There are always words for children who worry parents, confound teachers, and cause trouble everywhere they go. During the past century, these children have been called backward, delinquent, feeble-minded, retarded, minimally brain-damaged, and autistic. Recently, we have called them “developmentally disabled.” Deborah Blythe Doroshow is interested in children called “emotionally disturbed” between 1940 and 1970. She argues that one particular institution—the residential treatment center (RTC)—created the emotionally disturbed child. Her interesting book explains how “emotional disturbance became a diagnosis, a policy problem, and a statement about the troubled state of postwar American society.” (p. 4)
RTCs included both private and public institutions. Southard School was part of the famous Menninger Clinic in Topeka, Kansas. The Sonia Shankman Orthogenic School, affiliated with the University of Chicago, was directed by Bruno Bettelheim, a prominent psychoanalyst. In popular books with titles like Love Is Not Enough (1950) and Truants from Life (1955), Bettelheim told stories about emotionally disturbed children that were at once distressing and fascinating. The Wiltwyck School in New York, founded in 1936 by the Episcopal City Mission Society, became a nonsectarian organization within a few years. Supported by public funds, its mandate was to serve African American boys who were juvenile delinquents or “potential” delinquents.
Many RTCs that included “school” in their names were residential settings, and children sometimes lived in RTCs for years on end. RTCs provided in-house education, although a few sent children to local public schools. In 1952, the US Children's Bureau counted thirty-six RTCs in the country. By 1966, the Bureau estimated that RTCs housed a total of 6,900 children. RTCs may have publicized the plight of emotionally disturbed children, but probably no more than fifty RTCs were in operation at once and their reach was limited. (Today's therapeutic boarding schools and wilderness programs exceed that number but lack any unifying concept like “emotional disturbance.”)
Who exactly were “emotionally disturbed” children? For Doroshow, this category was defined by what it was not. Emotionally disturbed children were neither intellectually impaired nor young criminals. In theory, their developmental trajectories could be repaired. Logically enough, emotional disturbance was rooted in emotional ties disturbed early in life, typically in “broken” families where parent-child relationships were marked by “deprivation,” a key word at midcentury. The severity of children's familial trauma justified separating them from parents and placing them in RTCs.
Few at the time doubted that gender governed the damage done by emotional disturbance. Boys tended toward aggression and rule-breaking while girls were anxious or withdrawn. In contrast, normality radiated moderation rather than extremity. Children whose personalities and behaviors conformed to the social norms of families and communities—conventional gender expectations included—were normal. Children who went off the rails and were unmanageable at home and in school belonged in RTCs.
Like the children they treated, RTCs identified with what they were not: custodial warehouses. RTCs were institutions that, above all, were not supposed to feel institutional. By 1900, child welfare reformers and professionals agreed that children should grow up in a family—not institutional— environment, but orphanage populations continued to expand until the 1930s. Many RTCs evolved out of orphanages, but insisted they were nothing like state mental hospitals or training schools, “snake pits” tarnished by scandalous abuses. According to Doroshow, the architects of RTCs aspired to create progressive, optimistic programs that would heal children, return them to families and communities, and allow them to function in life.
All RTCs used one thing to accomplish this goal: the “milieu.” Constructing therapeutic institutional environments was hardly a new idea in the mid-twentieth century. In late eighteenth-century Europe, hospital buildings were suspected of spreading, rather than curing, disease, so new architectural plans were drafted to remedy the problem. Nineteenth-century reformers set out to build asylums that were adapted to the community practices of “moral treatment.” In the decades prior to the establishment of RTCs, some children's institutions tried a “cottage system” consisting of small, house-like structures inhabited by cottage “mothers” and “fathers.” What made RTC founders distinctive was not their commitment to the power of environment but their belief that every aspect of RTC design, and every activity or relationship that took place under RTC auspices, might restore emotional balance. Faith in the milieu extended from decorating children's bedrooms to resemble middle-class homes to utilizing mealtimes to remediate bizarre behavior. Some RTCs even had pets.
All RTCs conducted formal therapy with children and casework with parents, but the milieu mattered because it leaked into every corner of children's daily lives, from painting in the playroom to conversations with the custodians. RTC staff starred in the psychodrama of the milieu. Doroshow found that social workers had the widest occupational jurisdiction in RTCs, but the people who spent the most time with children had little or no professional training. Their personal qualities—deep reserves of patience and permissiveness—were considered essential ingredients in the interpersonal recipe that RTCs used to calm and correct emotional disturbance. Leaders strove to professionalize RTC operations, but if RTCs worked, it was because they experimented constantly. Did it help? We have no idea. Few RTCs did outcome research. We do know that approximately half of the children who left RTCs returned home. Half moved to other institutions. Was that success or failure?
Doroshow admires the spirit of RTC “pioneers.” Before a coherent field of child mental health existed, she points out, they utilized integrated teams to help children cope and change without resorting to drugs or other somatic therapies. She contrasts this with the pessimism, punishment, and prescriptions that have proliferated since 1980. The juvenile justice system is now the largest child mental health system in the United States. The number of children imprisoned annually peaked in 1995 at over 107,000. It has declined dramatically, but we still confine around 50,000 children in trouble. For decades, research has shown that the country's mental health challenge is far greater than the institutional and community-based resources devoted to addressing it. By 1980, RTCs had been sidelined, partly because they were swamped by the problem they were trying to solve.
It is significant that as the era of emotional disturbance waned, the movement demanding educational equality for disabled children gained ground. In 1975, Congress passed the Education for All Handicapped Children Act, which, for the first time in US history, guaranteed public education in the “least restrictive environment” to all children with disabilities. Spearheaded by parent activists who formed groups during the 1950s like the National Association for Retarded Children and the League for Emotionally Disturbed Children, children with developmental disabilities were eventually swept into the rights revolution. Why did this happen just as the hopeful vision of RTCs was eclipsed? Was there a trade-off between providing compassionate services to well-defined groups of vulnerable, largely white children and endowing large numbers of children of color with rights? Did the formal expansion of educational equality transform children from troubled to troublesome? Future histories should explore that troubling question in the political and cultural history of childhood and education.
