Science, medicine and childhood

There is now a substantial body of historical analysis on the transformation of British and North American medicine, from the late nineteenth century to the inter-war period and beyond, as a result of the impact of the laboratory sciences. Steve Sturdy and Roger Cooter, for example, point to the intellectual and organizational shift in British medical practice. They argue that proponents of the laboratory sciences claimed that ‘their work would lead to a new body of medical knowledge, based not on the narrow empiricism of clinical experience, but on systematic and rational investigation of the underlying causes and processes of health and disease’. Hence the new forms of science ‘became dominant in medicine primarily because of the cultural values and ideals that they were seen to embody’. Such values and ideals were based on ‘the specific technical and intellectual ends that science was understood to serve’.Footnote ¹ Christopher Lawrence highlights the significance of the inter-war period for the processes described by Sturdy and Cooter. He suggests this was the era when debates about the significance of the laboratory sciences for medical practice became particularly intense. Echoing Sturdy and Cooter, Lawrence categorizes the philosophy, methods and efficacy of these sciences as ‘academic medicine’ that tended to distrust ‘individual clinical experience and held that only a team comprising clinicians and laboratory workers … could arrive at sound knowledge of, say, the therapeutic efficacy of a new drug’. Unsurprisingly, therefore, medical specialization was a further outcome of academic medicine's rise. Two other aspects of Lawrence's argument are especially significant for this article. First, he notes that, for academic medicine, ‘Science, and especially scientific research, was seen as a premier instrument for analysing social problems and providing solutions to them’. Second, he further observes that, in contrast to the preceding era, after 1918 ‘the flow of medical ideas and practices was largely from America to Europe’, not least because of the power and ambitions of American philanthropy.Footnote ²

Of course, none of this was uncontested. But for present purposes the central point is that a significant body of medical reformers sought to establish medicine on a more scientific basis and thereby call upon the cultural and social values and status that science had come to embody by the inter-war era. What, though, of psychiatry, the branch of medicine which informed child guidance? As one historian of American psychiatry remarks, between 1880 and 1940 a ‘new psychiatry’ came into being which, inter alia, articulated new theories and practices, embraced not only mental disorders but also ‘the problems of everyday life’, and thereby began to move into the field of preventive medicine. The aim was thus ‘nothing less than the reintegration of psychiatry into medicine, which would permit (the former) to share in the status and prestige enjoyed by the latter’. In particular, psychiatrists wanted to ‘emulate their medical colleagues who had created a laboratory-based profession that sought to identify the causes of disease and to develop appropriate interventions for acute illnesses’.Footnote ³ Consider the example of the American psychiatrist Adolf Meyer, a major influence on child guidance as a whole as well as on a generation of British psychiatrists and as such an instance of the ‘flow of ideas and practices’ identified by Lawrence.Footnote ⁴ Katherine Angel notes the crucial part Meyer played in creating ‘a new professional role for psychiatrists’, so ensuring ‘membership of the scientific and medical establishment’. Moreover, this move to ‘place psychiatry on a par with scientific medicine’ was complemented by ‘a more general change in society's conception of mental illness and psychiatry, especially after the First World War’.Footnote ⁵ Psychiatry thus sought, and for the same reasons, the mantle of scientific status so central to the project of academic medicine.

How did this impact on proposals for the reform of child welfare? Harry Hendrick argues that from around the end of the nineteenth century, ‘medical and psychomedical science … provided the intellectual justification for the creation and identification of children's distinctive attributes’.Footnote ⁶ Here we might also note the concurrent influence of the American psychologist G. Stanley Hall, particularly on the child study movement. The latter ‘made studying children a priority in science, easing the way for a scientific vision of childhood and adolescence by psychologists, psychiatrists, and other professionals’.Footnote ⁷ The medical sociologist David Armstrong comments that by the twentieth century, children were being observed and classified in an ever-increasing number of ways and locations that ‘brought all the significant characteristics of childhood under the monitoring eye of medicine’.Footnote ⁸ The observation of children was crucial to child guidance, as will be evident throughout what follows.

Andrew Scull remarks that in the second and third decades of the twentieth century, psychiatry ‘ventured forth to capture an even wider sphere for its ministrations and interventions’. This ‘wider sphere’ embraced ‘the management of infancy and childhood’ and, as in other areas of intervention, was achieved through the identification of ‘problems’ as ‘technical, medicalized conditions’. Forms of ‘deviance’ were thus ‘systematized within an orderly framework’.Footnote ⁹ While acknowledging the historic roots of movements such as child guidance, Hendrick pays particular attention to the period under study here, noting that after the First World War, forms of child welfare arose claiming scientific status, not least under the influence of the ‘new psychology’. These included the nursery school movement and educational psychology, as well as child guidance.Footnote ¹⁰ We return to the issue of the ‘new psychology’ in the next section, which examines in more detail what child guidance was and what it sought to achieve.

