Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Monday, January 30, 2012

Shades of "The Snake Pit": The Wet Pack is Back


I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.


  


 I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.


  


 I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.


  


 I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.


  


 I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.


  


 I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.


  



Friday, January 27, 2012

If It Isn't Spanking That's a Problem, What Else Could It Be?



Recently I’ve spent quite a bit of time in discussion with Jeff of punishmentmadeobsoletebypsychology.blogspot.com. Jeff maintains that even mild physical punishment is a risk factor for child development and is the cause of later violent behavior. I point out that there is no evidence that, other things being equal, mild physical punishment distorts personality development, although there is good evidence for an association between experience of physical abuse (as defined in law and for research purposes) and later antisocial behavior.

In all candor, of course, I have to acknowledge that the evidence we need would be very hard to establish, no matter what the outcome. Parenting practices don’t exist independent of other family characteristics. Education, family income, marital status, and certainly ethnicity are all strongly associated with the parenting methods someone uses. In the real world, all those characteristics of a family are confounded/confused with each other, so it becomes impossible to tell what causes what--   especially if the effects of each factor on the children are small ones. In addition, logic tells us that it is not possible to prove that an effect does NOT exist under any circumstances; even if it’s never been seen or reported, it might very infrequently be there.

What I’ve just said--   that a cause for an outcome may be very hard or impossible to demonstrate--  naturally goes for all kinds of parenting, not just for spanking. You have to have a major effect, like that shown for genuine abuse, before it shows up strongly. Nevertheless, it’s of interest to consider some parenting events other than physical punishment that may be risk factors for personality and behavioral development.

I’m going to talk about a few of those in a minute, but first let me point out that not everything I’m going to mention happens in early childhood. It’s an important tenet of psychoanalytic thought that events in infancy and early childhood have special formative power, which later events lack, and this view has been accepted in popular thought….  but, no, it ain’t necessarily so. If we’re going to think about factors that may cause antisocial behavior or other problems, we need to look at all of development. This is not to say that infancy and toddlerhood are not important periods--  maybe even the most important periods--  but it is to say that they are not the only important periods.

So, what are some aspects of experience, with parents or other people, which may mark children with undesirable personality and behavioral traits? The first one I want to mention is maternal depression. Perinatal mood disorders interfere with the ordinary sensitivity and responsiveness to a baby’s signals that are displayed by the majority of adult caregivers. That interference means that a baby with a depressed caregiver experiences constant frustration of its efforts at active communication of its needs, and also fails to experience the joyful communication “just for fun” that characterizes a healthy adult-child relationship. The baby also begins to act depressed and apathetic;  a vicious circle of cause and effect makes the child less appealing to adults, who become even less likely to be attentive to communications or to “woo” the baby into a satisfying relationship. An obvious early outcome of these experiences is a delay in speech and in other earlier communicative techniques like facial expression and hand gestures. (Incidentally, the irritability that often accompanies adult depression may mean that the child also receives more physical punishment than usual.)

Let’s look at emotional abuse--  not as obvious to the outside observer as physical abuse, but possibly as influential. The psychologist James Garbarino has described clusters of emotionally abusive behaviors, some of which may begin in very early life, others of which are likely only later in childhood. To list Garbarino’s suggestions briefly: Rejecting is denying the child’s value and the importance of his or her needs; this can begin in infancy with failure to smile back at the child’s smiles or answer her babbling, and it can continue into childhood as constant verbal abuse and criticism or “scapegoating” in which one child in the family is treated badly and others are not. Terrorizing is creating an atmosphere of fear by constant threats and intimidation, including deliberate teasing and scaring, often followed by punishing the child for being a “sissy” or a “poor sport”. (I often think of this when I hear the line, “I brought you into this world, I can take you out of it.”) Ignoring includes failing to respond to the child’s speech, but it also can involve failing to engage in the child’s schooling needs and failing to provide necessary supervision and care. Isolating is the process by which parents gradually prevent children from making friends or associating with outsiders, speaking to neighbors, joining groups for play, or having any experiences that would provide either a variety of role models or possible help for an abused child. (Homeschooling parents need to be careful that they consider the possible results of their decision in terms of the child’s isolation.) Finally, Garbarino suggests that a form of emotional abuse is corrupting. Corrupting parents intentionally teach antisocial behavior, involve the child in criminal activities, or act toward the child in ways like introducing him to drug use “because somebody else is going to do it”. Corrupting may begin in toddlerhood through deliberately antagonizing the child and encouraging him to fight, but criminal behavior is obviously more likely as the child gets older.

