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Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20
Children's Feelings About the Hospital Mary S. Sheridan ACSW
a
a
Instructor in Medical Social Work, Department of Medical Social Work, University of Illinois Medical Center, Chicago, IL 60680 Published online: 26 Oct 2008.
To cite this article: Mary S. Sheridan ACSW (1975) Children's Feelings About the Hospital, Social Work in Health Care, 1:1, 65-70, DOI: 10.1300/J010v01n01_09 To link to this article: http://dx.doi.org/10.1300/J010v01n01_09
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
CHILDREN'S FEELINGS ABOUT THE HOSPITAL
Downloaded by [University of Glasgow] at 00:12 02 January 2015
Mary S. Sheridan, ACSW
ABSTRACT. The concerned worker needs t o know how children perceive the hospital. The institution, the illness, and the procedures evoke specific reactions in children. They fantasize about all of these, and question whether the hospital will help them. Through good communication, consideration, and sound information, it is possible t o maximize the positive aspects of a hospitalization experience.
The purpose of this article is to identify the painful feelings of hospitalized children and to offer some ways in which a concerned staff can help them cope with these feelings. Children are observant and perceptive, and eager to speak if given a chance. Those new to working with children, or those who cannot deal with their pain, may assume that children do not see the harsh realities of life, or, that in their "innocence," they do not and need not understand them. If we are able to handle some of our own feelings of discomfort, we can approach the children openly, and will be able to help them cope with their feelings. NEEDLES AND BLOOD Of all that is done to children in the hospital or clinic, including surgery, needles evoke the greatest reaction. Ordinary injections, intravenous solutions, biopsy needles, anything in needle form is unwelcome, and at times the terror can be overwhelming and intractable. Various theories of body image or psychosexual stage have been advanced to account for this. Whatever interpretation the adult makes, the fact is that children cringe and protest. With preschoolers, there is simply no way to explain or reason about what the shot is going to do. After all, most adults do not appreciate getting stuck either. Confidence in the doctor or nurse is important. Children honor and trust the person who tells them, by word and deed, that he does not Mrs. Sheridan is Instructor in Medical Social Work, Department of Medical Social Work, University of Illinois at the Medical Center, P.O.Box 6998, Chicago, Illinois 60680. Social Work in Health Care, Vol. 1(1), Fall 1975
65
Downloaded by [University of Glasgow] at 00:12 02 January 2015
SOCIAL WORK IN HEALTH CARE
like to hurt them, but sometimes must. It can be helpful to describe the kind of pain and its duration. For the intradermal or subcutaneous shot, the explanation "It's going to feel like a bee sting for a minute, then it will be all over" is workable. For the intramuscular and intravenous injection, the pain is longer, and the concern of the person giving the shot, conveyed by attitude as well as by words, is needed. Children find it hard t o believe that getting hurt is for their own good. Some of them see shots as punishing or sadistic. Some are convinced that doctors and nurses enjoy sticking children. Their own fantasies of revenge may take the form of hoping t o grow up and stick the doctors as they were once stuck. The explanation for an intravenous injection that makes most sense t o children is that it prevents their getting a lot of little shots that would hurt even more. Closely allied to the fear of shots is fear of, and fantasy about, blood tests and transfusions. Some children believe that people are bled to death through blood tests, or that transfusions are necessary because the doctors take too much blood. Some associate blood-related procedures with vampire movies. Sometimes they act out dramas with this theme, holding the transfusion tubing between their "fangs" and smacking their lips. They may believe that blood for transfusions comes from pooling of the samples taken for blood tests, or that their parents must ransom it back. Older school-age children can appreciate explanations of all the things that can be learned from blood tests. Sometimes we let them visit the lab. We generally find that they are interested and relieved to know that the "used" blood is simply thrown out. Older children who receive frequent transfusions may like to think about blood donors, and enjoy hearing a firsthand account from someone who has donated blood. It is helpful for them to learn that the body constantly replenishes the blood supply. PROBLEMS OF BEING SICK Various diseases, and the fact of being sick, have varied consequences in children. They suffer social as well as physical disfigurement. Sometimes it is necessary for them to take on particular roles because of their illness. Each diagnosis presents its own problems. The anal retentives stand out in their reluctance to talk or s h a e with anyone. Hemophiliac children may be provocative, angry, and have trouble getting along with othe~s.Children with growth problems may adopt the role of the precocious child as a response to people treating them as though they were younger. Both boys and girls with sexual problems feel guilt about their problems and treatment. 'They axe sensitive to the discomfort parents and others manifest. Children often believe that illness is their own fault. Wealth and