The origins, aims and development of child guidance

In 1927 a subcommittee of the new London-based Child Guidance Council reported on the need to set up a ‘demonstration clinic’. This clinic's chief objects were:

1. 1. to demonstrate the need and the possibility of specialized scientific training for those who have to handle delinquent and difficult children;

2. 2. to demonstrate to parents, officials, social workers and the public generally the importance and value of making an individual study of such cases by scientific means; and

3. 3. to demonstrate the importance and value of scientific research upon the general problem involved.Footnote ¹¹

Around a decade later the medical director of the London Child Guidance Clinic, William Moodie, noted that in its early days his institution had been viewed with considerable scepticism. Attitudes had changed, however, as a result of its ‘thorough, unobtrusive and scientific practice’.Footnote ¹² Just after the outbreak of the Second World War the psychiatrist John Bowlby, later internationally famous for his work on attachment theory, published a paper on the influence of childhood experiences on the development of neuroses and the neurotic character. This was based on some 150 cases diagnosed at the London Child Guidance Clinic, where Bowlby had undergone part of his training. He commented on the necessity of such studies and their importance to clinical work: it was ‘as important for analysts to make a scientific study of early environment’ as it was ‘for the nurseryman to make a scientific study of soil and atmosphere’.Footnote ¹³ The following year another prominent psychiatrist and child guidance practitioner, Emanuel Miller, told the Child Guidance Council that children evacuated from threatened urban areas must be ‘studied scientifically – for the data to be revealed will be of practical value’. Once the war was over it would be necessary to make the political case that ‘the care of the minds of the children is the best safeguard against any form of social decay and upheaval’.Footnote ¹⁴ Reviewing the history of child guidance at the end of the war, the chief medical officer to the Board of Education noted that while for centuries doctors had ‘intuitively’ engaged with child psychology, its ‘scientific study’ in child guidance clinics was a relatively recent innovation.Footnote ¹⁵ These extracts all illustrate the claims of child guidance to scientific status – notably on the basis of the systematic use of observation and the subsequent analysis of the data gathered – and the need for its practitioners to have scientific training. Claims to scientific status were made repeatedly: we shall encounter further instances below.

The child guidance movement emerged after 1918, first in the United States then further afield, frequently as a result of American intervention. The British psychiatrist Aubrey Lewis, for instance, noted during his investigative tour of Europe in 1937 that Georges Heuyer, a pioneer of child psychiatry, had founded a child guidance clinic in Paris. With sponsorship from the American philanthropic body the Commonwealth Fund of New York, another British psychiatrist, C. L. C. Burns, soon to be director of the Birmingham Child Guidance Clinic, likewise visited Europe in the 1930s and investigated child guidance provision in Italy, Switzerland, Austria, Germany, Hungary, Czechoslovakia, the Netherlands and Belgium.Footnote ¹⁶ In Britain the 1920s saw the formation of the Child Guidance Council.Footnote ¹⁷ This body, and through it much of British child guidance training and practice, was financially supported until the early 1940s by the above-mentioned Commonwealth Fund, an illustration of the consciously internationalist agenda of American foundations in the inter-war era.Footnote ¹⁸ The fund had supported child guidance in the US, where it was part of what one historian describes as ‘science in the service of children’.Footnote ¹⁹ The ambitions and impact of American philanthropy in child welfare are worth stressing. As Julia Grant points out, in the 1920s and 1930s the Rockefeller charities were crucial in the creation of a ‘science of child development’.Footnote ²⁰ In the wake of the First World War, foundations such as the various Rockefeller bodies and the Commonwealth Fund had, moreover, committed themselves to ‘scientific and medical research’, one crucial component of which was placing ‘the health-care, education, and social-service professions on a scientific, non-sectarian basis’.Footnote ²¹ In Britain philanthropy also sought to align itself with scientific approaches to social and medical problems. As Elizabeth Macadam, the much-cited commentator on the ‘new’ philanthropy of the 1930s, remarked, British charitable endeavour had entered a ‘new phase in which men and women work together to bring about … early treatment on scientific lines’.Footnote ²²

All this was part of a broader cultural concern about children and their upbringing. US publicity for the new journal Children: The Magazine for Parents claimed that in contrast to the child-rearing practices of the past, today ‘we have a science of child-rearing’.Footnote ²³ The British publication Mother and Child, another product of the 1920s, carried articles on raising children contributed by members of the three professions involved in child guidance: psychiatry, psychology and psychiatric social work. Such non-specialist publications, aimed at a concerned, intelligent audience, were important in spreading the child guidance message. The interests of both readers and professions were almost certainly mutually reinforcing. They were thus a part of what Ludmilla Jordanova identifies as ‘the process whereby health and disease are conceptualized’, one agent of which is popular culture.Footnote ²⁴

In Britain the Commonwealth Fund promoted child guidance as the principal component of its ‘English [sic] Mental Hygiene Program’.Footnote ²⁵ Mental hygiene was also an international movement which sought to promote mental well-being and saw itself thereby as a form of preventive medicine.Footnote ²⁶ In Britain, as elsewhere, advocates of mental hygiene were closely involved with child guidance. Mental hygiene's organizing body, the National Council for Mental Hygiene, was represented on the Child Guidance Council and included among its key aims the ‘study of mental hygiene of child-life in relation to education and parental responsibility’.Footnote ²⁷ The Commonwealth Fund's centrality to the development of British child guidance was widely recognized. A Board of Education memorandum of 1937 noted the volume of money donated by the fund and that this was ‘yet another instance of the universality of science’.Footnote ²⁸ In similar vein Miller and a psychiatrist colleague, Noel Burke, claimed in 1929 that while the relationship between child rearing and adult behaviour had long been an object of study, the ‘more scientific attitude to the subject, coupled to philanthropy, has been the product of almost modern thinking’. This relationship between science and the Commonwealth Fund had enabled British child guidance to build firm foundations.Footnote ²⁹ Macadam, meanwhile, cited the fund's role in promoting British child guidance as an important example of cooperation between voluntary and statutory services.Footnote ³⁰ The fund's commitment can be measured by its financial support. Some $61,000 was appropriated in 1931–2 for the English Mental Hygiene Program. This rose to a peak of $86,600 in 1933–4, remained in the range $52,000 to $68,000 for the rest of the 1930s, and then declined rapidly during the Second World War.Footnote ³¹