My last candidate for a parenting practice that could cause personality and behavioral disorders is intrusive parenting (see B.K.Barber [2002]. Intrusive parenting: How psychological control affects children and adolescents. Washington, DC: American Psychological Association). This term refers to controlling and manipulative parental actions that demand not only behavioral compliance to parental desires, but psychological commitment to parents’ beliefs and wishes. Intrusive parenting attempts to counter the natural development of autonomy that is usually considered to be an aspect of healthy personality growth. Parents who are highly controlling psychologically may be more sensitive to hurt and less tolerant of negative emotion than others. In any case, children who experience much psychological control are likely to have increases in both internalizing and externalizing problems, as well as lower academic achievement.

Here we have several parenting factors that appear to have a negative impact on development and behavior, but none of them necessarily involve physical punishment, either mild or severe. I point this out simply to show that the single factor of physical punishment is not likely to be the whole cause of undesirable adult behavior. In fact, I’d suggest that even the negative outcomes of experiencing abusive treatment may well result from other, accompanying factors like terrorizing and ignoring. To speculate further, the psychological ill effects of physical abuse may have nothing to do with its physical side, but with other experiences that are present or absent in abusive families.

Once again, it’s not rocket science. It’s more complicated than that.
  

Thursday, January 26, 2012

The Regression Myth versus Developmentally Appropriate Practice



A disturbing report about a family in Snohomish, WA (www.heraldnet.com/article/20120121/NEWS01/701219927) states that a college-age adopted daughter has confronted her father with accusations of sexual assault, and that investigation has shown that a “therapist” concerned with attachment issues recommended years ago that the family share a bed. The intention behind this advice was to correct the daughter’s posited problems resulting from abandonment and lack of emotional attachment.

The details of the sexual relationship were outlined in the news report, but they are not the real point of this post. My guess would be that an adoptive father who was strongly tempted to be sexual with a young girl under his care would probably find some way to do this, shared bed or  no shared bed. However wrong-headed the therapist’s approach, her advice probably had little to do with the sexual misconduct, other than possibly offering an increased level of temptation.

Sorry as I am that the girl had repeated experiences of unwanted sexual approaches from one who should have protected her, what concerns me in a broader way is the belief system that made the practitioner (and note that I am not calling her a psychologist--  I doubt that she was one) think her advice was appropriate. That belief system must have included the idea that through regression a person can rework earlier experiences and resolve problems resulting from her early history, such as problems about emotional attachment to caregivers. The system is likely also to have involved the belief that regression can be brought about by behaving like a young child, or being treated like a young child. This view, which is common among advocates of rebirthing, patterning, primal therapy, and similar unconventional treatments, suggests that the cure for any problems that may date from early life is to re-enact early life events--  but, this time, make sure the experiences are right.

How does this link up with having the family share a bed? There is a popular set of beliefs (not usually necessarily associated with the idea of regression), advocated by William Sears and his family, and often called “attachment parenting”. Attachment parenting focuses on the idea that infants need intensive and extensive social and physical contact with their caregivers in order for attachment to develop. “Kangaroo care”, skin-to-skin contact, breastfeeding, and the “family bed” are all part of this approach. As a general comment, I’d say these activities are harmless but unnecessary; the development of attachment is a robust phenomenon that will occur if it’s given half a chance and does not need this kind of artificial cultivation. (By the way, if you wonder how people maintain a sex life while doing the family bed routine: some friends of mine used to give their 5-year-old a quarter to keep his little sister downstairs while Mom and Dad got it on--  necessity as the mother of invention!)