Downloaded by [University of Glasgow] at 00:12 02 January 2015
Mary S. Sheridan
safety education, valuable as they are, often promote the notion that good health is the responsibility of the individual. We need t o send the message as.well that "accidents do happen," and that there are some illnesses that also "just happen," in spite of everyone's best efforts. Unfortunately, staff members sometimes implicitly place blame for illness on children or their families. We see this at times with our hemophiliac patients. Even though research shows that they can bleed spontaneously, staff members often regard each new hospitalization as the fault of the child for taking unnecessary risks, or the fault of the parents for not providing better supervision. After an accident has occurred, it is easy to see what was dangerous. The family of an afflicted boy must walk a narrow path between encouragmg masculine interests and inhibiting dangerous ones. Their options for punishment are narrowed, and the child is often provocative. Children who face surgery see it as assaultive and mutilative. They have strong feelings about how the decision is made that an operation is necessary. One boy, for example, was outraged because, he said, some strange clerk in the clinic told him he would have t o have surgery done. Generally a child can accept the decision of his doctor or parent, if the reasons are explained t o him. For elective procedures a child might participate in decision making, but t o leave the decision entirely up t o the patient is overwhelming and unfair. Children express their concerns about illness in fantasy themes of things getting broken and put together. Frequently they also express themselves through concern and caring for the other children on the ward. We usually interpret this as an externalized desire to be cared for, but it can have other meanings. Some of our children live in neighborhoods or families where the older ones quite naturally care for the younger. Some children feel an essential unity of spirit with the other sick children, and identify with them as they do not with well peers. "CAN THEY
HELP ME?"
A natural concern of children is whether we in the hospital will be able t o help them. This concern is especially strong in those children to whom medicine has the least to offer, the congenitally and chronically ill. They see us as most fallible and helpless. The worry over whether we are adequate caretakers is often expressed by children in isolation, who fear that no one will come t o help them. One reason children lose confidence in the hospital is that they cannot see results in terms that are meaningful t o them. The importance of clearly explaining t o a child, in terms he can grasp, how his procedures will help him cannoh be overemphasized. He needs t o know that the doctor can find out what is making him sick from looking at
Downloaded by [University of Glasgow] at 00:12 02 January 2015
SOCIAL WORK IN HEALTH CARE
his blood. We needs t o know that after he goes home, he will feel better or @OW faster, if that is the case. Intellectual mastery is the major tool we can give to counter fear. Children report a higher level of anxiety at night, of which one major component is the fear that helpers will not come, or hazy "memories" of someone calling out with no response. For a night nurse to reassure the children that she will be awake and nearby is realistically comforting. Children are ambivalent about those who cry at night. On one hand, they feel sympathy and understanding. On the other, they feel it is somehow shameful. We have chosen t o emphasize that everyone has sad feelings, particularly at night, and that everyone has the right t o express these. HOSPITAL PROBLEMS
Those who work with children need t o understand some of their common reactions t o what goes on in the hospital. Children are correct in their observation that a hospital is organized for the convenience of the staff and not the patients. Children frequently feel that the treatment is worse than the disease. Those who have suffered agonizing attacks of sickle cell anemia can appreciate a program of prophylactic transfusion. But as medicine becomes more preventive, more children experience no discomfort fieom illness t o match that of periodic hospitalization or clinic visits, frequent injections, and the like. Often children express a wish that they could bargain for a more tolerable treatment, such as oral medications rather than injections. Children may also feel out of age sequence in the hospital. Teens frequently complain of being babied on the ward, as their dependenceindependence conflicts are exacerbated. With older teens, if a special unit is not available, it can be helpful t o let the patient papticipate in a choice between hospitalization on a pediatric or on an adult unit. Thus, the rationale for rules can be understood, and enforcement may be more tolerable t o the patient. Teens also frequently ask to read their own charts, or t o sign consents for themselves. The actual handling of these requests must be decided on the basis of hospital policy and local law. But whatever the decision, the basic social work principles of respect for the individual and trying t o undemtand the motivation behind the request are useful. In a teaching hospital the children (and sometimes parents) may believe that patients are being experimented on. They generally think of experiments as they are pictured in monster movies, as dark and sinister, unleashing a monster on the world. We try to counter this by