An important intellectual component of the context in which child guidance developed was the ‘new psychology’, which, like mental hygiene and child guidance, had deep historical roots but likewise gained considerable ground after 1918. Although it had a number of different strands, the ‘new psychology’ – a rather confusing term but one which, at the time, generally meant ‘psychiatry’ – tended to stress the irrational and subconscious nature of human behaviour. As Mathew Thomson puts it, what was now envisioned was an ‘instinct-driven, purposive mind – a mind with a mind of its own’.Footnote ³² Potentially, of course, this was problematic – hence the need to promote mental hygiene to ensure mental well-being. This shift in understanding as applied to children was articulated in 1931 by the British psychiatrist Bernard Hart. The diagnosis and treatment of maladjusted or difficult children had progressed ‘from an ethical to a physical conception, and thence to one predominantly psychological and biological’. The mental and emotional problems of childhood were thus not the result of ‘original sin’, nor did they derive exclusively from ‘disease or disordered functioning of one or other organic system’. Rather, it was necessary to begin with ‘the conception of the child as a psycho-physical organism’ which reacted to ‘an environment composed of material, mental, and social constituents, … disturbed in its reactions by faults involving an uncertain number of these various components’.Footnote ³³ Child guidance did not therefore seek to deal with what were then called the ‘mentally deficient’, nor with specifically educational problems. Nor did it generally deal with severe cases of delinquency, although research into delinquency and child guidance remained closely related. The Tavistock Clinic in London pioneered child guidance and in 1931 set up the Institute for the Scientific Treatment of Delinquency.Footnote ³⁴ The main thrust of child guidance, nonetheless, was to address the problems of ‘maladjustment’ in the otherwise ‘normal’ child and in so doing it contributed to and embodied two closely related developments.

First, attention in the first half of the twentieth century shifted from a concern with children's bodies to a concern with their minds.Footnote ³⁵ Second, as Roy Porter has shown, the inter-war era in particular saw the ‘discovery of the neurotic nation’, and there emerged a range of individuals and organizations urging the ‘routine psychological examination of children’.Footnote ³⁶ Similarly, Armstrong suggests that the twentieth century sees the rise of ‘surveillance medicine’, one aspect of which was the ‘problematisation of the normal’. The child was the ‘first target of the full deployment of the concept’. From now on physical growth was not the sole variable to be monitored. In the child, ‘psychological growth was construed as inherently problematic, precariously normal’, and so in need of ‘close medical observation’. Consequently, ‘The nervous child, the delicate child, the eneuretic child, the over-sensitive child, the unstable child and the solitary child, all emerged as a new way of seeing a potentially hazardous normal childhood’.Footnote ³⁷ Such children constituted the clientele of child guidance clinics.

Advocates of child guidance highlighted childhood's fragility – any child could experience problems in the course of their emotional and psychological development – and the movement's observational, diagnostic, therapeutic, preventive and research roles. Two psychologists argued that the problems of maladjusted children ‘more and more clearly … stood out as a challenge and a menace’. It was only through specifically focusing on them – notably through the child guidance clinic – that ‘we are beginning fully to realise the magnitude and nature of these problems’.Footnote ³⁸ The psychiatrist Douglas MacCalman, a key figure in British child guidance, observed that ‘the normal child has to bear vast personal and environmental strains if he is to grow up to healthy adulthood’. Most children would, in fact, cope. Nonetheless there were those who were ‘genuine problems, whose difficulties will only increase with age, and who, eventually, will become a burden on the community’.Footnote ³⁹ An article on the London clinic noted,

The stress on the wider social implications of child mental ill health is noteworthy in these sources. As to the ‘problems’ such children might experience, the psychiatrist attached to the Liverpool Child Guidance Clinic noted the presence of ‘a group of children whose difficulties are not so obvious’ because they are psychological rather than physical. Such problems could nonetheless be identified through the observation of ‘manifestations of a behaviour disorder’, examples of which included lying, stealing, wandering, playing truant or defying authority. Alternatively, they could be ‘milder’, as, for instance, moodiness, solitariness, nervousness, bad habits, sleeplessness or backwardness in school subjects.Footnote ⁴¹ Such a list confirms Armstrong's analysis. It is also far from clinically precise, an issue to be discussed further.

For the child guidance movement, then, childhood was a potentially fraught time. If not addressed, problems perpetuated the unhappiness and maladjustment of the individual concerned, now and in later life. This could lead to familial and social instability. Childhood was doubly important because it was the stage at which to address mental ill health since the child's mind was less fully developed and more susceptible to change than that of the adult. As David Kennedy Henderson, professor of psychiatry at the University of Edinburgh, put it, the ‘plastic period of childhood is the ideal time for guidance into those channels and ways of life which are to be so important for the future’.Footnote ⁴² It is apparent how child guidance was central to the campaign for mental hygiene and its emphasis on preventive medicine. The aspiration to address social problems also parallels that of academic medicine.