But surely the Searses do not say 15-year-old adoptees should be in the family bed? No, indeed they don’t. And this is where our so-called therapist fell prey to the regression myth. She knew that co-sleeping was supposed to encourage attachment; she knew the girl had a history of separation and loss, as well as a new relationship with adoptive parents whom she didn’t know well. If the girl would have developed an attachment to parents in her early childhood, given a chance---  and if co-sleeping was a way to develop an attachment--- and if regression through re-enactment of experiences typical of early childhood was a way to rework early personality development—voila! Put the girl in bed with the parents, she will regress to early childhood because of this experience, because she is co-sleeping she will become attached to the parents , and that attachment will dissolve any personality problems she has developed because of her lack of attachment. It’s all so simple, really.

Except…. Except that these things aren’t true. People can’t regress to earlier stages of life, although of course they can behave in immature ways and may do so particularly under emotional stress. Treating people as if they are infants or young children is a pointless “magic” ritual that cannot actually cause them to return to early development (and if it did, would you expect them to return to maturity immediately, or would they have to repeat years of normal development?). Co-sleeping is not necessary or sufficient for the development of attachment. And, an individual who is already 15 years old has a vastly different perspective on emotional attachment than an infant is capable of having; she doesn’t form attachments as an infant does, and she doesn’t show them through an infant’s attachment behavior when she does form them.

The therapist and the parents fell for some common myths about personality development. In addition, they forgot an important theme of childhood interventions for emotional, physical, or cognitive problems: treatments need to be developmentally appropriate if they’re to be effective. We feed a tiny infant milk, an older baby strained food, a five-year-old most of what adults eat. Giving the five-year-old an all-milk diet will cause malnutrition, and so will feeding the three-month-old barbecue. Treating an infant or toddler who is grieving over separation and loss may well require staying with her a lot of the time, but treating a teenager who has experienced many separations requires a much more complex treatment approach.

We can’t expect most parents to be aware of developmentally appropriate practice, but we surely should expect, even demand, that therapists working with children and families will know this concept. Regrettably, training and licensing in many related fields (like marriage and family therapy) may completely ignore this and other important ideas. We seem to have a long way to go before we can be sure that all psychological treatments are either effective or safe, let alone both.  The therapist in this case made mistake after mistake because she misunderstood some basic concepts, although her mistakes may not have been the cause of the sexual mistreatment that will probably be the focus of any discussion.  


Monday, January 16, 2012

What About Alice Miller?

Reader Neil Samuels has queried my unwillingness to accept Alice Miller’s views on physical punishment as necessarily correct, and has asked what I mean by the “Alice Miller belief system.” Before I go on to talk about these matters, let me state once more my position that mild physical punishment (open hand, one or two smacks on buttocks or upper legs) for preschool children may be effective and harmless when used very occasionally to enforce important rules. I have argued in an earlier post that there is no support for the claim that this parental behavior models a general tendency to violence. I have also argued for many years against genuinely abusive practices like those recommended by the Pearls and the “Babywise” books.

So, why do I not accept Alice Miller’s statements as unarguably correct? My reasoning is that those statements are based on a series of abstractions that lack empirical support, rather than on systematically-collected information about parenting practices and child development outcomes.

Alice Miller was a European lay-analyst and shared the attitudes and views of many such people, who have tended to reason from what they regard as first principles rather than to consider the necessity of working with reliable information. Much of Miller’s work resembles closely that of Marguerite Sechehaye and of Frieda Fromm-Reichmann. Like those authors, Miller emphasized the psychoanalytic principles of repression and regression, and by doing so placed the essential events in personality formation early in childhood and outside of consciousness. In addition, her view completely ignored the concept of transactional processes by which changing interactions between a specific child and a specific adult have developmental outcomes that would be different if either individual were different.

