(2) DUNLAP, K. A. Project for Investigating the Facial Signs of Personality. Amer. J. Psychol. 1927, xxxix, 158. and FERNBERGER, S. W. Six more Piderit Faces. Ibid. 162. (3) GILLESPIE, R. D. Epidemic Encephalitis: some Psychical Sequelae. J. of Ment. Sci. 1924. (4) SULLIVAN, H. S. Affective Experience in Schizophrenia. Amer. J. of Psychiat. 1926, VI, 467. (5) MACCURDY, J. T. Psychology of Emotion. London, 1925. (6) Syz, H. C. Psychogalvanic Studies on Sixty-four Medical Students. This Journal, 1926, XVII, pt. 1, 54. Observations on the Unreliability of Subjective Reports of Emotional Psychogalvanic Studies in Schizophrenia. Arch. Neur. and Psychiat. (7) GILLESPIE, R. D. Variability of the Blood-pressure in some Morbid Conditions. J. of Ment. Sci. 1926, LXXII, 325. (8) GILLESPIE, R. D., RITCHER, C. P. and WANG, G. Ibid. 1926, LXXII, 321. (9) MEYER, A. Genetisch-dynamische Psychologie versus Nosologie. Zeitschr. f. d. ges. Nerv. und Psychiat. 1926, cı, 406. (10) FREUD, S. Character and Anal-Erotism. Collected Papers. 1924, II, 45. (11) ADLER, A. The Neurotic Constitution. London, 1917. (12) MEYER, A. Dementia Precox. Brit. Med. Journ. 1906, 11, 757. (13) AMSDEN, G. S. The Study of the Personality in Mental Disorders. Amer. J. of Psychiat. 1923, II, 501. (14) MCDOUGALL, WILLIAM. Abnormal Psychology. London, 1927. (15) KRETSCHMER, E. Physique and Character. New York, 1925. (16) Medizinische Psychologie. Leipzig, 1922. (17) ADLER, A. Organ Inferiority. New York, 1917. (18) STORCH, A. Primitive-Archaic Forms of Inner Experiences and Thought in Schizophrenia. New York, 1924. (19) HOFFMANN, H. Das Problem des Characteraufbaus. Berlin, 1926. (20) MAGSON. How we judge Intelligence. Brit. J. of Psychol. Monog. Supp. 1926. (21) ROBACK, A. A. Psychology of Character. London, 1927. THE MENTAL HYGIENE OF THE PRE-SCHOOL CHILD1. BY SUSAN S. ISAACS. It will, I suppose, be agreed that no subject of greater psychological interest or practical importance could come before this Society than that of mental hygiene in the little child. As with disease in general, attention has within the last few years shifted from the problem of cure to that of prevention; and this has come to mean, here perhaps more than anywhere, a corresponding shift of interest from the adult to the child, and from the child to the infant. Whether as doctors, social observers or educators, all those who have any concern with the neurotic adult, or with any disturbances of conduct and mental health in youth or manhood, are now developing an interest in the early disposing factors, and possible ways of dealing with these. The intelligent parent is asking for advice as to what he should do to avoid neurosis-if there be anything to be done; and here and there he meets with those who speak with no uncertain voice as to what should be done and what should be left undone. Others of us who have had opportunities of studying both neurotic and normal children at close hand over a long period, and in the light of some knowledge of their parents' minds and home conditions, are more sensible of the obscurities of the problem, and of the difficulties of laying down any broad body of clear and definite principles of certain prophylaxis, in the present state of our knowledge. We know much, but by no means all, nor with complete certainty. I should like to consider some of the difficulties in the way of setting out clear lines of advice for the prevention of neurosis—whether to this or that parent, or as general social and educational doctrine, bearing on the mental hygiene of the pre-school child. If, then, we have come to look for the point of origin of neurosis in early childhood, the first question clearly is how to know the neurotic child, or the neurotic-child-to-be, when we see him. In many cases that is, of course, easy enough. If a child of, say, 1 Being a paper read at a joint meeting of the Educational and the Medical Sections of the British Psychological Society on June 27th, 1928. five or six years has persistent night-terrors, or enuresis; if he masturbates constantly; if he is patently and continually destructive and defiant, stealing, biting, behaving with marked cruelty to younger children; if he is excessively clinging and querulous, if he shows overt anxieties and phobias, or marked speech disturbances such as stammering or refusal to try to talk at a late age-in any of these situations it is easy enough to affix the label of neurotic. The physician will do it at once, and nowadays many a well-informed parent is able to. But it will, I think, be agreed that in these very cases it is hardly any longer a matter of prophylaxis, but already one of well-developed neurosis. If one approaches the problem in a stereotyped way from the point of view of the grown-up, then of course anything that happens in the years under six might be held to be an 'early' stage of development and disease; and anything that is done to alleviate matters might be considered prophylactic. But that is to give a naïve value to the mere passage of time which it does not deserve. All our knowledge of genetic psychology in general, and of the nature of neurosis in particular, runs counter to such a view. The analysis of adults shows that the pattern. of their responses was already firm by the end of the period we are considering, the rest of their development being very largely an embroidery around the original theme. But particularly is this true of the neurotic, since a certain fixity of response, a way of forcing all later experience into the mould of the earlier, is one of the essential characters of neurosis. Young as the child may be in years, the psychology of the neurosis compels us to regard such manifest difficulties as those mentioned as signs of definite and matured neurosis; and the problem in these cases as already one of cure, not prevention. For preventive mental hygiene, our signs must needs be more delicate, and earlier seen. Unfortunately, we have so far hardly any comparative data upon which to go, since the child is not, except in the rarest instances, brought to the physician or the psychologist