiency. Through them, the intelligence tests that have become such a familiar aspect of life in America for the school-aged child were introduced. The mental tests of Binet and Simon were translated from the French, and variations were introduced in the transition to indigenous American tests for intelligence, of which the Scholastic Aptitude Tests and the Weschler Adult Intelligence Scale are contemporary examples (19).

Dr. William Healy’s leadership in the treatment of wayward children illustrates the commitment of a different group of professionals to understanding child development in the context of social environment. Several distinguished individuals in Chicago were interested in the problems of disadvantaged children who were referred to the justice system because of criminal acts. Prominent among those persons who brought Dr. Healy out of a neurology practice to a much more psychologically informed investigation of juvenile delinquents were Ethel S. Dummer, a philanthropist, Julia Lathrop, later the first head of the U.S. Children’s Bureau (1912), and Jane Addams, social worker and founder of Hull House in Chicago, where the planning meetings were held for what would become the first juvenile court clinic. These individuals persuaded Healy to inform himself, through travel and study, on the best techniques for understanding and treating youthful offenders.