TY - JOUR
AU - Hirshbein, Laura D
AB - Summary Throughout its history, American child psychiatry has been a hospitable specialty for women physicians. In its early years when practitioners were often steeped in psychoanalysis and influenced by theorists such as Anna Freud, many leaders within the field were women. By the 1960s and 1970s, child psychiatry was moving away from analysis and towards more research-based practice. The biography of an important leader in this area, New York University’s Stella Chess, illustrates the mechanism of that transformation and the role of ideas about mothers and working women. Chess, along with her husband and collaborator Alexander Thomas, gathered data to disprove the popular notion that mothers were to blame for children’s behaviour problems and demonstrated instead that issues resulted from a poor fit between a child’s temperament and his/her environment. Chess not only demanded that facts support theory, but also used her own parenting experiences and common sense to guide her work. women physicians, child psychiatry, psychoanalysis, mental health, temperament, Stella Chess, Alexander Thomas In 1946, psychiatrist Stella Chess published a piece in the journal Nervous Child on the issue of parents’ attitudes and their role in children’s mental and behavioural problems. Chess, who had just finished her psychiatry training, took a stand against the drive towards conformity that structured parents’ expectations. She offered case examples to illustrate that parents who looked for socially derived ideal qualities in their children were at risk of losing sight of the attributes of their actual offspring, with resulting serious emotional and behavioural issues. She named both mothers and fathers in her cases to show their influences. The problem was that ‘parents are seeking reassurance from the children, are using them as a means of gaining security, rather than accepting them as individuals in their own right whose separate identity must be accepted if the fullest and happiest development of both the child and the parent-child relationship is to be assured’. If a child did have problems, she explained that the key to treatment was for parents to recognise that their attitudes were an issue and to shift towards addressing the needs of their individual children.1 Chess’s 1946 paper hinted at the role she would play in the emerging field of child psychiatry over subsequent decades. She not only used language suggestive of psychoanalysis, the dominating theories of the time, but also insisted on the importance of learning from individual children. Chess consistently argued that mothers should not be the sole focus of mental health professionals’ attention. And she articulated that preconceived notions about child development or theories of unconscious conflict needed to be put aside if they did not fit the facts. Chess eventually evolved her ideas into a fully formed and research-backed set of explanations about how the fit between a child’s temperament and his or her parents’ expectations and parenting styles facilitated—or harmed—a child’s adaptation to the world. Chess was only one of a number of women who were important in the field of child psychiatry. Many early members of the field had expansive ideas about the role of child psychiatry in the changing culture and society in the USA, building on older ideas about child guidance and fears of juvenile delinquency.2 The child guidance movement was shaped by women reformers within a framework that some scholars have identified as maternalist, in which women used their expertise with mothering and children to make broader statements about society.3 The enhanced role of women continued as the emerging field of child psychiatry included women (even women leaders) without fuss, fanfare, discrimination or even much in the way of comment. In 1953, 4 of the 17 founding members of the American Academy of Child Psychiatry (AACP) were women.4 Close to 20 per cent of the first large cohort of physicians who were board certified in child psychiatry were women.5 A third of the initial editorial board of the Journal of the American Academy of Child Psychiatry (JAACP) in 1962 was comprised of women, and the journal was edited by two different women from its founding until 1975.6 And the main theoretical thrust of child psychiatry for decades was its attention to how mothers cared for their children. During Chess’s career, which spanned from the immediate post-World War II years through the 1980s, child psychiatry was transformed. In its early years, it was dominated by the intellectual framework provided by psychoanalysis. Like adult psychiatry, the professional approach towards children also employed theories originally elucidated by Sigmund Freud. For children, however, the field was enriched by the insights of Anna Freud and other prominent women analysts. As Boston University psychiatrist Eveoleen Rexford explained in 1962, psychoanalysis provided a critical research base for child psychiatry: ‘Child analysis is a research tool of unparalleled value in investigations of the emotional life of the child, yielding data inaccessible to any other approach and hypotheses rich in potential for studying a wide variety of mental and emotional phenomena.’7 Analysis in children, Rexford asserted, was the way forward for the profession. As Rexford’s 1962 statement illustrates, child psychiatry from that time was based in research. Psychoanalysts in general were confident that their research was valuable, and volumes of writings were devoted to case histories to delineate the evolution of neuroses and the mechanisms of emotional disturbances.8 Yet by the late 1980s, child psychiatrists had largely abandoned psychoanalysis in favour of a shift towards medications, specific diagnostic criteria and a focus on neuroscience and the brain.9 The presence of research was not what changed. As historian Jonathan Sadowsky has pointed out, the transition from psychoanalysis to biological psychiatry in adults involved much more intermingling than a swing from one approach to another.10 Rick Mayes and Adam Rafalovich suggested that, at least for attention deficit disorder in children, medications and diagnosis evolved together and gradually overtook psychoanalytic psychotherapy.11 But attention deficit disorder was only one element of child psychiatry practice. How did psychoanalysis take a back seat within the broader field? And what happened to the focus on mothers? The biography of Stella Chess provides an important window into the major changes in the field and particularly how personal and professional concerns could empower a woman to help shift the profession from psychoanalysis to a different kind of research and data-driven approach. Chess was trained as a psychoanalyst but was dissatisfied with what she (and others) felt was a rigidity within the analytic field, especially the focus on mothers’ failures as aetiology for mental disturbance. Chess, along with her husband and research collaborator Alexander Thomas, began a longitudinal study of middle-class children in New York and developed a model of interaction between children and parents and the environment more broadly. Chess was committed to social justice and emphasised the importance of understanding children’s social and cultural contexts. Furthermore, she was a data-driven researcher who helped to shift child psychiatry towards observations that could be measured. Chess was one of a small number of child psychiatrists trusted by Robert Spitzer, the architect of psychiatry’s Diagnostic and Statistical Manual (DSM). Chess brought her life experiences, including those involved in her own parenting and her personal and professional partnership with Thomas, along with a passion to understand why and how things might happen. Although she did not single-handedly change the profession, she did lead an important cohort of investigators down a path that redefined how child psychiatrists approached their work. Opportunities and Opinions Stella Chess was born in 1914 into a family in which books and education were expected for girls, as well as boys, and went to Smith College with the original plan of becoming a teacher. Instead, she chose medicine and graduated from a medical school at New York University (NYU) in 1939. Chess recalled that the expectation for women medical students at the time was that they would go into paediatrics or gynaecology. She was not interested in what she called ‘sexist tracking’ and looked for alternatives. She went to a lecture by the pioneering Lauretta Bender, the director of the Children’s Psychiatric Services at Bellevue Hospital, who talked to the students about mental illness in children. Chess was hooked on both the topic and the model of a woman physician as demonstrated by Bender, who was pregnant when Chess first saw her give a lecture.12 Chess volunteered on Bender’s ward for disturbed children at Bellevue and then went in practice with children. She married a fellow medical student, Alexander Thomas, and they eventually raised four children of their own.13 Chess, like many in her generation within child psychiatry, was