As to the causes of maladjustment, these might lie in the very condition of modernity. To quote further from the prolific Miller, in this case from an article aimed at a popular audience, ‘with the growth of civilisation’ to its modern complex form the individual was no longer able to pass easily from childhood to adolescence to maturity as was the case in ‘primitive societies’. It had to be recognized that the pressures of contemporary life had ‘brought about strains and tensions and disruptive tendencies which probably did not exist before’.Footnote ⁴³ Commenting on the situation in wartime Britain, the Commonwealth Fund remarked that even under such difficult circumstances child guidance practitioners were ‘doing their best to fortify anxious and unhappy children against the brutalities of war and the stupidities of peace’.Footnote ⁴⁴ As we shall see, in practice child guidance saw maladjustment as being created, literally, much closer to home. But whatever the cause, child guidance was a vital aid to navigating what another psychiatrist, again writing for a popular audience, designated ‘the dangerous age of childhood’.Footnote ⁴⁵ This was an increasingly widely held view. In 1927 there was one self-described child guidance clinic in Britain, though others were to claim to have been operating in the field earlier. By the outbreak of the Second World War there were around sixty. Despite differences between them, most noted a rising demand for their services. The Liverpool clinic, for instance, had forty-seven referrals in 1930. This had risen to 166 by 1935 and to 268 in 1938.Footnote ⁴⁶ The war saw further development. In 1943 the Commonwealth Fund reported the creation of ‘nearly a score of new clinics’ since 1939, notwithstanding the problems of obtaining properly trained staff.Footnote ⁴⁷ By 1945 the total was nearly one hundred.Footnote ⁴⁸

The war also saw a broad consensus emerge on the need for still more provision. The experience of evacuation was important because of the problems it revealed and the research it engendered, carried out by child guidance practitioners.Footnote ⁴⁹ The Scottish Women's Group on Public Welfare sought to draw lessons for post-war reconstruction from the evacuation experience. Among its recommendations was the expansion of child guidance.Footnote ⁵⁰ A 1941 Board of Education discussion document suggested that child guidance was one of a number of children's medical services which local authorities should be obliged to provide.Footnote ⁵¹ From a medical viewpoint Henderson told a Scottish committee in the mid-1940s that one way of addressing the wartime concern of juvenile misbehaviour was more and better-equipped child guidance clinics.Footnote ⁵² Consequently child guidance became embedded in the ‘welfare state’ through the 1944 Education and the 1946 Education (Scotland) Acts, which empowered local authorities to provide a free child guidance service. This was the culmination of the Board of Education's 1935 ruling that local authorities could financially support clinics in their area, which thereby constituted the beginning of the move from voluntary to statutory provision.Footnote ⁵³

Child guidance therefore grew significantly between its inception in the mid-1920s and the end of the Second World War. It saw itself as a form of preventive medicine aimed at ensuring the healthy emotional and psychological development of the ‘normal’ child to the benefit of the child, its family and the wider society. In so doing it advanced claims for its scientific nature. But how did it operate?

The child guidance clinic and the primacy of psychiatric medicine

The key institution was the child guidance clinic. This was defined by the psychologists Mary Collins and James Drever as a ‘social agency whose object is to study and treat any child showing in its behaviour characteristics that might possibly, and even probably, lead in later life to social inadequacy, criminality, or mental disorder, or generally any undesirable characteristics whatsoever’.Footnote ⁵⁴ The child guidance clinic had three specific functions: diagnosis, treatment and research. At the clinic the child ‘patient’ would encounter members of three distinct professions: psychiatry, psychology and psychiatric social work. The responsibility of the medically trained psychiatrist was to conduct both physical and mental examinations. The psychologist administered mental tests while psychiatric social workers concerned themselves with the child's environment. A training manual for child guidance workers, co-authored by a representative from each of these professions, employed a series of revealing analogies with the physical sciences. Just as an explosion might result from the ‘ignorant playing in a chemical laboratory’, equally dangerous was ‘the practice of playing at psychology’ where the ‘material’ to be damaged was the mind rather than the body. In the ‘practice of all sciences’, including psychology, a little learning was indeed a dangerous thing. The authors concluded that ‘just as we have learned of medicine that certain drugs must be on the “poison list” and only obtainable at the hands of the expert, so should this be true of psychological treatment’.Footnote ⁵⁵ Clearly the clinic had to have a scientific basis and approach.

In the realm of research, clinics were to be laboratories where systematic investigation into a range of child-related questions could take place under controlled circumstances. A 1928 report on the Jewish Health Organization clinic commented that materials accumulated in the course of diagnosis and treatment were ‘at the disposal of research students at all times’.Footnote ⁵⁶ In 1938 staff at the London School of Economics (LSE), the institution responsible for training the psychiatric social workers who worked in child guidance clinics, noted that as a result of this work ‘it has now become evident that there is an important and relatively unexplored field of scientific research in the relationship between social problems and individual abnormalities’.Footnote ⁵⁷ Child guidance's aspiration to address social problems is again notable.

In 1939 Bowlby drafted a proposal for the Medical Research Council. This sought to compare the home circumstances of three hundred patients of the London Child Guidance Clinic with a control group of five hundred non-clinic children with a view to testing ‘the widespread clinical impression that the home conditions are worse in certain specific respects amongst the unstable group’.Footnote ⁵⁸ Although the war intervened to prevent this proposal being adopted, its underlying philosophy is clear: systematic research conducted in child guidance clinics is of scientific value and should inform future policy and practice. As previously discussed, a number of articles and papers, for both professional and popular journals, were based on research findings derived from observations and analysis from the clinics.