The psychoanalytic concept of repression claims that memories of disturbing experiences can be removed from conscious awareness and inaccessible to the individual except through psychoanalytic treatment, but can continue to influence mood, behavior, and motivation in ways that feel foreign to the personality. Although this idea has become almost universally accepted in Western popular culture, there is in fact no empirical support for such a mechanism. As Susan Clancy and Richard McNally have pointed out, ordinary mechanisms of memory and forgetting are perfectly adequate explanations of events that have been categorized as repression (for example, Clancy, McNally, Schachter, Lenzenweger, Pitman. [2002]. Memory distortion in people reporting abduction by aliens. Journal of Abnormal Psychology, 111, 455-461).

The psychoanalytic concept of regression claims that earlier versions of personality and experience can be re-accessed through psychoanalytic techniques, and that such re-accessing allows the individual to change a developmental trajectory that went wrong at a given time. In fact, as I have shown in my own work (Mercer [2011]. The concept of psychological regression: Metaphors, mapping, Queen Square, and Tavistock Square. History of Psychology, 14, 174-196), the idea of personality regression is a metaphor drawn from 19th century work on the results of physical damage to the nervous system. Although psychoanalytically-oriented practitioners over the years encouraged the acting-out of apparent regression (and this was especially true of proponents of “wild psychoanalysis” like Ferenczi), there is no empirical support for the existence of such a mechanism.

Thus, there is no evidence for the existence of Miller’s two major personality mechanisms repression and regression, and I believe this is a strong argument against the general accuracy of her claims. However, there are additional problems in her thinking. As is well known, Miller spent some years of involvement with and commitment to primal therapy, a form of treatment suggesting that psychological treatment must depend on regression to very early stages and intense acting-out of pain and distress posited to have been part of those stages ( an idea associated with Otto Rank’s and later with Wilhelm Reich’s views of development). Primal-related thinkers such as the “psychohistorian” Lloyd DeMause; David Chamberlain,who claims that all babies remember their births; and William Emerson, who massages babies until they cry as a way of working through the notional birth trauma, are all enthusiasts of Miller’s beliefs.

I see two major problems in this association. The first is that the concepts of early development espoused by primal therapists are based on adult experiences under LSD or hyperventilation rather than any systematic and replicable evidence about infancy and early childhood. When there are conflicts between LSD-based ideas and those derived from systematic study (for example, our understanding of infants’ memory and forgetting), I would hold that the latter source is more trustworthy, and I don’t believe it’s necessary to spell out why I take that position.

A second problem has to do with the assumption of the primal group, shared by Miller, that mechanisms characteristic of the individual (and speculative mechanisms at that) are sufficient to explain behavior of a group-- for example, that repressed anger and fear, were they in existence in members of a group, would be the reason for abusing children, going to war, etc. This belief ignores decades of work on, for example, economic factors in racial conflict, and fails to note that there must be some way in which such notional individual mechanisms would be translated into coordinated behavior of a group. Like the primal therapists, Miller chooses to ignore the complexities of social behavior in favor of discussion of the poorly-documented personal backgrounds of a few historical figures. Although this makes for entertaining reading, it is a very weak basis for a world-view.

These are the reasons that I do not accept Miller’s broad prohibition on all forms of physical punishment as necessarily correct. Her position is not in any way empirically based. Her thinking in general has the Platonic form so appealing to those who would prefer not to engage deeply with a topic, but instead are attracted to statements of what “must be”. I would suggest that people who are genuinely interested in how disciplinary methods influence children’s development should seek out the work of Grace Kochanska, who has shown how child personality differences interact with parental behavior to produce predictable outcomes.