trained in psychoanalysis. Advocates for children at that time were passionate about the idea that early intervention into children’s lives could prevent major problems in the future. What was needed was painstaking management of children’s drives and defences, as well as treatment of mothers and their often conflicted approaches to their children. There had been many within the nascent child psychiatry profession from the 1930s through the 1950s who saw promise in applying Sigmund Freud’s insights to children—especially with the specific work done by Sigmund’s daughter Anna Freud who worked directly with children.14 Child psychoanalysis seemed to be a fruitful field for women practitioners who understood the richness of the interaction between mothers and infants.15 But when Chess entered the field, there was a growing disconnect between those who favoured adherence to all of classical psychoanalytic ideas and those who wanted to question dogma and explore new insights, even within the realm of the unconscious. As Chess recalled years later, she had the opportunity to train with psychoanalytic maverick Karen Horney after Horney and others created the American Academy of Psychoanalysis, a group intended to have a broader, more intellectually open exchange of ideas around psychoanalytic theories.16 Chess later said that she had learned about the value of gathering data from Lauretta Bender and the importance of avoiding rigidity in theories from Horney.17 Chess, like Horney, challenged conformity when it did not fit her observations about children and their families. In the 1950s when Chess was gaining expertise in the field, conformity was an integral element of American culture. During the post-war decade, businesses and advertising, public policy and private assumptions steered families towards ideals based on white, middle-class stereotypes. Although these stereotypes did not necessarily match reality for most American families, the ideal was hard to avoid.18 As historian Deborah Doroshow has pointed out, within the white middle-class ideal, the concept of a ‘normal’ child took root for both boys and girls. Doroshow described the creation of new spaces for children who did not fit these norms, children who were loosely described by the label ‘emotionally disturbed’.19 Cynthia Connelly has also explored the efforts of psychiatrists such as Lauretta Bender to use medications to treat children who did not conform to ideals of the time.20 Stella Chess, however, criticised the stereotypes of normal children and the ways in which cultural ideas were specific to race and class. One of Chess’s expressed dissatisfactions with psychiatry, especially psychoanalysis, was the ways in which foundational theories contained biases with regard to race. Early in her career, Chess was the medical director of the Northside Clinic, a multiracial child mental health organisation founded by African American psychologists Kenneth and Mamie Clark in Harlem. In her work at Northside, Chess saw the effects of structural racism and environmental discrimination on children’s mental health.21 In 1953, Chess authored a paper with her husband Alexander Thomas and Kenneth Clark that called out the problems of psychoanalysts using interpretations gathered from white children. As they explained, ‘pseudo-scientific distortion in the thinking of psychiatrists may do irreparable harm if the individuals having these prejudices are charged with the responsibility of providing therapy for minority group members assigned to them’.22 Chess insisted that psychiatrists owed it to their patients to understand children’s family and environmental contexts. She dismissed the concept of the ‘emotionally disadvantaged child’ by pointing out that the concept had racist bias embedded within it.23 Chess was a good fit at Northside as she encouraged an open atmosphere with multidisciplinary collaborations that were intentionally non-hierarchical and flexible to meet the needs of the children.24 Throughout her career, Chess advocated for the particular skills and expertise of different members of her clinical teams. Chess was an active member of the multidisciplinary American Orthopsychiatric Association (Ortho). She was sponsored for membership within Ortho by prominent woman psychiatrist Viola Bernard who attested that Chess worked well with other disciplines.25 In the years before the formation of a specific professional group dedicated to child psychiatrists, Ortho was in essence the organisational home for the field and combined academic inquiry with social justice advocacy. Chess fit well within the organisation’s structure and mission and published frequently within its journal. Chess was also an early member when the AACP emerged in the early 1950s. She forged tight connections with influential leaders of the field, including Lauretta Bender. She became an admirer of Johns Hopkins psychiatrist Leo Kanner, often identified as the father of child psychiatry, in reading his writings and listening to his talks at academic meetings. She eventually met him in person, and he developed such respect for her in return that he referred patients to her. Kanner encouraged child psychiatrists to avoid rigidity and branch out to work with other disciplines and in other locations, especially the schools.26 Chess recalled that her relationship with Kanner was founded on their shared desire to gather data and avoid overarching theories for which there was not adequate evidence.27 Kanner wrote the first textbook of child psychiatry in 1935. When Chess published what was identified as the second textbook in the field in 1959, her work was hailed as the logical successor. Like Kanner, Chess’s work was written clearly, without jargon, and with respect for children and for the important work of the field. But her criticism of psychoanalytic theories was initially subtle enough that some reviewers could read her as being entirely analytic, while others accused her of failing to address the role of parents in creating children’s unconscious conflicts.28 In the first couple of decades of her career, Chess embodied a focus on several aspects of psychiatry that helped steer the profession in a different direction from its founders. Many of the pioneering women in child psychiatry used the profession’s focus on the centrality of the mother figure in child development, a stance that helped to support the role of women in the field but may have diminished the status of the profession.29 Chess, however, took a much more critical approach towards the role of mothers. As she repeatedly explained, theories about child development had been swinging back and forth between nature and nurture, from strictly constitutional ideas about inborn capacities to theories of the complete dependence of children on their environment. She said that it was not one or the other but rather both.30 Furthermore, she emphasised that theories were fine, but they needed to be supported by facts, and she put most of her energy over subsequent decades gathering those facts. Parents and Families Chess and Thomas were dissatisfied by the gaps between the theory and the real children and families with whom they were interacting in clinics associated with NYU where they were both on faculty. Chess in particular was vocal in her critique that mothers had been blamed for too much of their children’s problems in classic psychoanalytic theory. She observed that mothers could become crippled with anxiety around the idea that their every action—or thought—could result in the long-term success or failure of a child.31 There was so much more to a child’s environment than just the mother, though. Chess and Thomas wanted a more practical way of approaching children with mental health issues. Although they were primarily clinicians, Chess and Thomas collaborated with a growing team of professionals who could help them with assessments, evaluations and data collection. The team began a longitudinal study of children from NYU in 1956. They recruited more than 130 infants and followed them (with their parents) over decades. They assessed the families and also looked at their interactions. As they explained in numerous publications over the years, the critical feature of the longitudinal study was that it was something that Chess called ‘anterospective’. It was not looking backwards at what happened in the past (retrospective) but rather was getting data in real time that would later be important in determining what factors had led to which outcomes.32 In language that was later echoed among the teams that worked on the nomenclature committee within the American Psychiatric Association (APA), Chess’s team promised that they would take a neutral stance with regard to theory and follow where the data led.33 In their work, they discovered that a child’s inner conflicts were not the only determinant of issues. Instead, Chess and Thomas and their collaborators found that children and parents interacted with each other in ways that influenced both the child and the parent. They identified nine different aspects of behaviour and rated them in levels of intensity. The team then grouped