In terms of professional relationships within child guidance, much was made of ‘teamwork’. For Sturdy and Cooter ‘teamwork’ is one of the ‘key medical concepts of the inter-war years’ and a means of criticizing what its proponents saw as uncoordinated, inefficient, and individualistic medical practice. It was thus ‘quintessentially corporatist, repudiating the older style of competitive individualism in medical practice and teaching in favour of a new hierarchy in which consultant experts would oversee an integrated organization of the parts of medical labour’. Sturdy and Cooter in turn link this push for administrative efficiency with the rise of laboratory science to produce a medical form of, in the language of the time, ‘scientific management’ involving a ‘formal and functional division of medical labour’.Footnote ⁵⁹ Child guidance bears out this argument. In both America and Britain it was for the most part the psychiatrist, the consultant expert, who was dominant in the clinic hierarchy. As a Child Guidance Council publication puts it, clinic staff consist of three experts, but it is the psychiatrist who ‘directs the team of workers’. The psychiatrist is ‘a doctor with special knowledge of mental as well as physical growth, whose understanding of personality and of mental functions makes him better able to interpret behaviour’. The other two professionals also had clearly defined, but nonetheless subordinate, roles. The observations of all three would be brought to various case conferences for discussion and interpretation.Footnote ⁶⁰ In directing the child guidance team the psychiatrist would, for example, organize the work of the clinic, lead case conferences, and initiate research. Ultimately it was the psychiatrist's responsibility to arrive at the underlying cause of the patient's maladjustment and to prescribe a course of treatment.

These characteristics collectively embodied the American and medical model of child guidance which was adopted in the period under consideration by the majority of British clinics. In line with its internationalist strategy, the Commonwealth Fund had sought to ‘export’ the American model to Britain. To a large degree it succeeded. So in 1936 the fund found ‘room for considerable satisfaction’ in the fact that the principles on which it had based its work in Britain ‘and which were quite unfamiliar there eight years ago, have won such a degree of acceptance’.Footnote ⁶¹ This medical model encapsulated the insistence that child guidance was a form of preventive medicine, and further illustrated the desire of psychiatry to align itself with scientific medicine. It is clearly evidenced by the language that permeates child guidance literature and practice. Glasgow's Notre Dame clinic, for example, described the children referred to it as ‘patients’ displaying ‘symptoms’. The latter were outward manifestations of deeper-rooted problems. It was the task of clinic staff, led by the psychiatrist, to uncover and diagnose the ‘aetiological factors’. It was often the case that ‘the problem as referred’ was ‘one of behaviour-disorder’ such as truancy or ‘habit disorder’ such as backwardness at school. However, ‘when diagnosed’, it was revealed that ‘the real trouble was found to lie in disorders of the personality or in some physical defect’. The proper ‘treatment’ could then be prescribed.Footnote ⁶² Other clinics emphasized similar points. In Liverpool it was noted that once the child's confidence had been gained, a sympathetic psychiatrist could then ‘discern the mental processes that have led up to the production of symptoms’. Once these had been fully understood ‘it is no difficult matter to bring about a more satisfactory outlook’. Nonetheless, time, patience and experience were necessary, ‘and quick results must not be expected’ in solving problems which were the product of ‘a chain of experience’ and a ‘long series of mental processes’.Footnote ⁶³ The position of the psychiatrist was thus privileged: psychiatrists' approach and organizational practice were that of academic medicine.

The dominance of psychiatry was justified by its supporters on medical and scientific grounds. Henderson argued that child guidance was a development in the field of ‘social psychiatry’ with considerable potential and one in which properly trained psychologists and social workers had an important role to play. Nonetheless, leadership should remain in the hands of psychiatrists, for

This territorial position was asserted by other psychiatrists. R. D. Gillespie was also concerned about the claims of ‘educationists’ to lead child guidance. On the contrary, he continued, while there should be ‘co-ordination’ between medicine and education, the ‘list of complaints for which children seek advice at [child guidance] clinics suggests very strongly that the investigation must primarily be a medical psychological one’.Footnote ⁶⁵

There was no one fixed doctrinal position on the kind of psychiatry that should be practised. However, the whole essence of the movement was to see the child in his or her entirety, not simply in terms of maladjusted psychological or emotional processes. This approach owed much to Meyer, the American psychiatrist noted for his influence on child guidance and British psychiatry who has been described as the architect of ‘psychobiology’. Henderson, and his own former pupil MacCalman, had both studied under Meyer. MacCalman's professional career was to include positions as medical director of the Notre Dame Child Guidance Clinic in Glasgow and general secretary of the Child Guidance Council.Footnote ⁶⁶ As Jack Pressman put it, psychobiology rejected the dualism of ‘mind’ and ‘body’. Instead it argued that, for example, physiology of itself was insufficient as a diagnostic tool. An ‘equally rigorous examination’ was also required of how an organism's physiology ‘interacted with the circumstances of its unique life-history as an adaptive social being’.Footnote ⁶⁷ This holistic approach was neatly summed up by Gillespie in his description of the child guidance clinic at Guy's Hospital:

Psychology sidelined

If psychiatry led British child guidance, what of the other professions involved? Psychology as a discipline remained weak in inter-war Britain. Scull remarks that psychologists suffered ‘bureaucratic subordination’ in settings such as child guidance clinics.Footnote ⁶⁹ This was not least because, as Adrian Wooldridge observes, financial support from the Commonwealth Fund ‘played into the hands of psychiatrists and psychiatrically-trained social workers’. In certain circumstances, this resulted in psychologists being reduced to ‘little more than mental testers’.Footnote ⁷⁰ The partial exception was Scotland, where educational psychology was well entrenched and active in the child guidance movement, and it is notable that here the psychiatric model had a much harder struggle to gain acceptance.Footnote ⁷¹

