Symptom Tolerance in Pædiatrics

Abstract

MY theme, which is foreshadowed in the title, might lead along two distinct paths. I mention one of these only because I may have been expected to follow it. I refer to the fact that the natural bodily processes tending towards health and towards a resolution of illness have become more than a little obscured by the recent flood of advances in chemotherapy. It is indeed difficult for a House Physician at the present time to find out by experience what a child does with pneumonia with no more help than the good nursing which, thirty years ago, was the only treatment. To-day, and we all agree about this, even a boil must not be allowed to take care of itself. I feel that in the best of the medical schools the teaching does include a reminder that children lived through illnesses before penicillin and that even to-day it is the child and the living tissues that ultimately bring about a restoration to health, not the antibiotic.I have not followed this important trail because this theme has been developed with great competence in various addresses to medical students by physicians who remember the bad old times, and who see that from the teaching point of view the bad old times could claim some points in their favour. My theme follows another path which in the end will, I think, prove to be a related one, since again it concerns the natural tendency towards health and the use that we can make of this tendency as doctors. In the psychological field the principle that there is a natural tendency towards health or developmental maturity is one which has a particular significance. It could be said that much of physical disease is due to an invasion from the environment or to an environmental deficiency, and is not a purely developmental disorder. By contrast, psychological disorder can always be described in terms of emotional development either delayed or distorted or in some other way prevented from reaching the maturity that is due at the age which the child has reached. There is an even closer link therefore in psychological medicine between the normal and the abnormal than there is between physiology and the pathological processes of tissues and functions. In fact when there is only a disturbance of physiology then the illness is usually psychogenic.When I was thinking over the relationship between pediatrics and child psychiatry it occurred to me that this relationship involves not only a difference between the fields but also a difference of emotional attitude between those who adopt the one or the other approach to a case. The peediatrician feels the symptom as a challenge to his therapeutic armoury. It is hoped that this will always be true.If a child has a pain, then the sooner it is diagnosed and the cause removed the better. By contrast, the child-psychiatrist sees in the symptom an organization of extreme complexity, one that is produced and maintained because of its value. The child needs the symptom because of some hitch in emotional development.(Ior the purposes of clear argument it is helpful to assume t...

Psychoanalytic psychotherapy in paediatric liaison: a diagnostic and therapeutic tool

“…In his paper 'Symptom tolerance in paediatrics', Winnicott (1953) highlighted the importance of respecting symptoms as indicators of disturbance, signposts towards something likely to be important, rather than as ends in themselves. This is the crucial guiding element in the approach taken to liaison with the paediatric medical and nursing staff.…”

“…At a critical time in relation to Jenny's visual symptoms the understanding derived from Jenny's psychotherapy assisted in the avoidance of what Winnicott (1953) called 'a moral attitude' rather than a medical/psychological one. I felt disadvantaged in the work by the liaison not being within a department in which I was actually an integrated member.…”

Paediatrics and child psychiatry. The case for collaboration.

“…It was championed 20 years ago, for example, by Winnicott (1953), 6 years later by Mildred Creak in her Charles West lecture (1959), and more recently by Pinkerton (1972a). The need, if anything, has become increasingly urgent because of rapid advances in paediatric technology which threaten to overshadow the child as a person.…”