children in rough categories based on how they scored on these temperamental elements. They found that parents were a valuable source of information, but they discovered that they needed to interact with parents frequently in order to make sure that the parents’ recall of events was not distorted by time. The team described the extent to which they would strip parent reports of interpretation to obtain a strict recording of facts.34 Chess’s team identified three main patterns in temperament of children that could affect how they progressed (or ran into difficulties)—easy, slow to warm up and difficult. Easy children adapted quickly to change, were eager to try new things and generally wanted to please their parents. Children who were slower to warm up initially rejected new things but could eventually be brought to accept them. Difficult children were more irregular in their habits and had strong and negative reactions when introduced to new things. Chess and Thomas noted, though, that a child’s temperament was not determinant. Instead, they concluded that successful childrearing depended on what they called the ‘goodness of fit’ between the child’s temperament and the parents’ style of interaction.35 Easy children could still have problems if they experienced inconsistent environments (such as major differences between home and school expectations), and difficult children who were parented with their individual needs in mind could flourish. The goal of the longitudinal study was to gather data on children who had not necessarily been referred for psychiatric care. But in the process of the study, Chess’s team developed a procedure for assessing children who manifested more severe behaviour problems and needed additional help. The data they gathered about the circumstances of behaviour problems led them to emphasise interactions between children’s temperaments and their environments. They pointed out in their publications about these children that as a result of their findings, ‘one is led to question the utility of the complex intrapsychic explanations’ within traditional psychodynamic formulations. Furthermore, ‘One is led to wonder whether some of these explanations have not been developed as imaginative substitutes for a lack of anterospective developmental information.’36 Although Chess never entirely abandoned the language of psychodynamics in her work, she essentially accused analysts of creating stories to understand children instead of dealing with the individual children themselves. One of Chess’s passions was in making sure that parents got the help that they needed—and especially that mothers were reassured that everything was not their fault. As historian Kathleen Jones pointed out, the incorporation of psychoanalysis into child guidance clinics by the 1940s had led to a significant shift in the population of children who had access to help.37 Instead of focusing on children with severe problems or issues in their communities, psychoanalytically dominated clinics limited access to children who seemed amenable to long-term analysis—a population that skewed more towards middle-class and well educated.38 Like many in the field by the 1960s and 1970s, Chess expressed frustration with the pace of treatment and the lack of access to resources for traditional, psychoanalytic encounters with children.39 The profound mismatch between the number of trained child psychiatrists and the enormous quantity of emotional and behavioural issues in the USA was causing increasing concern. Although some within the field shrugged off the problem and continued to push for intensive, individual child psychoanalysis as the only method to help children, others worked on creating more responsive options. Chess, for example, formed a consultation unit at NYU to allow for team-based psychiatric evaluations, with collaboration, consultation and flexibility in getting help for kids.40 Chess and Thomas also reached out directly to parents to provide them advice on how to manage their children. In 1965, they (along with their colleague Herbert Birch) published a book of advice intended for parents entitled Your Child is a Person. In plain language with abundant common sense, Chess and Thomas reassured parents that everything was not their fault and that what mattered most was understanding their individual child and how their parenting style was (or was not) meeting the child’s needs. One chapter seemed directed at Chess’s own parenting cohort—‘The Working Mother: Not Guilty!’ The chapter recounted two recent episodes of young women with small children who were trying to get training in child psychiatry but were told by men in the field that they should not risk their children by returning to work. As Chess and Thomas explained, however, all this seemed to do was raise anxiety in the mothers. ‘The assertion by many psychiatrists and psychologists that the working mother hurts her children causes a mixture of anxiety, guilt, and resentment in large numbers of women.’ Yet the evidence (which was carefully reviewed by the authors) did not show any differences between children raised with the help of substitute caregivers and those with mothers who stayed home.41 Your Child Is a Person was reprinted a number of times over the subsequent decades and appeared in paperback in the early 1970s. Chess and Thomas knew that their work directed at parents was important to explain their longitudinal study (and other research) in clear language. But Chess understood that the longitudinal study could be limited because it included only middle-class white children. So Chess and her team expanded their work to include children from a variety of different groups. They recruited a sample of Puerto Rican children to which they had also used the same data-gathering methods and additionally studied samples of children with a variety of issues, including mental retardation and congenital rubella.42 Chess seemed to approach parents and children with the assumption that they were doing their best to adapt to their circumstances. In 1967, Chess and her colleagues presented a paper comparing a preschool group of middle-class white children and lower-class Puerto Rican children on their use of language and tasks. They noted that middle-class children responded to task requests with verbal answers, while the Puerto Rican children did not. But while many in the field had interpreted this difference as due to a ‘culture of poverty’ in the Puerto Rican community, her group found instead that the Puerto Rican families used language for social interactions rather than for task completion. They emphasised that this difference was due to cultural adaptation, not deficiency in the children or neglect in the parents—and the disadvantage to the Puerto Rican children in educational settings could be overcome by adaptations by the schools.43 Throughout the 1960s and 1970s, as the cohort of children in the longitudinal study aged, Chess did more and more collaborations with educators on the role of temperament in the classroom. She presented before the American Public Health Association on the role that temperament played in classroom performance, learning and the development of school phobia—and suggested that temperament was more important to school success than intelligence.44 She also collaborated on helping psychiatrists learn about school settings so that they could be more effective in helping children.45 While psychoanalysts had been interested in school settings since the time of Anna Freud, Chess took a different approach towards what psychiatrists had to teach educators about children’s emotional and behavioural attributes. Psychoanalysts wanted to address early childhood repression of drives and the subsequent effect on behaviour.46 Chess saw that school itself was a setting for interaction between a child’s temperament and the challenges of the environment. Chess consistently looked outward beyond the mother–child dyad that was the hallmark of understanding children among psychoanalysts. For the 1969 second edition of her Introduction to Child Psychiatry, Chess expanded even farther to incorporate concepts of community psychiatry within the text because of its importance: ‘Community psychiatry involves all the relationships with schools, pediatric clinics, recreation centers, baby health stations, and community agencies that are relevant in case finding, diagnostic understanding, and treatment efforts calling for environmental manipulation.’47 A reviewer of her book praised her broader perspective on treatment options from the first edition (from psychoanalysis to other methods) and also her sense of competence in the field.48 Like pioneers in adolescent medicine described by historian Heather Munro Prescott, Chess wanted to expand paediatricians’ views of children and adolescents, parenting and mental health, and the role of the environment.49 And she and Thomas made efforts to reach out to paediatrics audiences. In 1977, they published a review article in the glossy summary journal Pediatric Annals. They emphasised the role of temperament and the value of parent guidance. They offered the hope that paediatricians