James Drever, by the mid-1930s professor of psychology at the University of Edinburgh, had run a clinic for children from the mid-1920s. In 1935 he told a child guidance conference that the essence of child guidance was, indeed, teamwork. But the idea that psychologists in child guidance clinics be confined to mental testing was ‘palpably absurd’, as was any restriction of the psychologist's role to ‘the intellectual aspect of the child's mental life’. Failure to recognize a broader, clinical, responsibility would lead to the creation of separate psychiatric and psychological clinics, to the detriment of both disciplines.Footnote ⁷² Drever later told Board of Education officials that psychology was a science distinct and independent from medicine and again rejected any idea that psychologists should have no clinical input to child guidance.Footnote ⁷³ However, the fact that Drever had to keep making this point attests to psychology's struggle to make its voice heard.

Drever's approach echoed that of inter-war Britain's leading psychologist, Sir Cyril Burt. Burt had been closely involved in the child guidance movement from the outset. Determined to advance the scientific status of his own profession, he was famously sceptical of psychiatry and, as Wooldridge points out, of the view that neurosis was a disorder rather than a disease and thus the provenance of the psychologist rather than of the doctor.Footnote ⁷⁴ Reviewing the preceding twenty years of child guidance in the mid-1940s, Burt noted the divisions among psychiatrists about how to diagnose and interpret, and the absence of training in psychology and the diseases of childhood in psychiatric medicine. This was in contrast to psychologists, whose discipline, ‘by its very definition, takes the entire human personality as its province’. Although overall rather more conciliatory than these remarks might suggest, it is clear that Burt remained highly sceptical about psychiatry.Footnote ⁷⁵ The role of psychology in child guidance, and its own claims to scientific expertise in this field, deserves greater attention than is possible here.Footnote ⁷⁶ This is not least because psychological testing in at least some child guidance clinics was extensive and attuned to the latest developments in the discipline.Footnote ⁷⁷

The ‘scientific’ role of psychiatric social workers

We now focus, however, on the third member of the child guidance team, the psychiatric social worker. As we shall see, tensions over the scientific claims of child guidance were present throughout the movement but are particularly evident in psychiatric social work. Psychiatric social work emerged in the US after the First World War and was seen as an integral part of the child guidance movement. In the mid-1920s, with Commonwealth Fund support, a delegation of British child guidance advocates visited America. On their return one of the delegates, herself a social worker, remarked that over the last decade the ‘rapid growth and development’ of American psychiatric social work was ‘one of the most striking facts in the history of Mental Hygiene work’. The group as a whole urged that psychiatric social workers be part of any British child guidance set-up as ‘they are an indispensable part of the Clinic’ without whose assistance it would be impossible ‘to treat the maladjusted child’.Footnote ⁷⁸ The first British training course in psychiatric social work – the Diploma in Mental Health – was set up at the LSE in 1929, once again with Commonwealth Fund support. The fund was determined that psychiatric social work be adopted in Britain. As its director told the Child Guidance Council in 1928, ‘the training of psychiatric social workers is an essential and fundamental part of your child guidance programme’.Footnote ⁷⁹

Trained psychiatric social workers were ‘essential and fundamental’ because they had most contact with patients and their families, the child's environment. An understanding of environment was crucial to the child guidance enterprise precisely because of its holistic approach. As Collins and Drever put it, ‘environmental factors operate in every case; there are no born delinquents or criminals’. These environmental factors could take a number of forms. School and locality might be important, as might poverty. But the most prominent cause of maladjustment was ‘defective family relationships, defective home discipline, moral laxity or vice in the home’.Footnote ⁸⁰ The emotional landscape of the child's family surroundings was thus crucial in shaping emotional and psychological health.

Psychiatric social workers had three crucial functions. First, they interviewed the child and its family both in the clinic and at home and reported their findings to case conferences, so participating in the diagnosis of the child's ‘problem’. Second, once the diagnosis had been made, they conveyed this to the child and family and helped them achieve the prescribed outcomes. As the Feversham Committee on the Voluntary Mental Health Services commented in 1939, the psychiatric social worker's place in the child guidance team was ‘now firmly established’. She was, moreover, ‘no longer exclusively occupied in the mere collection of data and the preparation of an elaborate report on the environmental situation. She is expected to co-operate in treatment’.Footnote ⁸¹ Psychiatric social workers thus had both diagnostic and treatment roles, albeit under the supervision of the psychiatrist.