Mary S. Sheridan
Downloaded by [University of Glasgow] at 00:12 02 January 2015
giving the children a concept of study and learning as positive forces, so that they are participating in helping themselves and others. Children also resent the formality of rounds, where people gather outside their doors and mumble about them, or perhaps come in, poke, and "talk doctor" t o each other. They do not like doctors who talk t o their parents and not them, leaving them unable to ask questions. They are disappointed also when familiar doctors and nurses rotate to other sections, and may perceive this as rejection. HOME PROBLEMS Children bring their worlds t o the hospital with them. Inner-city children know about crime, drugs, and violent death. Children frequently are angry with their parents for bringing them to the hospital, and this may be impossible for them t o express. They have a constant longing for parents and home, a fear that their parents did not care for them adequately (which the hospital regime may subtly reinforce), and an anger when visits must end. Many of our children expect money and presents while they are in the hospital. Parents and relatives may try t o assuage their guilt with cash. It is important t o offer alternate ways of relating. LEAVING THE HOSPITAL While they are hospitalized, children often fear that everyone else will be discharged, and they will be left alone. They are angry and jealous when others are discharged before they are. A patient's own discharge is generally a joyous event; those few patients who clearly prefer the hospital and do not want t o go home generally have serious home problems. Imminent discharge, like the ending of a therapy hour, frees a patient to express many of his fears that he could not vocalize before. Chief among these is the fear of death. Children often believe they will die in the hospital. A surprising number know of people who have either relatives or patients with the same diagnosis. Preventive and realistic counseling is needed. Children either know about death or will learn about it shortly as is openness when a death occurs on the ward. POSITIVE ASPECTS OF HOSPITALIZATION While it is important to understand the negative effects hospitalization can have on a child, there are also many things children like about it. Hospitalization can be a "mini-vacation" from their chores and responsibilities at home, and a time of special atten-
SOCIAL WORK IN HEALTH CARE
tion. In our schoolroom, for example, children work on an individual or small-group basis with a teacher who is especially skilled in diagnosing their weaknesses. They often return to the regular classroom with a firmer grasp of the basics. Much has been done in the modem hospital to meet the needs of the total child. Visiting hours are liberal, wards are cheerful, and activities are structured. These prevent many problems, and help resolve the crisis of hospitalization in the direction of growth.
Downloaded by [University of Glasgow] at 00:12 02 January 2015
CONCLUSIONS It is as bad to "overpsychiatrize" children as it is to ignore their psychic needs. Balance and judgment, setting controls, and looking for the effects of the setting itself must be employed before a child can be judged "disturbed." In order to minimize the disturbance of hospitalization, these are the primary things we have to offer a child: 1. Good communication, so that he can share with us what he wishes. This means talking, but also listening to whatever speech or behavior the child brings. Webpaya good deal of attention to children's fantasies, because they serve many ends. They give clues to issues confronting the child. They may also give him the chance to resolve his feelings of' anger and helplessness. The unconscious implications of children's fantasies at a deeper level, of course, are many. Undoubtedly, some of our disfigured and chronically ill children see themselves as monsters. They would like to unleash their anger upon the world, wreaking destruction as the monster does. Generally it is not necessary to interpret such things. Simple expression, listened to with tolerance and understanding, is often enough. 2. Information, to maximize intellectual mastery and support the healthy coping mechanism. Information given must be truthful and honest. 3. Consideration of feelings, even if we cannot do what the patient wishes. This implies respect for his opinions and choices, within the constraints of reality. 4. A total milieu in which child and family can feel comfortable, and be assured that everything possible is being done in their behalf.
Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20
Children's Feelings About the Hospital Mary S. Sheridan ACSW
a
a
Instructor in Medical Social Work, Department of Medical Social Work, University of Illinois Medical Center, Chicago, IL 60680 Published online: 26 Oct 2008.
To cite this article: Mary S. Sheridan ACSW (1975) Children's Feelings About the Hospital, Social Work in Health Care, 1:1, 65-70, DOI: 10.1300/J010v01n01_09 To link to this article: http://dx.doi.org/10.1300/J010v01n01_09
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
CHILDREN'S FEELINGS ABOUT THE HOSPITAL
Downloaded by [University of Glasgow] at 00:12 02 January 2015
Mary S. Sheridan, ACSW
ABSTRACT. The concerned worker needs t o know how children perceive the hospital. The institution, the illness, and the procedures evoke specific reactions in children. They fantasize about all of these, and question whether the hospital will help them. Through good communication, consideration, and sound information, it is possible t o maximize the positive aspects of a hospitalization experience.
The purpose of this article is to identify the painful feelings of hospitalized children and to offer some ways in which a concerned staff can help them cope with these feelings. Children are observant and perceptive, and eager to speak if given a chance. Those new to working with children, or those who cannot deal with their pain, may assume that children do not see the harsh realities of life, or, that in their "innocence," they do not and need not understand them. If we are able to handle some of our own feelings of discomfort, we can approach the children openly, and will be able to help them cope with their feelings. NEEDLES AND BLOOD Of all that is done to children in the hospital or clinic, including surgery, needles evoke the greatest reaction. Ordinary injections, intravenous solutions, biopsy needles, anything in needle form is unwelcome, and at times the terror can be overwhelming and intractable. Various theories of body image or psychosexual stage have been advanced to account for this. Whatever interpretation the adult makes, the fact is that children cringe and protest. With preschoolers, there is simply no way to explain or reason about what the shot is going to do. After all, most adults do not appreciate getting stuck either. Confidence in the doctor or nurse is important. Children honor and trust the person who tells them, by word and deed, that he does not Mrs. Sheridan is Instructor in Medical Social Work, Department of Medical Social Work, University of Illinois at the Medical Center, P.O.Box 6998, Chicago, Illinois 60680. Social Work in Health Care, Vol. 1(1), Fall 1975
65
Downloaded by [University of Glasgow] at 00:12 02 January 2015
SOCIAL WORK IN HEALTH CARE
like to hurt them, but sometimes must. It can be helpful to describe the kind of pain and its duration. For the intradermal or subcutaneous shot, the explanation "It's going to feel like a bee sting for a minute, then it will be all over" is workable. For the intramuscular and intravenous injection, the pain is longer, and the concern of the person giving the shot, conveyed by attitude as well as by words, is needed. Children find it hard t o believe that getting hurt is for their own good. Some of them see shots as punishing or sadistic. Some are convinced that doctors and nurses enjoy sticking children. Their own fantasies of revenge may take the form of hoping t o grow up and stick the doctors as they were once stuck. The explanation for an intravenous injection that makes most sense t o children is that it prevents their getting a lot of little shots that would hurt even more. Closely allied to the fear of shots is fear of, and fantasy about, blood tests and transfusions. Some children believe that people are bled to death through blood tests, or that transfusions are necessary because the doctors take too much blood. Some associate blood-related procedures with vampire movies. Sometimes they act out dramas with this theme, holding the transfusion tubing between their "fangs" and smacking their lips. They may believe that blood for transfusions comes from pooling of the samples taken for blood tests, or that their parents must ransom it back. Older school-age children can appreciate explanations of all the things that can be learned from blood tests. Sometimes we let them visit the lab. We generally find that they are interested and relieved to know that the "used" blood is simply thrown out. Older children who receive frequent transfusions may like to think about blood donors, and enjoy hearing a firsthand account from someone who has donated blood. It is helpful for them to learn that the body constantly replenishes the blood supply. PROBLEMS OF BEING SICK Various diseases, and the fact of being sick, have varied consequences in children. They suffer social as well as physical disfigurement. Sometimes it is necessary for them to take on particular roles because of their illness. Each diagnosis presents its own problems. The anal retentives stand out in their reluctance to talk or s h a e with anyone. Hemophiliac children may be provocative, angry, and have trouble getting along with othe~s.Children with growth problems may adopt the role of the precocious child as a response to people treating them as though they were younger. Both boys and girls with sexual problems feel guilt about their problems and treatment. 'They axe sensitive to the discomfort parents and others manifest. Children often believe that illness is their own fault. Wealth and