could manage most concerns that were brought to their offices, unlike many of their colleagues whose main advice to paediatricians was to identify signs in children that would require a referral to a child psychiatrist.50 Chess took on some of the most complex and difficult problems in child psychiatry with her approach of gathering data first before coming to conclusions. She pointed out that although hyperactivity was a common reason for presentation to mental health clinics, it could have a complex set of causes that included both environment and brain function.51 Furthermore, Chess and collaborators looked at children diagnosed with autism or childhood schizophrenia (at a time when the two terms were used interchangeably) and focused on behavioural descriptions rather than on assumptions about parent attitudes.52 Chess took her method of assessing children's temperament in interaction with the environment to further understand how to manage schizophrenic children.53 As a biographer later noted, Chess had a young daughter who became profoundly impaired after a bout of meningitis.54 Chess became interested in disabled children and collaborated on investigations of temperament, environment, and management of children handicapped in different ways. She looked at mentally retarded children with behaviour problems and what factors led to some parents to be able to manage their children at home without institutionalising them.55 Chess helped to remind her colleagues that mental retardation fell within the scope of child psychiatry, and that just because retarded children were vulnerable did not mean that they were inevitably headed towards institutionalisation.56 Chess’s reputation as a researcher and independent thinker led her to have significant opportunities within child psychiatry as more investigators split from the psychoanalytic tradition of the field. Chess demonstrated her careful use of data and her assessment of variables in studying children. Chess’s approach was at the vanguard of shifts in child psychiatry as a whole when the profession shifted its publications away from psychoanalytic case studies and towards data-driven analysis. When the editor of the JAACP stepped down in 1975, her replacement Melvin Lewis announced that the journal was going to become more focused on research to take the field into the future. For this project, he asked Chess—who had been on the editorial board of the journal from the beginning—to become an associate editor to help raise the scientific level of the journal.57 Towards Diagnostic Categories Although Chess insisted that behavioural disturbance in individual children was due to problems in the interaction between temperament and environment, she did advocate for basic diagnostic categories of disorders. Like others in research who wanted to develop more careful diagnosis in psychiatry, she pointed out that it would be impossible to compare research studies that were using different diagnostic groupings. So Chess became prominent in efforts to solve one of the more vexing questions in child psychiatry—how to classify children with emotional and behavioural problems. Psychoanalysts generally did not use diagnostic categories for children, arguing that every child was unique and that it would not be possible to classify them into types. But this stance was untenable for those involved in research who wanted to have some agreement about types of problems and possible interventions. The Group for the Advancement of Psychiatry (GAP), an activist group that was created in the late 1940s out of frustration with the slow pace of change and general conservatism of the APA, created a committee to look at the question of child diagnoses in 1966, and they published a classification.58 Chess was asked to be on the GAP Committee as her working classification of child disturbances was one of the pieces of data used by the GAP to create a large framework. Although she was unable to promise to prioritise weekend meetings of the Committee ahead of her obligations to her family, she was named as a consultant to the project and thanked for her contributions.59 With great care and in substantial detail, the GAP Committee on Child Psychiatry explored theories of development and ideas about aetiology of disorders. As they explained, when they began their work, there was no comprehensive way to address ‘the intricate interrelationships among somatic, intellectual, emotional and social processes and phenomena in the developing child … comprehended and organised in a thoroughly logical, all-inclusive fashion’. The GAP Committee proposed a classification with major categories to include healthy responses, reactive disorders, developmental deviations, psychoneurotic disorders, personality disorders, psychotic disorders, psychophysiologic disorders, brain syndromes, mental retardation and other disorders. The naming of the disorder types, especially the language of reaction, suggested adherence to at least some psychoanalytic concepts, though it was by no means orthodox. The classification provided descriptions of these disorders but not particular instructions for how to make them. The assumption seemed to be that this was a reasonable guide with which to sort children who might come to psychiatric attention. While the classification included symptoms, there was more of a connection between presumed cause of the problem and the diagnosis than the particular symptom constellation.60 The members of the GAP Committee on Child Psychiatry understood that a nomenclature for child disorders was only the first step in trying to manage the multitude of concepts, opinions and agendas of people trying to address the mental health of children. In the mid-1960s, at the same time that the GAP Committee was formulating the child nomenclature, the Joint Commission on the Mental Health of Children (JCMHC) was gathering data and opinions on the full expanse of issues related to children’s emotional welfare. The JCMHC, which was initially created in response to the finding that President John F. Kennedy’s assassin, Lee Harvey Oswald, had not received recommended treatment for mental disturbance as a teenager, created a sprawling array of suggestions to address children’s mental health. Many of the leaders in American child psychiatry were involved on some level with the JCMHC, which published its findings in 1970.61 But this big picture, socially aware approach to children by the GAP and the JCMHC was in direct contrast to how psychiatrists within the APA were beginning to address adult mental illness by the 1970s. It is not particularly surprising that there was a disconnect. Child psychiatrists had been fairly separate from the APA since the founding of the AACP in the early 1950s. The American Journal of Psychiatry remained a venue in which some members of the specialty organisation published their work. But in general, child psychiatrists found less in common with their colleagues who addressed psychiatric issues in adults than they did with other professionals who worked with children. The issue of diagnosis in particular was one that tested the relationship between the two psychiatry organisations. The APA had published the first edition of the Diagnostic and Statistical Manual (DSM) in 1952 in response to a need to classify the broadened numbers and types of cases of patients seen in hospitals and clinics after World War II.62 The second edition of the manual, published in 1968, was similar in scope and function to the first—that is, the volumes were of use internally in the profession but of little significance to broader society or mental health community. In the 1970s, the nomenclature committee of the APA was led by New York State Psychiatric Institute faculty member and measurement enthusiast Robert Spitzer.63 Spitzer assembled small committees of research-minded psychiatrists to rewrite the DSM to create not only just a list of diagnoses but also criteria to define each of them. The criteria as Spitzer and others conceptualised the categories were based on symptoms rather than the presumed cause of the illness. One of the DSM committees was tasked to address diagnoses in children, and Chess and a couple of other child psychiatrists were asked to be members. In many ways, Chess was an ideal person to participate in the DSM revision process. She had been an associate editor with the JAACP for more than a decade and was used to evaluating evidence in professional writing. In the early 1970s, she was also asked to be an associate editor for Leo Kanner’s journal, originally titled Journal of Autism and Childhood Schizophrenia. As Chess outlined in the journal in 1972, one of the challenges in child psychiatry was to understand that similar symptoms could be visible but represent completely different causes of the problem. She insisted that it was critical to avoid dogmatic approaches, and that it was necessary to develop data analysis techniques.64 As Chess explained to a concerned New York colleague in 1976, Spitzer approached the idea of psychiatric diagnosis by gathering small groups of experts and making them discuss concepts until they could