Sunday, January 15, 2012

Comments I Can't Respond To

There have been several comments in the last couple of days that I'd like to answer, but blogspot doesn't seem to let me. This has happened before and I hope it will be fixed soon-- otherwise I'll just make a post that responds to each.

Monday, January 9, 2012

Physical Punishment Tales from the Memory Vault

All this discussion of physical punishment has brought back memories from the long ago, and I want to recount one just to show how complicated these things really are.
Years and years and years ago, my older son was about three years old. I decided that it would be nice for him to have a blackboard in his room, because he always liked to write on the board if he came to class with me. I got some blackboard paint and painted a section of wall, got colored chalk, even fixed up a little chalk tray with a piece of quarter-round, and painted the rest of the wall a nice clean white. [Parents who are more experienced than I was at the time will see what’s coming.] I did all that, then left the room for half an hour-- and when I came back my firstborn had climbed up on some shelves, studiously avoiding the blackboard, and chalked all over the nice white wall. I was infuriated, which was really quite unreasonable because I hadn’t thought to tell him not to do this. I told him off thoroughly and delivered a couple of swats on the bottom.

A few hours later, this conversation took place.

CHILD: (firmly) Mom! I don’t like all that screaming and spanking.

ME: Well… what do you think I should do when you’re naughty?

CHILD: (thinks a minute) Tell me quietly, and clean it up.

ME: Oh. Well, if I did that, would you stop doing it?

CHILD: No.


It just goes to show-- as the saying goes, the camel driver he has his opinion; the camel he has his. But the family caravan still needs to keep lumbering along and usually manages to do so to the best of everyone’s imperfect ability.

Sunday, January 8, 2012

More Mulling on Physical Punishment

Boy, I never thought I’d be arguing against people who argue against physical punishment for children. However, I think and have always thought that blanket prohibitions or admonitions either require some evidence or, as an alternative, need to be stated on moral grounds. If anyone wants to say they simply think it’s wrong to use physical punishment, I can’t argue with their belief. But when a belief is disguised as a statement of evidence-- I can’t go along with that without a response.

There are three issues about physical punishment that I want to noodle about for a bit. One is the fact that if punishment is to be used, mild physical punishment has certain advantages. Another is an alternative way of thinking about the idea that parents who spank are acting as inappropriate role models and teach their children to use violence. The last involves the belief that it’s all right for parents to use physical punishment, but not for schools or day care centers to do so.

1. When I refer to mild physical punishment, I’m referring to one or two smacks with an open hand on the clothed buttocks or backs of the legs of a preschool child. If punishment is needed to bring about behavior change favorable to the health and safety of all concerned, mild physical punishment has some real advantages. It’s well established that punishment works when it is given concurrently with an unwanted behavior; it actually works best when it occurs just as the child prepares for the behavior; the longer after the behavior the punishment comes, the less effective it is. Punishment is quite ineffective when it’s delayed “until Daddy gets home”, or when it involves deprivation of some future treat like dessert tonight or a birthday party on Saturday. Mild physical punishment can be performed more or less on the instant. Note, though, that if it isn’t done right away, you might as well not do it at all, as it will not later be connected with the unwanted behavior, but instead will be associated with whatever has gone on just before. (Any thoughts about our correctional system, by the way?)


2. Now, this role model thing: everybody and their brother states with certainty that a parent who uses physical punishment is acting as a role model to encourage violent behavior. But is that actually true? Not everything parents do serves as a role model for their child’s general behavior. For example, single mothers regularly teach their toddler and preschool sons to pee standing up, even though the little boys, in their frequent invasions of the bathroom, always see Mom sitting down on the toilet. Mothers can wear high heels; little children don’t except for playing “dress-up”. Fathers and mothers too are heard to say selected words which children aren’t supposed to say.