in the very early stages, while the neurosis can be looked upon as incipient. Clearly, if a child of two or three years is seen by ordinary, unspecialized parents to be even a little abnormal, then it is ill indeed. The psychologist, it is true, can make his opportunities of watching ordinary infants and young children; and since, very fortunately, there have been a few parents who have brought their 'normal' children for observation or analysis on purely prophylactic grounds, the experienced observer has learnt to read the signs to some extent. It needs, however, a very sensitive perception to recognize the neurotic child in the earliest stages. The inherent difficulties are clearly far greater than in the case of the grown-up, since many things that would mark serious illness in the case of the adult are entirely normal in the young child. It is, for instance, quite normal for the young infant to cry and shout angrily when he cannot get what he wants, to fear the unknown, to empty his bladder and bowels when it pleases him, to depend helplessly upon his mother's love and care. These are the characters of the instinctual life of infancy, and are found in every child, whether or not he becomes neurotic. The problem for us is to know how to distinguish at this early age between, for example, neurotic anxiety and the fear normal to infancy; or, again, between neurotic defiance, hiding deep anxiety, and healthy self-assertion. To know in general that it is a matter of how much and at what age, or of the appropriateness, intensity and fixity of emotion, is one thing; to be able to read the situation precisely in any given case, is another. In the highly intensive and sustained observation afforded by the actual analysis of a child, the diagnosis may be clear enough; but apart from this, and from the cultivated perceptions which such experience brings, I suggest that the reading of the less obvious and dramatic signs of ordinary life is far from easy. Clearly there will always be a general tendency to overlook the earliest indications and to under-estimate their seriousness. But let us go on to another difficulty, one of perhaps even wider practical import; and that is, that many of the ways of behaviour in a very young child which would at once suggest the possibility or even the certainty of neurosis to the more experienced observer are actually welcomed by the parent and educator as signs of moral development, or chuckled over as evidences of childish quaintness and precocity. A pleasing docility, the absence of open defiance and hostility, particular tidiness, a precise care in folding and arranging the clothes at bed-time, careful effort not to spill water when drinking or washing, anxious dislike of soiled hands or mouth or clothing, solicitude for the return and safety of the mother or the younger child, meticulous kindness and sensitive dislike of cruelty to other children or pet animals, ritual attention to the saying of prayers, frequent endearments and shows of affection, waiting always until one is spoken to before speaking, the offering of gifts to older and stronger children, an ardent desire to be good or clever, an intense ambition not to have to be helped, docility to punishment, drawing-room politeness, the quiet voice and controlled movements-most of these things either please or amuse the parent. Yet any one of them, and particularly several of them found together, may be and often are effects of a deep neurotic guilt and anxiety. The textbooks have, of course, long been telling the educator that he must beware of 'excessively' good behaviour; the parent who has read anything at all about recent psychology has heard of reaction-formations, and so on. But how is anyone, other than a pure psychologist, and one trained in the study of the neuroses, to know when goodness begins to be excessive, to notice in time that the child is adapting himself only too dangerously well to his 'life-task,' and the demands of adult values? Above all, how is a parent or educator, whose job is to bring about that very adaptation, to be aware of the deep suffering which may be hidden behind the fair exterior of the good child? Let me describe a few examples. Among a group of little children which I have recently had the opportunity of observing, under special research conditions, was a charming boy of four years of age, an only child, of not too robust physical health. As was not very surprising, he was at first shy and timid, on being plunged into the group of ten or twelve very vigorous and lively boys running and shouting freely, and sat very quietly watching. Soon, however, he found his feet, and ran and shouted freely with the others, showing, as time went on, increasing initiative and enterprise. He was essentially a good and tractable child, never showing hostility or defiance. There was no trace of priggishness about him, however, and he was very far from being the 'good child' of the caricature. He was, in fact, distinguished by a robust and delightful sense of humour-he would play at being defiant with the most attractive roguish laughter. Laughter was, indeed, at this stage, the main outlet for his anxieties. For example, he invented a humorous game when using clay, which he very much enjoyed. He pretended that his thumb-nail was coming off, putting a piece of clay on his thumb, and pulling it off, with hearty and infectious laughter. He had, however, before coming to school, shown two symptoms of neurotic anxiety— occasional frightening dreams which woke him up, and nail-biting. Apart from the nail-biting, his governess had no difficulty in keeping him up to her strict standards of behaviour, and, at home as at school, he was a pleasant and amenable child. After a time, under the freer conditions of the group, his nail-biting almost disappeared, never occurring in school-where, indeed, he now stood out among the other children as an unusually well-adapted child, with a free and vigorous mental life, and great aptitude for happy and constructive play. Yet after a year of apparently most satisfactory intellectual and emotional |