reach consensus. She further noted that they agreed that behaviours needed to be described without reference to specific theories, and they also included behaviours that might or might not be in existence to allow for study in the future. She clarified, apparently in reference to concerns that the proposed nomenclature was eliminating psychoanalysis, that they were explicitly not using a psychodynamic point of view but rather using descriptions that could be employed by any practitioner regardless of theoretical orientation. As Chess noted, Spitzer provided all members of his committees with voluminous correspondence relating to every aspect of the topics under discussion.65 Though Chess was satisfied with Spitzer’s process and orientation away from psychoanalysis, the majority of child psychiatrists were not. University of Colorado child psychiatrist Dane Prugh, who had been a primary architect of the GAP classification and was involved with the JCMHC, was troubled with how little Spitzer included the viewpoint of child psychiatrists. Prugh felt that Spitzer only selectively allowed input from others, and his group dismissed the GAP work because they said it had not been validated.66 Spitzer did not ask the AACP for official input into the proposed nomenclature, and there was considerable suspicion and some overt animosity on the part of the child psychiatry organisation. J. Gary May, who acted as a liaison with the child and adolescent advisory committee for Spitzer’s nomenclature task force, complained that child psychiatrists were not really being asked their opinion. He also noted with disapproval that the proposed nomenclature was oriented around a specific kind of research (biological and statistical rather that dynamic), and that it only had a limited reference to developmental factors. Furthermore, May observed that the DSM leadership was pushing the agenda based on their own perspective and were not really open to alternative suggestions. Finally, May complained that the DSM did not reflect child psychiatric practices or teachings.67 The watershed DSM-III was published in 1980. Child psychiatrists were generally dissatisfied with how the APA had represented their patient population and issues, though the new nosology expanded public interest in specific diagnosis in children.68 Going forward, Spitzer and the APA allowed for a more formal relationship with the AACP. Chess was invited to be part of a larger group that tried to make substantial recommendations for the revision of the manual, what eventually became the 1987 DSM-IIIR.69 Although the child psychiatry organisation members were not satisfied with the results within the publication of that edition of the manual, either, there were more interactions with the APA regarding concerns about psychiatric diagnosis and children. By the late 1980s, the leadership of the AACP (which had become the AACAP, the American Academy of Child and Adolescent Psychiatry) had integrated more with the APA process. For better or worse from the AACAP perspective, Spitzer had been removed from his leadership role in the DSM revision process, and there was a new group managing the evolving nomenclature.70 Chess ended her role within the AACAP’s diagnostic category committee and focused on continuing to advocate on themes of temperament and goodness of fit. Though Chess had been on the DSM advisory committee that helped to set criteria for mental illness definitions in children, she never fully embraced the method of diagnosis suggested by DSM-III and its subsequent editions. Instead of using symptoms to derive the diagnosis, Chess emphasised understanding the child in his or her context. Children who were otherwise fine might still manifest problems if they were in environments that held them to unreasonable expectations. She also stressed that no single type of treatment should be offered to all patients. Research, treatment options and classification were all important. But Chess came back again and again to the key factor, the individual child in his or her environment.71 Festschrift for Chess and Thomas Chess was in some sense a maverick in her field. She was questioning and critical of psychoanalysis at a time when many members of the field embraced its theory and practice patterns. But at the same time, she also had opportunities to lead child psychiatry and was involved in two of the areas that resulted in major changes in how psychiatrists approached child mental health: diagnosis and research. Without apparent difficulty, Chess followed her mentor, Lauretta Bender, in terms of having a full family life along with a flourishing career at a time when many women found themselves forced to choose between one or the other. Chess found an ideal partner in her husband, Alexander Thomas. As a biographical sketch of the two of them noted, Chess and Thomas had complementary strengths, and they both turned down conferences and professional opportunities because of their shared commitment to family life.72 Though Chess was part of a team, her identity as an authority figure in her own right was widely recognised. In fact, she had admirers who encouraged her to write more and put her wisdom into training materials for students and residents. British psychiatrist Michael Rutter, who collaborated with Chess and Thomas during a year when he was doing a fellowship in the USA, wrote a foreword to another textbook coauthored by Chess. He commented that the text ‘has all the hallmarks we have come to recognise as distinctive of the Chess approach to child psychiatry – gentle yet subtle and penetrating, always appreciative of the feelings and concerns of both the children and their parents, well informed and critically aware of research findings but far from overawed by the contributions of science, and above all immensely practical’.73 A reviewer of her textbook praised her big picture perspective and her concerns about prevention, as well as service delivery.74 One of Chess’s goals in the later years of her career was to encourage interventions with children, arguing that her research demonstrated that things could be changed for the better. In the work she did with Thomas and in her collaborations with others on children with congenital rubella and other handicaps, she stressed that children were flexible and could overcome obstacles.75 As she and Thomas explained in a review article in the American Journal of Psychiatry in 1984, the framework provided by Freud about the early origins of behaviour problems in children was wrong. Children were not irrevocably damaged by early childhood traumatic battles with their mothers over weaning or toilet training. The longitudinal study illustrated instead that children developed problems at different stages of development, often because of a poor fit between their temperament and what was being asked of them. In the end, Chess and Thomas emphasised that the message to take away from their research was optimism about the power of family guidance: ‘In reviewing the developmental course of our subjects, we have been deeply impressed by the human capacity for flexibility, adaptability, and mastery in the face of all kinds of adverse and stressful life situations.’76 Harvard psychiatrist George Vaillant, who was himself conducting a longitudinal study (of men who graduated from Harvard), praised the careful work of Chess and Thomas, especially in being open to finding conclusions from their data instead of using assumptions to guide their findings.77 Chess’s work was very much visible to the public—the paper that she and Thomas published in the American Journal of Psychiatry was covered in the New York Times.78 She continued to aim towards audiences outside of her peer group, including writings for nurses and teachers.79 But she was also attuned to what other messages were circulating in the popular media, especially around issues in mothering. In the early 1980s, she confronted the resurgence of the idea that a mother’s presence was so critical to an infant that she could not possibly leave the infant’s side for fear of long-term damage. In 1976, paediatricians Marshall Klaus and John Kennell published an influential book in which they asserted that newborns who did not adequately bond with their mothers immediately after birth were doomed to long-term negative emotional consequences. Chess praised the effect that Klaus and Kennell’s work had had on reducing germ fears and eliminating sterile newborn nurseries, with the result that women were encouraged to care for their newborn babies in the hospital. But she noted that the consequences of the ideas about the centrality of mother–infant bonding had been devastating in that it resurrected the idea that a mother could not do anything in society outside of her mothering role for fear of damaging her children.80 Klaus and Kennell published a new edition of their book in 1982 retitled Parent–Infant Bonding. Chess commented about this in a paediatrics journal. While Klaus and Kennell responded to some concerns that had been raised about the focus on the mother, Chess complained that the changes in the new edition were not widely known, and that their