A CASE FROM GUIDANCE PRACTICE
BY DR ADLER ALFRED
FRITZ, twelve years old, was introduced to our child guidance clinic on the twenty-first of November, in the company of his mother. Dr. Marianne Langer gave an introductory report. The report and explanatory remarks made by the adviser are reproduced here in small type in accordance with the stenographic text:
Fritz, twelve years old, comes into the clinic suffering from enuresis.
He is a militant child, was probably pampered in his early childhood, but was thrown out of this pampered position by some event or other. He does not feel well at present and begins to make such demands on his mother that she also has to attend to him during the night, We must look here for signs of his previous pampered state: that he is slovenly as a rule, probably jealous of a younger or older sister or brother, has difficulties with eating, and wants to be in the center of things and to draw others near himself.
ā¦ frequently during the day ā¦
When we hear that a child wets himself we can infer that it is a case of violent struggle. He is not satisfied with bothering others at night, he does it also during the day. We have also to ascertain whether we are not confronted here with a mental defect. Organic diseases occur seldom in these cases.
ā¦ seldom at night.
While struggling violently during the day, he seems to be in a better situation at night, when he quiets down. We shall not be surprised to learn that he carries on his struggle consciously, and that defiance is an outstanding feature of his character. Defiance is a somewhat more conscious struggle.
He never wets himself when his mother is with him or when he is at school.
This shows that we have to deal with psychic motives. When his mother is with him there is no necessity for drawing her near him. At school he probably does not feel bad either. He may not be a bad pupil at all, or perhaps he does not like the idea of being thrown out of school.
The mother is separated ā¦
Matrimonial discords have a bad effect upon children. When parents quarrel, they often give vent to their ill-humor in the presence of their children. It is a striking fact that backward, delinquent, neurotic, sexually perverse, drinking children very often come from families with unhappy matrimonial relations. It is important to find out whether the child is not overburdened; overburdening is always a cause of difficulties.
ā¦ he lives with his grandparents ā¦
Here we must remember that grandparents generally pamper children. To be sure, not always: if the mother does the pampering, then she is blamed by the grandmother; if the mother does not pamper, then the grandmother does the pampering.
The child used to sleep in the parents' bedroom.
This shows either that the pampered child himself made efforts to be with his parents or that the parents always wanted to keep him near themselves.
At present he sleeps alone.
This circumstance cannot be indifferent to us, it plays a part in the enuresis. If the child slept in the mother's bed, he would not wet himself.
The child is tremendously attached to his mother ā¦
This confirms our supposition that the bond between the mother and the child is a very intimate one. He tries to gain the mother for himself and to use her as a prop.
He is especially pampered by his grandmother.
We see then that we did not go far astray in our suppositions.
Four years ago he was laid up for seven weeks in the hospital with osteomyelitis of the hip and thigh.
This is an ailment which is extraordinarily favorable to pampering. After such an ailment children feel the need of pampering more intensely.
It looked at that time as if the leg would have to be amputated, but it was healed through ancylotic treatment.
In other words we have to deal with a bodily defectāa circumstance that largely contributes to developing a feeling of inferiority in the child. The mere fact that children are pampered is sufficient to generate in them a feeling of inferiority and to deprive them of self-confidence. The treatment by ancylosis tends to intensify this feeling of inferiority and makes the patient rely a great deal upon the support of others.
On account of this disease he did not attend schocl from the age of seven to ten.
It is obvious that he was always in the company of his mother.
At the age of ten he was put in the third class of the school for backward children and he is at present in the fourth class of this school.
To attend a school for backward children means an intensification of the feeling of inferiority if the child is not an imbecile or an idiot. If the child is feeble-minded, he is naturally not aware of the fact that he is exclusively among backward children. A normal child, on the other hand, feels that he is being degraded if he is sent to such a school. Such a child has many reasons to think that he is inferior and degraded.
He gets ahead in school quite well.
If he is normal it is not surprising to see him get ahead. There is no advantage in this for him. To see with one eye among the totally blind is no triumph.
He has some difficulties with arithmetic.
If he is only shown properly how to do the thing, he will certainly be able to calculate just as well as the others.
When one of the pupils is asked a question in school he always butts in with his answers.
This suggests that he is an intelligent boy. This pampered child would like to stand in the foreground. His wetting of the bed is also a means to this end. He plays quite a good role at school, he is probably not entirely dissatisfied, but he would like to be prominent, and this is why he butts in with his answers.
In playing, also, he must always play the first fiddle.
He has his style-of-lifeāa thing not to be found among feeble-minded children. We can say that the school for backward childen is not a place for him. We know that he is not prepared for a normal class as a result of his diseases, and that he could not make much progress there without preparation. It would be necessary to establish a special preparatory school for such children.
He has a brother who is four years older than he and who also has been greatly pampered by his father.
We can infer from this that he has no younger brothers or sisters. He probably goes around with the idea that his elder brother is, in comparison with him, quite favored by fortune. The latter is preferred by the father and he does not have to go to the school for backward children.
The elder brother is very handsome, was left back once, but he is quite a good pupil now. He is very serious and grown-up.
If the elder brother is well-developed and is not to be beaten, then the younger one becomes the chief problem. If the younger one makes good progress, keeps up with his brother and threatens his supremacy, then the elder one becomes a problem. This experience is confirmed in the present case. The elder brother probably does not lose an opportunity to point out that the younger one is in a school for backward children.
The younger gladly plays the clown.
This happens frequently in the case of children who have a feeling of inferiority and who try to push themselves to the foreground. We find in this child three co-ordinated facts: enuresis, the tendency to butt in with his answers when others are questioned, and to play the clown. These are nothing but forms of expression chosen by ambitious weaklings. Anyone with a feeling of self-confidence would not act in this way.
He often cries out at night.
Here again, he looks for attention. That he cries out, that he plays the clown, shows that he is intelligent, that he proceeds in the right way, that he does things in the same way as we would do, if I may say so, if we were in the same position.
With eating he has no difficulties.
A sign that no great errors have been committed by the family in this regard is the fact that the importance of eating is not unduly stressed. The child has started off wrong in his development, and we should really expect him to have difficulties with eating. We must not be surprised at the fact that we fail to observe in the structure of a style-of-life, things which we might reasonably expect on the basis of our experience with the general run of such cases.
He washes and dresses by himself.
In this respect, too, the family has evidently proceeded in the right way.
The parents and the paternal grandparents are blood-relations.
This would properly speaking be of no significance, for the facts observed in this case can also be found in other children. The difficulties cannot be reduced here to heredity. But I should like to point out that I always find marriages between blood-relations among discouraged persons; such persons look for a sort of security in the selection of their life mates, and they find this in persons whom they have known since their childhood. This also bears testimony to a poorly developed social sentiment, because all society is confined for these people to the family. It must not be denied that the offspring of blood-relations may often display organ inferiorities (defects of ears or eyes). But as far as I have been able to establish this is only true in cases where both partners happen to possess parallel inferiorities. We very often see quite healthy children in families with no parallel inferiorities. We are opposed to marriages between blood-relations simply because the proper development of the social sentiment requires the widest blood-mixture possible...