restricted access A Doctor of Their Own: The History of Adolescent Medicine (review)
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Bulletin of the History of Medicine 74.2 (2000) 409-410

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Book Review

A Doctor of Their Own: The History of Adolescent Medicine

Heather Munro Prescott. A Doctor of Their Own: The History of Adolescent Medicine. Cambridge: Harvard University Press, 1998. xi + 238 pp. Ill. $35.00.

This well-researched account of the rise of adolescent medicine offers an excellent model of how professional specialty history ought to be written. A Doctor of Their Own is centered on the interaction of adolescent patients and the professionals who aspired to care for them, set against the background of changing societal attitudes regarding adolescence. Central to Heather Prescott's argument is that adolescents themselves shaped the rise of adolescent medicine as much as did medical professionals. To be sure, the twentieth century began with a discourse dominated by adults. G. Stanley Hall articulated adolescent rebellion as a kind of evolutionary regression released by the storm of puberty--yet his success in promoting compulsory schooling to contain this behavior ironically contributed to the rise of an adolescent subculture that further challenged adult authority. Hall's successors came to accept adolescent rebellion as a normal stage of development. As authority shifted from the parent to the peer group, however, adolescents faced a new kind of pressure to be "normal" in the increasingly conformist culture of the 1940s and 1950s. The door was thus opened for the intervention of medical expertise in mediating the ensuing conflict.

Prescott's portrayal of the way in which adolescent physicians negotiated their way between the cultures of adulthood and adolescence is particularly subtle. Her analysis focuses on J. Roswell Gallagher, a school physician who developed an adolescent research unit at Phillips Academy at Andover that eventually made him the logical candidate to head the Adolescent Unit at Boston Children's Hospital. The main portion of the book centers on an extensive analysis of patient records from the unit, which eventually became a prototype for others around the country and helped make Gallagher the prime catalyst in the rise of adolescent medicine.

The result is a richly textured portrait of both physicians and patients. Parents may have brought Gallagher their adolescents in hopes of avoiding the stigma of a psychiatric diagnosis, but Gallagher saw his own task as supporting his patients' autonomy in resisting the conformist urges of the 1950s. Indeed, in doing so he and his colleagues were responding to the wishes and actions of their patients. A major theme underlying Prescott's study is the transformation of the adolescent patient from subject to participant in medical care. Beginning with eliminating cartoon figures from their waiting rooms and eventually going as far as promoting community clinics and adolescent confidentiality, adolescent physicians developed a style of practice designed in response to their clientele. They thus maintained a degree of sympathy with youth culture even as its manifestations became more alarming in the 1960s.

The irony that closes the story is the fact that, despite such professional flexibility, the promise that adolescents might truly have a "doctor of their own" remains elusive in the 1990s. Adolescent physicians, most of whom have been [End Page 409] trained initially in pediatrics, remain divided over whether they should really constitute a separate specialty, or focus on promoting good adolescent care through traditional primary care and subspecialties. And although parents have shown remarkable support for the specialty, their ultimate financial power always has the potential to undercut the confidentiality of the doctor-adolescent relationship. Academic physicians treating adolescents thus continue to fight for outside financial support and for respect within their departments.

Prescott's excellent analysis of Gallagher's experience in the 1950s does have the effect of largely sidestepping the turbulence that engulfed youth culture during the following two decades. Although on one level she is right to emphasize that anxiety over adolescence has been a recurrent theme of the entire century, her account of how the specialty has evolved in more recent years deserves further exploration against the background of the evolution of adolescence itself. Her book...