advice was likely to go too far in terms of pressures on women: We are back to the professional ideology of the 1950s and 1960s, by now fortunately outmoded, in which the causation of all psychopathology, from simple behavior problems to juvenile delinquency to schizophrenia itself, was blamed on the mother. Then the mother's fault lay in her noxious actions during her child's first few years of life and the attitudes, both conscious and unconscious, that determined them – emotional rejection, rigid childcare practices, “double-bind” messages, etc. Now the fault lies in what the mother fails to do, namely, failure to establish skin-to-skin contact with her baby. Further, the time of danger has now been moved back to the first few hours, or enlarged to the first weeks after birth. How, then are parents to provide their children with psychological immunity for the future? Or has the old wine been poured into new bottles?81 Chess pointed out that the evidence on development of emotional or behavioural issues in children did not support Klaus and Kennell’s theories. She also encouraged paediatricians to remember that children were physically and psychologically resilient. By the 1990s, Chess and Thomas were wrapping up their longitudinal study. Their subjects had reached their 30s and were raising families of their own. Chess and Thomas were confident that they had established a body of research on the importance of temperament and interaction with parents. They published review articles and books describing their conclusions. In 1994, they were celebrated with a collected volume of essays written by investigators who had been shaped by their work. Mahin Hassibi, who had collaborated with Chess on a couple of editions of a child psychiatry textbook, noted that Chess and Thomas had been ignored when they first started publishing on temperament, but they had so much effect on the field that many others were following in their footsteps and replicating their findings.82 Epilogue In 1988, Stella Chess contributed an essay to the Journal of the Academy of Child and Adolescent Psychiatry that reflected on the field, its history and its future. She explained that when she began her training, everyone was focused on the damage that mothers supposedly did to their offspring. It was the work of many—including her own group—that broadened the perspective of the field beyond psychoanalysis and mother-blaming towards an understanding of children’s temperament, their social contexts and their biology. She not only lauded the advances in the field but also cautioned that her colleagues should not be lulled into a false sense of complacency about their work. Children were not simple, she explained. Therefore, it was unreasonable to expect that the work of child psychiatry should be simple. At a time when more child psychiatrists were calling for medication therapies, she said that children needed more than drugs: ‘Furthermore, we have learned that our traditional role as advocates for the troubled children carries many responsibilities. These responsibilities do not stop in our professional offices but take us into the schools, courts, day-care centers, and the many governmental and voluntary agencies that are concerned with disturbed or abused children and their families.’ She emphasised the reciprocal relationship between clinicians and researchers and the need to connect research to real clinical practice.83 In the decades after Chess retired, she continued to keep an eye on the field and to periodically comment about things that she felt to be especially good—or particularly harmful. She noted that diagnostic categories could take on a life of their own and that it could be challenging to separate symptoms from diagnosis.84 She praised teaching cases that could help to illustrate multiple points of view rather than just a single perspective.85 Chess and Thomas published versions of their work for general teaching purposes and to summarise the lessons from their longitudinal study.86 But in the time since Chess passed from the field (she died in 2007), child psychiatry returned to the problems she tried to solve with her data—but in a different direction. While others like her were invested in making sure parents did not feel that they were solely to blame for their children’s problems, the solution has increasingly become to blame a brain disorder and to recommend a prescription.87 Instead of being dogmatic in a psychoanalytic approach, child psychiatrists have become increasingly rigid about diagnostic categories and medications—often to the detriment of practitioners who feel constrained by this kind of treatment.88 Chess’s work on the importance of interaction between a child’s innate characteristics and his or her environment appears to be lost from current child psychiatry textbooks, though it continues to influence child psychology.89 Chess emphasised to parents that they could learn to work with their children to make sure that their children were able to achieve mastery in their own way. Current parents are exhorted to find the right psychiatrist to help find the correct medication to manage their child’s behaviour.90 Women pioneers and advocates for broad social change have had a profound effect on the nation. Early twentieth-century women reformers helped to eliminate child labour, improve working conditions for women, and create specialised institutions for children.91 Many advocates for women in medicine for more than a century and a half have suggested that more women in medicine can transform the profession by bringing a special perspective to patient care.92 But it has become clear that there are no inherent qualities about women that will lead to reform or to particular approaches towards society. As another pioneering child psychiatrist Elissa Benedek pointed out, adding women to medicine did not result in increasing women’s leadership positions, their integration into academic psychiatry, or their publication profiles.93 More women in child psychiatry over the last few decades does not seem to have led to more of a clinical focus on relationships, more time interacting with patients or changes in the direction in the field. Yet sometimes a woman in medicine might have a different perspective that, with the right circumstances and colleagues, can change the field. Stella Chess joined a profession in which her personal identity as a mother might have given her more authority—and more passion—to argue against the mother blaming of the time and shift the direction of child psychiatry research and practice. Funding This work was supported by a Robert Wood Johnson Foundation Investigator Award. Conflictof interest statement: I have no commercial relationships of any kind and therefore no conflicts of interest. Laura Hirshbein is a historian and psychiatrist at the University of Michigan. She has published two books (American Melancholy: Constructions of Depression in the Twentieth Century and Smoking Privileges: Psychiatry, the Mentally Ill, and the Tobacco Industry in America, both published by Rutgers University Press). Her current project is on the history of American child mental health. Footnotes 1 Stella Chess, ‘The Decisive Influence of Parental Attitudes’, Nervous Child, 1946, 5, 165–71, 166. 2 For historical analysis of the child guidance movement, see Margo Horn, Before It’s Too Late: The Child Guidance Movement in the United States, 1922–1945 (Philadelphia: Temple University Press, 1989); Kathleen W. Jones, Taming the Troublesome Child: American Families, Child Guidance, and the Limits of Psychiatric Authority (Cambridge, MA: Harvard University Press, 1999). 3 Seth Koven and Sonya Michel, eds, Mothers of a New World: Maternalist Politics and the Origins of Welfare States (New York: Routledge, 1993); Marian van der Klein et al., eds, Maternalism Reconsidered: Motherhood, Welfare and Social Policy in the Twentieth Century (New York: Berghahn Books, 2012). 4 ‘The History of the American Academy of Child Psychiatry’, Journal of the American Academy of Child Psychiatry, 1962, 1, 196–202. AACP had its first woman president in 1959, while a woman did not achieve the highest office for the American Academy of Pediatrics until 1990 (and the first woman became president of the APA in 1985). 5 American Board of Psychiatry and Neurology, ‘Certified in Child Psychiatry’, Journal of the American Academy of Child Psychiatry, 1962, 1, 493–505. 6 Stella Chess, ‘Editorial Policy of the Journal of the American Academy of Child Psychiatry’, Journal of the American Academy of Child Psychiatry, 1962, 1, 1–2. 7 Eveoleen N. Rexford, ‘Child Psychiatry and Child Analysis in the United States Today’, Journal of the American Academy of Child Psychiatry, 1962, 1, 365–84, 381. Rexford would become the second editor of this journal. 8 Nathan G. Hale, The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917–1985 (Oxford: Oxford University Press, 1995). 9 John E. Schowalter, ‘Child and Adolescent Psychiatry Comes of Age, 1944–1994’, in Roy W. Menninger and John C. Nemiah, eds, American Psychiatry After World War II, 1944–1994 (Washington, DC: American Psychiatric Association, 2000), 461–80. 