Third, in its evidence to the Feversham Committee, the Association of Psychiatric Social Workers (APSW) highlighted a further dimension of its members' work. This was their ‘special educational function’, which involved ‘interpretation of psychiatric attitudes and findings’ to other social workers who had not ‘undertaken a Mental Health Training’.Footnote ⁸² A sense of the scientific basis of this training can be gained from a late 1930s Diploma in Mental Health examination paper on ‘The psychology and mental health of childhood and adolescence’. One question asked candidates to describe ‘general appearances and common abnormal symptoms found in a child with (a) thyroid gland over-activity and (b) pituitary gland insufficiency’, while another required students to describe ‘the mental development of the normal child from birth to the end of the pre-school age’.Footnote ⁸³

Psychiatric social work was thus seen as qualitatively different from other forms of social work. In surveying its history a government report noted that it had been ‘acknowledged from the outset that a high standard of clinical practice was essential to the success of the training’.Footnote ⁸⁴ The word ‘clinical’ is significant, reinforcing the diagnostic and treatment aspects of the psychiatric social worker's role. A child guidance authority in the late 1930s explained what this might mean in practice. The problems dealt with by the psychiatric social worker, he argued, ‘cannot either be approached or treated in the same way’ as the more ‘concrete’ problems faced by ordinary social workers. The latter's clients could define and describe their problems. For the psychiatric social worker, though, ‘the problem can often hardly be defined by those who are anxious to find a solution to it’.Footnote ⁸⁵

Psychiatric social workers emphasized the specialist aspects of their profession and their integral part in the child guidance movement and its desire to establish scientific credentials. Among the APSW's declared aims was contribution to ‘the general progress of mental hygiene’ and ‘promoting and facilitating research’.Footnote ⁸⁶ The association was also keen to advance the LSE course and its specialized content. In 1936, for instance, it noted that Professor Lancelot Hogben had been asked to give four lectures on heredity. This would meet a ‘long felt need’ and it was good that this could be ‘met by so distinguished a scientist, and that a closer link can thereby be brought about between the Mental Health Course and the Department of Social Biology’.Footnote ⁸⁷ In stressing such dimensions of their training the British once again followed the American path. The APSW drew heavily on the experience of its sister organization in the US, where stress was also laid on the scientific nature of their profession. In 1930, for example, a social worker from the Institute of Child Guidance, New York, described to the National Conference of Social Work a case in which she had been involved. Commenting on this, another delegate remarked on the speaker's ‘objectivity’ in dealing with her patient. ‘This objectivity’, the commentator continued, ‘signifies a scientific study of the problem rather than an emotional response to it’.Footnote ⁸⁸

Speaking to a child guidance conference in 1935, Noel Hunnybun, a central figure in British psychiatric social work, remarked that her profession's development had gone through a number of stages. In Britain as in the US the psychiatric social worker's role had initially been seen as ‘a sort of lay assistant to the psychiatrist’. Now, however, she was engaged in ‘the more ambitious type of work in which [she] takes an active share in the plan of treatment, on a psycho-therapeutic level’.Footnote ⁸⁹ Another prominent member of the British profession, Beatrice Robinson, told readers of Mother and Child that in certain cases the social worker ‘will find that she is very completely involved’ not only through her investigations of the child's familial circumstances, ‘but also in the handling of the socio-psychological problems in the case’. Such involvement, she continued, might last years rather than months.Footnote ⁹⁰ Perhaps most ambitiously of all, a Miss Goldberg addressed a child guidance conference in 1939 on the theme of the psychiatric social worker as ‘interpreter’. This had a number of dimensions, the broadest of which was

From a psychiatrist's perspective, William Moodie remarked that when the psychiatric social worker investigated the child's home life this was ‘no matter of question and answer, but of scientific observation’, essential if accurate environmental information were to be fed into the case conference. Forcing the point home, Moodie stressed the need for ‘extremely scientific observation of the home environment’ since it was ‘impossible to assess a child's temperament from his reactions to that environment, unless we have a clear picture of the emotional forces existing therein’.Footnote ⁹² R. G. Gordon took a similar line. A social worker trained ‘in psychiatric work’ was essential to child guidance not only ‘so that she could deal with specially pertinent problems’ but, perhaps even more importantly, ‘so that she could avoid the pitfalls with which the path of the well-meaning “common-sense” worker is so liberally strewn’.Footnote ⁹³ What is striking in these statements, as in child guidance as a whole, is the relentless search for underlying causes and a rejection of moralizing, categorized as the ‘emotional response’, and of shallow empiricism, characterized as ‘well-meaning common sense’.

Science questioned

However, the claim of British child guidance to scientific status was questioned even at the time and can be further questioned now. In the first instance, consider once again the example of psychiatric social workers. As we have seen, in the course of their LSE training they were examined on issues such as thyroid gland overactivity and pituitary gland insufficiency. But closer scrutiny of the Diploma in Mental Health questions the depth in which any subject might be studied. When the course was being set up it was suggested that lectures would include topics such as ‘Psychological foundations of abnormal mental states. The theories of Freud, Jung and Adler’. However admirable this might be, students had only a year to complete the diploma. They were to have lectures encompassing ten different topics, from psychiatry through to social case report presentation. In any event they were to spend only two days a week on academic work at the LSE, with the rest of their time devoted to practical work at various clinics.Footnote ⁹⁴ It is thus significant that at a meeting of the course committee in 1939 a letter was read out from the psychologist Lucy Fildes complaining of the ‘difficulty in planning an adequate syllabus in the basic facts and concepts of psychology during this short course’.Footnote ⁹⁵