Downloaded by [University of Glasgow] at 00:12 02 January 2015
Mary S. Sheridan
safety education, valuable as they are, often promote the notion that good health is the responsibility of the individual. We need t o send the message as.well that "accidents do happen," and that there are some illnesses that also "just happen," in spite of everyone's best efforts. Unfortunately, staff members sometimes implicitly place blame for illness on children or their families. We see this at times with our hemophiliac patients. Even though research shows that they can bleed spontaneously, staff members often regard each new hospitalization as the fault of the child for taking unnecessary risks, or the fault of the parents for not providing better supervision. After an accident has occurred, it is easy to see what was dangerous. The family of an afflicted boy must walk a narrow path between encouragmg masculine interests and inhibiting dangerous ones. Their options for punishment are narrowed, and the child is often provocative. Children who face surgery see it as assaultive and mutilative. They have strong feelings about how the decision is made that an operation is necessary. One boy, for example, was outraged because, he said, some strange clerk in the clinic told him he would have t o have surgery done. Generally a child can accept the decision of his doctor or parent, if the reasons are explained t o him. For elective procedures a child might participate in decision making, but t o leave the decision entirely up t o the patient is overwhelming and unfair. Children express their concerns about illness in fantasy themes of things getting broken and put together. Frequently they also express themselves through concern and caring for the other children on the ward. We usually interpret this as an externalized desire to be cared for, but it can have other meanings. Some of our children live in neighborhoods or families where the older ones quite naturally care for the younger. Some children feel an essential unity of spirit with the other sick children, and identify with them as they do not with well peers. "CAN THEY
HELP ME?"
A natural concern of children is whether we in the hospital will be able t o help them. This concern is especially strong in those children to whom medicine has the least to offer, the congenitally and chronically ill. They see us as most fallible and helpless. The worry over whether we are adequate caretakers is often expressed by children in isolation, who fear that no one will come t o help them. One reason children lose confidence in the hospital is that they cannot see results in terms that are meaningful t o them. The importance of clearly explaining t o a child, in terms he can grasp, how his procedures will help him cannoh be overemphasized. He needs t o know that the doctor can find out what is making him sick from looking at
Downloaded by [University of Glasgow] at 00:12 02 January 2015
SOCIAL WORK IN HEALTH CARE
his blood. We needs t o know that after he goes home, he will feel better or @OW faster, if that is the case. Intellectual mastery is the major tool we can give to counter fear. Children report a higher level of anxiety at night, of which one major component is the fear that helpers will not come, or hazy "memories" of someone calling out with no response. For a night nurse to reassure the children that she will be awake and nearby is realistically comforting. Children are ambivalent about those who cry at night. On one hand, they feel sympathy and understanding. On the other, they feel it is somehow shameful. We have chosen t o emphasize that everyone has sad feelings, particularly at night, and that everyone has the right t o express these. HOSPITAL PROBLEMS
Those who work with children need t o understand some of their common reactions t o what goes on in the hospital. Children are correct in their observation that a hospital is organized for the convenience of the staff and not the patients. Children frequently feel that the treatment is worse than the disease. Those who have suffered agonizing attacks of sickle cell anemia can appreciate a program of prophylactic transfusion. But as medicine becomes more preventive, more children experience no discomfort fieom illness t o match that of periodic hospitalization or clinic visits, frequent injections, and the like. Often children express a wish that they could bargain for a more tolerable treatment, such as oral medications rather than injections. Children may also feel out of age sequence in the hospital. Teens frequently complain of being babied on the ward, as their dependenceindependence conflicts are exacerbated. With older teens, if a special unit is not available, it can be helpful t o let the patient papticipate in a choice between hospitalization on a pediatric or on an adult unit. Thus, the rationale for rules can be understood, and enforcement may be more tolerable t o the patient. Teens also frequently ask to read their own charts, or t o sign consents for themselves. The actual handling of these requests must be decided on the basis of hospital policy and local law. But whatever the decision, the basic social work principles of respect for the individual and trying t o undemtand the motivation behind the request are useful. In a teaching hospital the children (and sometimes parents) may believe that patients are being experimented on. They generally think of experiments as they are pictured in monster movies, as dark and sinister, unleashing a monster on the world. We try to counter this by