10 Jonathan Sadowsky, ‘Beyond the Metaphor of the Pendulum: Electroconvulsive Therapy, Psychoanalysis, and the Styles of American Psychiatry’, Journal of the History of Medicine & Allied Sciences, 2006, 61, 1–25. 11 Rick Mayes and Adam Rafalovich, ‘Suffer the Restless Children: The Evolution of ADHD and Paediatric Stimulant Use, 1900–80’, History of Psychiatry, 2007, 18, 435–57. 12 David M. Oshinsky, Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital (New York: Doubleday, 2016), 235; Stella Chess, ‘Wisdom From Teachers’, Journal of the American Academy of Child & Adolescent Psychiatry, 2005, 44, 623–24. For more on Bender, see Dennis Doyle, ‘“Racial Differences Have to be Considered”: Lauretta Bender, Bellevue Hospital, and the African American Psyche, 1936–1952’, History of Psychiatry, 2010, 21, 206–23. 13 Leah J. Dickstein, ‘An Interview with Stella Chess, M.D.’, in Leah J. Dickstein and Carol C. Nadelson, eds, Women Physicians in Leadership Roles (Washington, DC: American Psychiatric Press, 1986), 149–58. 14 Elisabeth Young-Bruehl, Anna Freud: A Biography, 2nd edn (New Haven: Yale University Press, 2008). 15 Janet Sayers, Mothers of Psychoanalysis: Helene Deutsch, Karen Horney, Anna Freud, and Melanie Klein (New York: W.W. Norton & Company, 1991). On the broad networks of psychoanalysts involved in theories of and care for children, see George J. Makari, Revolution in Mind: The Creation of Psychoanalysis (New York: Harper, 2008). 16 Hale, Rise and Crisis of Psychoanalysis in the United States, 220. 17 Stella Chess, ‘Early Childhood Development and Its Implications for Analytic Theory and Practice’, American Journal of Psychoanalysis, 1986, 46, 123–48. 18 Stephanie Coontz, The Way We Never Were: American Families and the Nostalgia Trap (New York: Basic Books, 2000). 19 Deborah Blythe Doroshow, Emotionally Disturbed: A History of Caring for America’s Troubled Children (Chicago: University of Chicago Press, 2019). 20 Cynthia A. Connolly, Children and Drug Safety: Balancing Risk and Protection in Twentieth-Century America (New Brunswick, NJ: Rutgers University Press, 2018). 21 Gerald Markowitz and David Rosner, Children, Race, and Power: Kenneth and Mamie Clark's Northside Center (Charlottesville, VA: University Press of Virginia, 1996), 47–51. 22 Stella Chess, Kenneth B. Clark and Alexander Thomas, ‘The Importance of Cultural Evaluation in Psychiatric Diagnosis and Treatment’, Psychiatric Quarterly, 1953, 27, 102–14, 106. 23 Stella Chess, ‘Disadvantages of “The Disadvantaged Child”’, American Journal of Orthopsychiatry, 1969, 39, 4–6. Historian Michal Raz has made this point in reviewing the history of emotional deprivation. Mical Raz, What’s Wrong with the Poor? Psychiatry, Race, and the War on Poverty (Chapel Hill: University of North Carolina Press, 2013). On the limitations of racial liberals of Chess’s time period, see Dennis A. Doyle, Psychiatry and Racial Liberalism in Harlem, 1936–1968 (Rochester: University of Rochester Press, 2016). 24 Markowitz and Rosner, Children, Race, and Power, 48–51. 25 Letter from Viola Bernard to Morris Krugman, secretary of Ortho, 27 July 1950, Ortho General (1 of 2), Box 221, Viola W. Bernard Papers, Archives and Special Collections, Augustus C. Long Health Sciences Library, Columbia University, New York, NY. 26 See, for example, Leo Kanner, ‘Child Psychiatry: Retrospect and Prospect’, American Journal of Psychiatry, 1960, 117, 15–22. 27 Stella Chess, ‘A Remembrance’, Journal of Autism and Developmental Disorders, 1981, 11, 259–63. 28 See, for example, J. Franklin Robinson, ‘Review of An Introduction to Child Psychiatry’, American Journal of Orthopsychiatry, 1961, 31, 428–29; Stuart M. Finch, ‘Review of Your Child Is a Person’, American Journal of Psychiatry, 1966, 122, 955. 29 Robert M. Galatzer-Levy, ‘Women and Children Last: Reflections on the History of Child Psychoanalysis’, Psychoanalytic Study of the Child, 2015, 69, 108–45. 30 See, for example, Stella Chess, ‘Individuality in Children, Its Importance to the Pediatrician’, Journal of Pediatrics, 1966, 69, 676–84. 31 Stella Chess, ‘Editorial: Mal de Mere’, American Journal of Orthopsychiatry, 1964, 34, 613–14. See also, Stella Chess, Alexander Thomas and Herbert G. Birch, ‘Characteristics of the Individual Child’s Behavioral Responses to the Environment’, American Journal of Orthopsychiatry, 1959, 29, 791–802. On the extensive history of blame of mothers, see Rebecca Jo Plant, Mom: The Transformation of Motherhood in Modern America (Chicago: University of Chicago Press, 2010); Molly Ladd-Taylor and Lauri Umansky, eds, ‘Bad’ Mothers: The Politics of Blame in Twentieth-Century America (New York: New York University Press, 1998). 32 This kind of study would now be called prospective. 33 Stella Chess et al., ‘Implications of a Longitudinal Study of Child Development for Child Psychiatry’, American Journal of Psychiatry, 1960, 117, 434–41. 34 Herbert G. Birch et al., ‘Individuality in the Development of Children’, Developmental Medicine and Child Neurology, 1962, 4, 370–79. 35 Chess et al., ‘Implications of a Longitudinal Study’; Chess, ‘Editorial: Mal de Mere’; Stella Chess, Alexander Thomas and Herbert G. Birch, ‘Behavior Problems Revisited: Findings of an Anterospective Study’, Journal of the American Academy of Child Psychiatry, 1967, 6, 321–31. For a review of the influence of Chess’s work, see Margaret E. Hertzig, ‘Temperament Then and Now’, Journal of Nervous and Mental Disease, 2012, 200, 659–63. 36 Stella Chess et al., ‘Interaction of Temperament and Environment in the Production of Behavioral Disturbances in Children’, American Journal of Psychiatry, 1963, 120, 142–48, 147. 37 Jones, Taming the Troublesome Child. This was in notable contrast to the composition of child guidance in England. See John Stewart, ‘The Scientific Claims of British Child Guidance, 1918–45’, British Journal for the History of Science, 2009, 42, 407–32. 38 See, for example, Saul I. Harrison et al., ‘Social Class and Mental Illness in Children: Choice of Treatment’, Archives of General Psychiatry, 1965, 13, 411–17. 39 Stella Chess and Margaret S. Lyman, ‘A Psychiatric Unit in a General Hospital Pediatric Clinic’, American Journal of Orthopsychiatry, 1969, 39, 77–85. 40 Theodore R. Lanning and H. Paul Gabriel, ‘Use of Tandem Teams in Child Mental Health Training of Medical Students and Pediatric House Staff’, Journal of the American Academy of Child Psychiatry, 1975, 14, 142–49. 41 Stella Chess, Alexander Thomas and Herbert G. Birch, Your Child is a Person: A Psychological Approach to Parenthood without Guilt (New York: Viking Press, 1965). 42 See, for example, Stella Chess, ‘Autism in Children with Congenital Rubella’, Journal of Autism and Childhood Schizophrenia, 1971, 1, 33–47. 43 Stella Chess et al., ‘Social Class and Child-Rearing Practices’, American Psychiatric Association Divisional Meeting, 17 November 1967. 44 Stella Chess, ‘Temperament and Learning Ability of School Children’, American Journal of Public Health, 1968, 58, 2231–39. 45 Ruth L. LaVietes and Stella Chess, ‘A Training Program in School Psychiatry’, Journal of the American Academy of Child Psychiatry, 1969, 8, 84–96. 46 Shelley Phillips, ‘Psychoanalysis and Childhood Education: A Historical Review’, Paedagogica Historica, 1977, 17, 378–85. 47 Stella Chess, An Introduction to Child Psychiatry, 2nd edn (New York: Grune & Stratton, 1969), vii. 48 Jack C. Westman, ‘Review of An Introduction to Child Psychiatry’, American Journal of Psychiatry, 1970, 126, 1517–18. 49 Heather Monro Prescott, A Doctor of Their Own: The History of Adolescent Medicine (Cambridge, MA: Harvard University Press, 1998). 50 Stella Chess and Alexander Thomas, ‘Temperament and the Parent-Child Interaction’, Pediatric Annals, 1977, 6, 574–82. For a contrasting approach, see Waldo E. Nelson, Victor C. Vaughan, III and R. James McKay, eds, Textbook of Pediatrics, 9th edn (Philadelphia: W. B. Saunders, 1969). 51 Stella Chess, ‘Childhood Psychopathologies: The Search for Differentiation’, Journal of Autism and Childhood Schizophrenia, 1972, 2, 111–13. 52 Sulammith Wolff and Stella Chess, ‘A Behavioural Study of Schizophrenic Children’, Acta Psychiatrica Scandinavica, 1964, 40, 438–66; ‘An Analysis of the Language of Fourteen Schizophrenic Children’, Journal of Child Psychology and Psychiatry, 1965, 6, 29–41. On the historical context of autism, its terminology and theories about its aetiology, see Chloe Silverman, Understanding Autism: Parents, Doctors, and the History of a Disorder (Princeton: Princeton University Press, 2012). 53 Stella Chess, ‘An Interactive Concept of Childhood Schizophrenia’, International Journal of Psychiatry, 1968, 5, 222–24. 54 Mahin Hassibi, ‘Biographical Sketch of Alexander Thomas and Stella Chess’, in William B. Carey and Sean C. McDevitt, eds, Prevention and Early Intervention: Individual Differences as Risk Factors for the Mental Health of Children, A Festschrift for Stella Chess and Alexander Thomas (New York: Brunner/Mazel, 1994), 12–20. 55 Stella Chess and Sam J. Korn, ‘Temperament and Behavior Disorders in Mentally Retarded Children’, Archives of General Psychiatry, 1970, 23, 122–30. 