Emotionally Disturbed: A History of Caring for America's Troubled Children by Deborah Blythe Doroshow (review)

The decades surrounding World War Two were a "time of optimism" in child mental health, according to Deborah Blythe Doroshow, but it was, she thinks, only a brief interlude (p. 237). In Emotionally Disturbed: A History of Caring for America's Troubled Children, Doroshow describes a generation of "pioneer" psychiatric professionals who constructed the emotionally disturbed child as a new figure populating the mental health landscape and created a unique space - the residential treatment center (RTC) - in which to treat these seriously troubled children "who couldn't be managed anywhere else" (p.2). Doroshow argues that the development of category and space were co-dependent; each supported the existence of the other. Hers is a rosy picture of the work of the staff in these centers and the experiences of young people who found their way to the milieu therapy that defined the treatment strategy of an RTC. "Milieu therapy," as Doroshow explains, was the controlled environment in which all aspects of residential care were considered therapy directed toward changing the child's behavior. But as Doroshow cleverly shows, the optimism motivating this post-war generation of mental health professionals was short-lived. Both the emotionally disturbed identity and the residential treatment space were ill-suited to the cultural, political, and professional landscape that emerged in the 1970s and 1980s. Doroshow finds that the unraveling of emotional disturbance as a diagnostic category has left us today with a troubled group of children and their families but a mental health system that lacks a strategy for treating them. Part historian and part advocate, Doroshow convincingly advocates for a reexamination of the lessons to be learned from residential care as treatment for emotional disturbance that marked the time of optimism.

Doroshow grounds Emotionally Disturbed in the widely accepted notion that diseases may have a somatic component, but the experience of a disease and the meanings attached to it are constructed from social context. She sees identification of the emotionally disturbed child and the opening of residential treatment centers as consequences of a philosophy of child welfare and child guidance that, during the 1930s and 1940s, began to favor community-based care for dependent children and those with relatively mild emotional and behavioral problems. In this environment training schools, orphanages, schools for the "feebleminded," and children's units of psychiatric hospitals lost focus only to discover new purpose in providing psychiatric care for a class of children who fell outside the bounds of community care. These children-too odd for fostering or adoption and too troubled to remain at home - were targets of the emotionally disturbed label. By the 1950s a network of psychiatric specialists had created a professional identity tied to providing residential treatment as a last resort for these youths. The centers, Doroshow argues, legitimized the label applied to these children, just as the new diagnostic label provided legitimacy to residential psychiatric care centers for children.

Doroshow uses origin stories told about individual institutions along with published accounts of the treatment they offered to unpack the dimensions of a category as vague as emotional disturbance and to trace the experiences of the emotionally disturbed child from admission to discharge. The author reminds readers that the voices of the children heard in her book are mediated by the experts who wrote about them. Nonetheless, she has done an admirable job picturing the center through the eyes of the children as well as those who cared for and treated them, and the book brings to life the centers' use of milieu therapy.

Doroshow positions the emotionally disturbed child and the RTCs' milieu therapy in a mid-century psychiatric community steeped in psychoanalysis. She also points to the influence of a post-war culture that placed great value on normality. A child whose behavior transgressed mid-century social norms, particularly gender norms, was a child whose emotional disturbance correlated with...