Mary S. Sheridan
Downloaded by [University of Glasgow] at 00:12 02 January 2015
giving the children a concept of study and learning as positive forces, so that they are participating in helping themselves and others. Children also resent the formality of rounds, where people gather outside their doors and mumble about them, or perhaps come in, poke, and "talk doctor" t o each other. They do not like doctors who talk t o their parents and not them, leaving them unable to ask questions. They are disappointed also when familiar doctors and nurses rotate to other sections, and may perceive this as rejection. HOME PROBLEMS Children bring their worlds t o the hospital with them. Inner-city children know about crime, drugs, and violent death. Children frequently are angry with their parents for bringing them to the hospital, and this may be impossible for them t o express. They have a constant longing for parents and home, a fear that their parents did not care for them adequately (which the hospital regime may subtly reinforce), and an anger when visits must end. Many of our children expect money and presents while they are in the hospital. Parents and relatives may try t o assuage their guilt with cash. It is important t o offer alternate ways of relating. LEAVING THE HOSPITAL While they are hospitalized, children often fear that everyone else will be discharged, and they will be left alone. They are angry and jealous when others are discharged before they are. A patient's own discharge is generally a joyous event; those few patients who clearly prefer the hospital and do not want t o go home generally have serious home problems. Imminent discharge, like the ending of a therapy hour, frees a patient to express many of his fears that he could not vocalize before. Chief among these is the fear of death. Children often believe they will die in the hospital. A surprising number know of people who have either relatives or patients with the same diagnosis. Preventive and realistic counseling is needed. Children either know about death or will learn about it shortly as is openness when a death occurs on the ward. POSITIVE ASPECTS OF HOSPITALIZATION While it is important to understand the negative effects hospitalization can have on a child, there are also many things children like about it. Hospitalization can be a "mini-vacation" from their chores and responsibilities at home, and a time of special atten-
SOCIAL WORK IN HEALTH CARE
tion. In our schoolroom, for example, children work on an individual or small-group basis with a teacher who is especially skilled in diagnosing their weaknesses. They often return to the regular classroom with a firmer grasp of the basics. Much has been done in the modem hospital to meet the needs of the total child. Visiting hours are liberal, wards are cheerful, and activities are structured. These prevent many problems, and help resolve the crisis of hospitalization in the direction of growth.
Downloaded by [University of Glasgow] at 00:12 02 January 2015
CONCLUSIONS It is as bad to "overpsychiatrize" children as it is to ignore their psychic needs. Balance and judgment, setting controls, and looking for the effects of the setting itself must be employed before a child can be judged "disturbed." In order to minimize the disturbance of hospitalization, these are the primary things we have to offer a child: 1. Good communication, so that he can share with us what he wishes. This means talking, but also listening to whatever speech or behavior the child brings. Webpaya good deal of attention to children's fantasies, because they serve many ends. They give clues to issues confronting the child. They may also give him the chance to resolve his feelings of' anger and helplessness. The unconscious implications of children's fantasies at a deeper level, of course, are many. Undoubtedly, some of our disfigured and chronically ill children see themselves as monsters. They would like to unleash their anger upon the world, wreaking destruction as the monster does. Generally it is not necessary to interpret such things. Simple expression, listened to with tolerance and understanding, is often enough. 2. Information, to maximize intellectual mastery and support the healthy coping mechanism. Information given must be truthful and honest. 3. Consideration of feelings, even if we cannot do what the patient wishes. This implies respect for his opinions and choices, within the constraints of reality. 4. A total milieu in which child and family can feel comfortable, and be assured that everything possible is being done in their behalf.