56 Stella Chess and Mahin Hassibi, ‘Behavior Deviations in Mentally Retarded Children’, Journal of the American Academy of Child Psychiatry, 1970, 9, 282–97; Stella Chess, ‘Mental Retardation: Introduction’, Journal of the American Academy of Child Psychiatry, 1977, 16, 1–3. Historians have pointed out that institutionalisation dominated most of professional engagement with the mentally retarded population. James W. Trent, Inventing the Feeble Mind: A History of Mental Retardation in the United States (Berkeley: University of California Press, 1994); Steven Noll, Feeble-Minded in Our Midst: Institutions for the Mentally Retarded in the South, 1900–1940 (Chapel Hill: University of North Carolina Press, 1995). 57 Grant Hulse Wagner, The First Twenty Years: Journal of the American Academy of Child Psychiatry, 1962-1981, History Series, 1978-2002, n.d., Box 144, Archives of the American Academy of Child and Adolescent Psychiatry (AAACAP), Washington, DC . 58 On the context of the formation of the GAP, see Gerald N. Grob, ‘Psychiatry and Social Activism: The Politics of a Specialty in Postwar America’, Bulletin of the History of Medicine, 1968, 60, 477–501. 59 Group for the Advancement of Psychiatry, Psychopathological Disorders in Childhood: Theoretical Considerations and a Proposed Classification (Waverly, MA: Group for the Advancement of Psychiatry, 1966), 173. On Chess’s issue with the weekend commitments, see Dickstein, ‘Interview with Stella Chess’. 60 As Deborah Doroshow has pointed out, child psychiatric diagnosis was fairly utilitarian in practice as treatment and diagnosis could be created in tandem to support one another. Deborah Blythe Doroshow, ‘Residential Treatment and the Invention of the Emotionally Disturbed Child in Twentieth-Century America’, Bulletin of the History of Medicine, 2016, 90, 92–123. 61 Joint Commission on Mental Health of Children, Crisis in Child Mental Health: Challenge for the 1970s (New York: Harper & Row, 1970); Abraham Ribicoff, ‘The Dangerous Ones: Help for Children with Twisted Minds’, Harper’s Monthly, February 1965. 62 Gerald N. Grob, ‘Origins of DSM-I: A Study in Appearance and Reality’, American Journal of Psychiatry, 1991, 148, 421–30. 63 On the process of creating the DSM, see Hannah S. Decker, The Making of DSM-III: A Diagnostic Manual’s Conquest of American Psychiatry (Oxford: Oxford University Press, 2013). On Spitzer’s outsized role and somewhat controversial positions with regard to the concepts of validity and reliability, see Herb Kutchins and Stuart A. Kirk, Making Us Crazy: DSM, The Psychiatric Bible and the Creation of Mental Disorders (New York: Free Press, 1997). 64 Chess, ‘Childhood Psychopathologies: The Search for Differentiation’. 65 Chess to Alan Levy, Chief, Child and Adolescent Psychiatry, Beth Israel Medical Center, 11 March 1976, Disorders Evident in Infancy and Childhood Folder, Box 1, DSM Collection, American Psychiatric Association Archives, Washington, DC. 66 Dane Prugh, ‘Impressions of the Conference on DSM III’, St. Louis, MO, 10–11 June, 1976, APA—Council on Children, Adolescents, and their Families—Council Related Actions and Issues: DSM-III, Box 233, Viola W. Bernard Papers, Columbia University Archives. Spitzer’s conclusion that the GAP classification was inadequate because it had not been validated is ironic since, as Stuart Kirk and Herb Kutchins pointed out, Spitzer set validity aside for DSM-III in favour of reliability—agreement among practitioners. Stuart A. Kirk and Herb Kutchins, The Selling of DSM: The Rhetoric of Science in Psychiatry (New York: Aldine de Gruyter, 1992). 67 Memo from J. Gary May to the Council of the American Academy of Child Psychiatry, 23 October 1978, Research—DSM-III Liaison with AACAP, 1978–79 Folder, Box 1, DSM Collection, APA Archives. 68 Christopher A. Mallett, ‘Behaviorally-Based Disorders: The Historical Social Construction of Youths' Most Prevalent Psychiatric Diagnoses’, History of Psychiatry, 2006, 17, 437–60. 69 Report of the Committee on Diagnostic Categories, 12 October 1984, Diagnostic Categories Folder, Box 42, AACAP Archives; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 3rd rev. edn (Washington, DC: American Psychiatric Press, 1987). 70 Memo from James E. Simmons to the AACAP Diagnostic Categories Committee, 9 October 1987, Diagnostic Categories Folder, Box 42, AACAP Archives. 71 Stella Chess, ‘Selectivity of Treatment Modalities’, Canadian Journal of Psychiatry, 1981, 26, 309–15. 72 Hassibi, ‘Biographical Sketch of Alexander Thomas and Stella Chess’ . 73 Michael Rutter, ‘Foreword’, in Stella Chess and Mahin Hassibi, eds, Principles and Practice of Child Psychiatry (New York: Plenum Press, 1978), vi. 74 Jules R. Bemporad, ‘Review of Principles and Practice of Child Psychiatry’, American Journal of Psychiatry, 1979, 136, 364–65. 75 See, for example, Stella Chess, ‘The Plasticity of Human Development: Alternative Pathways’, Journal of the American Academy of Child Psychiatry, 1978, 17, 80–91. 76 Alexander Thomas and Stella Chess, ‘Genesis and Evolution of Behavioral Disorders: From Infancy to Early Adult Life’, American Journal of Psychiatry, 1984, 141, 1–9, 9. 77 George Vaillant, ‘The Longitudinal Study of Behavioral Disorders’, American Journal of Psychiatry, 1984, 141, 61–62. 78 Daniel Goleman, ‘Traumatic Beginnings: Most Children Seem Able to Recover’, New York Times, 13 March 1984. 79 See, for example, Stella Chess and Alexander Thomas, ‘Temperamental Differences: A Critical Concept in Child Health Care’, Pediatric Nursing, 1985, 11, 167–71. 80 Chess and Thomas, ‘Infant Bonding: Mystique and Reality’, American Journal of Orthopsychiatry, 1982, 52, 213–22. The book that they critiqued was Marshall H. Klaus and John H. Kennell, Maternal–Infant Bonding: The Impact of Early Separation or Loss on Family Development (St. Louis: Mosby, 1976). 81 Stella Chess, ‘Mothers Are Always the Problem – Or Are They? Old Wine in New Bottles’, Pediatrics, 1983, 71, 974–76, 974–75. 82 Hassibi, ‘Biographical Sketch of Alexander Thomas and Stella Chess’. 83 Stella Chess, ‘Child and Adolescent Psychiatry Come of Age: A Fifty Year Perspective’, Journal of the American Academy of Child & Adolescent Psychiatry, 1988, 27, 1–7, 6. 84 Stella Chess, ‘The Meaning of Classification’, Journal of the American Academy of Child & Adolescent Psychiatry, 1997, 36, 575. 85 Stella Chess, ‘Wild Child’, Journal of the American Academy of Child & Adolescent Psychiatry, 2004, 43, 647. 86 Stella Chess and Alexander Thomas, Temperament: Theory and Practice (New York: Brunner/Mazel, 1996); Stella Chess and Alexander Thomas, Goodness of Fit: Clinical Applications From Infancy Through Adult Life (New York: Brunner/Mazel, 1999). 87 Matthew Smith has pointed out that this idea of being relieved of blame for parents helped to fuel the rise of stimulants for attention deficit disorder. Matthew Smith, Hyperactive: The Controversial History of ADHD (London: Reaktion Books, 2012). 88 Dorothy E. Stubbe and W. John Thomas, ‘A Survey of Early-Career Child and Adolescent Psychiatrists: Professional Activities and Perceptions’, Journal of the American Academy of Child & Adolescent Psychiatry, 2002, 41, 123–30. 89 The most recent textbook named after Melvin Lewis, who was the editor of the Journal of the American Academy of Child Psychiatry when Chess was associate editor, does not cite Chess at all (other than an acknowledgment that she authored a chapter on deaf children in a previous edition). Andres Martin, Michael H. Bloch and Fred R. Volkmar, Lewis’s Child and Adolescent Psychiatry: A Comprehensive Textbook (Philadelphia: Lippincott Williams & Wilkins, 2017). For a child psychology textbook that makes a number of references to her work, see, for example, Eric J. Mash and David A. Wolfe, Abnormal Child Psychology, 6th edn (Boston: Cengage Learning, 2015). 90 See, for example, Demitri Papolos and Janice Papolos, The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder, 3rd edn (New York: Broadway Books, 2006). 91 The literature in this area is vast. See, for example, Linda K. Kerber, Alice Kessler-Harris and Kathryn Kish Sklar, eds, U.S. History as Women's History: New Feminist Essays (Chapel Hill: University of North Carolina Press, 1995); Theda Skocpol, Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States (Cambridge, MA: Harvard University Press, 1992). 92 Regina Markell Morantz-Sanchez, Sympathy and Science: Women Physicians in American Medicine (Oxford: Oxford University Press, 1985); Ellen S. More, Restoring the Balance: Women Physicians and the Profession of Medicine, 1850–1995 (Cambridge, MA: Harvard University Press, 1999). 93 Elissa P. Benedek, ‘A New Beginning II’, American Journal of Psychiatry, 1993, 150, 1305–08. © The Author(s) 2020. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Stella Chess and the History of American Child Psychiatry
JF - Social History of Medicine
DO - 10.1093/shm/hkaa004
DA - 2020-04-13
UR - https://www.deepdyve.com/lp/oxford-university-press/stella-chess-and-the-history-of-american-child-psychiatry-rdcybpmMnM
SP - 1
EP - 1
VL - Advance Article
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DP - DeepDyve
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