In addition, much of our instruction and modeling of behavior for children is a matter of teaching time, manner, and place. We don’t, in fact, usually teach children that violence is never acceptable. We accept and even approve of it in sports, in defense of a person under attack, in self-defense, and so on. A football player who is highly aggressive on the field is admired, but if he beats up his girlfriend later there will be some people (not enough, though) who will disapprove deeply. Children are socialized by their experiences with their parents into an understanding of the times, manners, and places in which violent behavior is permitted (or even required). Learning that it is acceptable for an adult to spank a child for repeated dangerous behavior does not involve the same time, manner, or place rules as learning that it is acceptable to mug old ladies or participate in gang warfare. To think so is to over-generalize--- what Jerome Kagan has called the “seductive idea” of abstractionism.

3. Our society’s great confusion about physical punishment is exemplified in the idea that parents may spank or smack, but day care centers and preschools may not. (I omit discussion of physical punishment in elementary and high schools, which when permitted has often gone far beyond the “mild” level, and which should not be necessary at those ages for children who are less impulsive and better self-regulated than younger children.)

We seem to have two conflicting ideas about spanking. One is that it’s a bad thing to do, and that’s why teachers aren’t allowed to do it. The other is that parents have a right to do things to their children as they choose, and if they don’t spank their children the children will run wild (and be annoying to the rest of us, I suppose is the real concern). Logically, of course, if it’s a bad thing, nobody should be doing it, although we can probably stop teachers a lot more easily than we can parents; if it’s an acceptable thing for parents, why shouldn’t teachers do it too?

I think it’s possible that this conflict is based on the assumption that because parents love their children and know them well, they will not let physical punishment get out of hand, and they will comfort a child who is upset--- but that teachers do not love the child and are likely to turn the Kiddie Academy into Dotheboys Hall if given any opportunity. In reality, the opposite might well be true, as teachers are less likely to experience the fatigue and frustration of daily and nightly child care, or conflict with a co-parent who focuses on relationship problems in connection with childrearing.


A [temporary] final thought on these matters: as for myself, as long as parents are hot-saucing children, keeping them in cages, limiting their food, making them sleep outdoor without blankets in winter, or whipping them with plumbing supply line, I am not going to worry too much about a limited and possibly appropriate use of mild physical punishment. My energies are going to be directed toward stopping treatment that is, frankly, torture. Admirers of Alice Miller’s position can either join me or continue to enjoy their ideological purity. I hope it will be the former, because there is a lot of thinking and a lot of work to be done.

Alice Miller, Physical Punishment, Ideology, and Reasoned Approaches to Parenting

On a number of recent occasions, I’ve come up against statements and ideas ascribed to Alice Miller, the late Swiss psychoanalyst. As Neil Samuels noted in a comment on one of my posts about physical punishment, Miller attributed war and other distressing actions and propensities of adults to their childhood experiences of punishment. I haven’t read all of Miller’s work, most of which is popularized and non-empirical in nature, but my impression from what I have read is that she argues strongly against all forms of physical punishment and categorizes together everything from a smack with the open hand onward, considering all of these behaviors to be deleterious. (If I’m wrong about this, no doubt I will receive speedy correction.)

I think there are many reasons to keep physical punishment to a minimum. An obvious one is that an incensed parent with an angry child may lose control and do physical harm. A less obvious one is that physical punishment may simply escalate everyone’s anger and make it more difficult to get the situation under control. Physical punishment may also substitute ineffectively for explanations and advice about how to behave. (There are a dozen more good reasons, but that’s not my topic just now.)

My concern in this post is to focus on the outcomes for parent and child of choosing one or another among the range of disciplinary methods, including both rewards and punishments of various kinds. (Negative reinforcement is not the same as punishment and does not lend itself well to use in everyday situations.) I think it is possible to consider what methods work best in specific circumstances and to use a reasoned approach to choice.

Miller, on the other hand, is primarily an ideologue. Her claims are based on a belief system that lacks empirical support, as are the claims of her companion-in-ideology, Lloyd DeMause, one of the founders of the “psychohistory” school that claims profound, although undemonstrated, effects of prenatal events. DeMause, Miller, and others have concluded that cause-and-effect relationships are plausible, not in the light of empirical work about families, but on the basis of statements by people like Frank Lake and Stanislav Grof, whose understanding of early development is founded on experiences with LSD. (These people were also strong though perhaps indirect influences on Nancy Verrier.)

I argue that an empirical, pragmatic approach is a more desirable way to think how people should act toward children, than an ideological one is. My reasoning is that there are multiple factors that help determine the outcome of any adult actions toward children, so it is unlikely that we can name a single factor and a single mechanism that have the same outcome for all children in all circumstances. An ideological approach argues that the truth is the same for all.

Here are some factors that seem to make a difference to children’s reactions to physical punishment:

1. Cultural differences: A smack on the bottom has a different meaning and therefore effect on children who have often seen other children get smacked than it does for those who have never seen such a thing and/or have heard it mentioned in discreet, horrified tones. There are great differences between cultural groups in the use of and attitudes toward physical punishment. Some groups would never dream of striking a child or using any other physical approach. Others, like many African-Americans, believe it is the obligation of parents, grandparents, and close family friends to employ physical punishment regularly. When a social group approves of the use of physical punishment, the children of that group do not respond as negatively to their experiences of mild punishment as do children whose group strongly disapproves.


2. Age: As a general rule, Europeans and North Americans believe that physical punishment is inappropriate for infants under a year of age and for older children and adolescents, but that well-thought-out physical punishments may be effective and suitable for many children from about age 2 to age 5. The reasoning about infants is that these children are too young to understand rules or to be expected to control their own behavior much, and that punishment may teach them to avoid adults at a time in development when their socialization depends on a lot of contact. The thinking about older children and adolescents is that physical punishment offers them challenges to physical fighting such that the child may win, or the combat become so serious that someone is hurt or the child runs away from home; in addition, many laws about child abuse would classify physical punishment of adolescents as abusive in itself.

Preschoolers, on the other hand, are capable of learning rules and regulating their behavior within reason, but are impulsive, over-confident, and able to hurt themselves and others unless carefully trained. Careful supervision and cue-ing of behavior can do a great deal, but many preschoolers show undesirable behaviors (like running into the street, or hitting each other, pets, baby brothers or sisters, or their parents) that are quite difficult to correct without the use of physical punishment. Balancing the possible consequences of those present behaviors against the long-term effect of punishment suggests that for everyone’s health and safety, brief, mild physical punishment may be an excellent choice. Many parents today attempt to use “time-out” methods but are unable to keep the child in the “time-out” chair or room; physical punishment as a back-up on a few occasions is likely to make it possible to transition to “time-out” alone.


3. Temperament: Children’s constitutionally-determined personalities may have strong influences on their responses to physical punishment. Some children have relatively little response to pain or other strong stimuli, and in my opinion should NOT be physically punished because of the temptation the adult may feel to escalate the punishment until the child seems to notice it. Others are extremely sensitive, and in fact are so overwhelmed by almost any kind of punishment that they forget what they are being punished for. However, some are attentive to physical sensations, but at the same time can notice and understand the adult’s admonitions and learn effectively what to do or not to do.

I believe these differences in children’ s responses to physical punishment, when coupled with the complete lack of anything but proof by assertion that physical punishment experiences are responsible for war and other social evils, lead us to only one sensible conclusion. That conclusion is that no single rule about punishment of children is applicable across the board. Parents need to consider carefully the characteristics of a child, the family’s social group and attitudes, and the goals they are trying to achieve through punishment or any other action. (This consideration, of course, has to happen during a calm time, not as the child pulls away from the parent and heads into traffic again.) The sense of righteousness one receives from ideology is much stronger than a reasoned approach can give, but I would suggest that a pragmatic, reasoned parenting mode is far more likely to produce happy children, families, and societies.