Roy Lubove has asked what it was that distinguished American psychiatric social workers, who at least superficially had the opportunity to gain psychiatric knowledge, from the psychiatrist and psychotherapist. His answer: ‘the social worker's inferior training’.Footnote ⁹⁶ This judgement applies equally to Britain. Scull observes that social work, as psychology, was subordinate to psychiatry and that this was in part due to its lack of ‘any independent intellectual claims to jurisdiction’.Footnote ⁹⁷ In fact, even some of the most vigorous proponents of child guidance and psychiatric social work recognized at the time that the claim to scientific status was not unproblematic. The training manual cited earlier made a number of important points in this respect. It noted, for example, that with adults it was necessary to adopt an ‘objective’ analytic approach, but that even here it was sometimes necessary to ‘modify this attitude’ and to ‘go some way to encourage and draw out the patient by a sympathetic understanding’. This was even more so in the case of children. While ‘we may observe and analyse and note our estimate of his problem, we must in dealing with him be more human and less scientific’. In the case of psychologists, meanwhile, here was a profession utilizing an ‘objective scientific method’. Nonetheless, ‘one has seen people testing whose own obvious anxiety clearly had its effect on the child’. Others still had a ‘cold, scientific detachment’ which was like a ‘polar atmosphere, freezing the child into a state of inhibition’. Such an approach frustrated more nuanced analyses. As to the social worker, there were clearly circumstances where more than ‘objective’ interpretative or observational skills were required. On the first visit to the child's home, for example, she had to be ‘creatively receptive’ to what was going on and thus ‘more of an artist than a social reformer’.Footnote ⁹⁸

This volume was published towards the end of our period, but clearly built on pre-existing concerns. A psychiatric social worker told readers of Mother and Child in 1936,

Similar comments can also be found in more specialist journals. In 1939, for instance, Mental Hygiene published an article by Sibyl Clement Brown, a leading British psychiatric social worker and tutor on the LSE course. She dealt with the training of psychiatric social workers and remarked that it was not difficult to plan courses wherein the little that was actually known about human personality and social relationships ‘may be served up in reasonably digestible form’. Nor was it difficult to devise an impressive syllabus ‘with lectures on such subjects as child psychology, psychiatry, physiology, law and casework’. What was difficult, though, was to ‘transpose this knowledge into the art of human understanding and the skill of personal service’. Students on the course should therefore be ‘sensitive, mature and intelligent enough to learn from experience’ and should be given the opportunity ‘not only of learning facts and theories, but of growing in wisdom’.Footnote ¹⁰⁰

Tensions between ‘art’ and ‘science’ were also evident in the US. Smith College, Massachusetts was the educational institution which did most to professionalize American psychiatric social work. In the inaugural edition of the college journal Helen Leland Witmer, prominent in American child guidance, sought to have things both ways. Social work was, she argued, an ‘art which utilizes the findings of various disciplines for the understanding and adjustment of human personalities’. The aims of ‘art’ and ‘science’ were similar, and could be distinguished by ‘emphasis’ rather than by ‘methodology’. To be a ‘good artist’ the social worker could not be ‘solely an artist’, and so the college ‘adds a touch of science to her training’.Footnote ¹⁰¹

The tension between ‘science’ and ‘art’ was not limited to psychiatric social work. Rather, it was part of a broader discourse about the aims and methods of medicine. It was also a constituent of the struggle between academic medicine and members of the clinical elite.Footnote ¹⁰² Indeed, the questioning of child guidance's scientific credentials was not confined to the domain of psychiatric social work, even among the movement's supporters. The Feversham Committee, reviewing the field as a whole, commended child guidance in general terms while noting that ‘little can be said of the success or otherwise of the efforts made by the child guidance clinics in this country to treat individual children, for no scientific method has been devised for measuring the results of treatment’.Footnote ¹⁰³ This was an appeal to science designed to show that scientific criteria were not – yet – being met.

The questions of efficacy and outcomes were repeatedly addressed, a sign that supporters of child guidance felt called upon to justify their work. Burns observed that it was ‘often said that Child Guidance is still in its experimental stage, and that only time will tell whether it has any real value’. In response, he suggested that ‘any art or science which deals with human beings – whether it be politics, education, or medicine – will always be in an experimental stage, with constant new theories and developments, often re-discovering ancient truths under new forms’.Footnote ¹⁰⁴ The conflation of art and science in the very disparate disciplines of ‘politics’, ‘education’ and ‘medicine’ is notable here. Burns may have been tailoring his remarks to his audience, the Education Committee that financially supported his clinic. There is, nonetheless, a sense of insecurity about the way in which the argument is formulated.

In an article on the results of child guidance Burns observed that the ‘facts and estimates’ were very difficult to ‘translate into figures, for there can be no fixed standard’. So, ‘for what they are worth’, the data from his own clinic showed ‘approximately the same kind of result as reported from other clinics’.Footnote ¹⁰⁵ In a similarly defensive vein Moodie claimed that, at least as far as the London clinic was concerned, its results ‘compare favourably with those obtained in other branches of medicine’.Footnote ¹⁰⁶ In part, of course, it was difficult to be precise about what was to be ‘measured’, and thereby to test the efficacy of ‘treatment’ and ‘diagnosis’. As MacCalman noted, it was relatively easy to measure a child's physical and intellectual attributes. However, ‘in the case of the growth of character and personality – surely the most important of the three modes of development – we have no standard of measurement’.Footnote ¹⁰⁷ Engagement with ‘character and personality’ also led, as we have seen, to imprecise clinical categories such as ‘moodiness’, a vague concept when compared with, especially, the claims of academic medicine and the natural sciences. In principle, of course, such problems could be resolved by the further consolidation of the scientific basis of child guidance. This could most obviously happen, for example, through what Burns describes as engagement with ‘new theories and developments’, an integral part of any scientific endeavour. However, the issue was broader than the current inadequacies of defining and measuring.

An internal London child guidance clinic document from the mid-1930s commented that at the outset child guidance had been seen as an import from America. Moreover, it had been linked with psychology – it is clear what is meant here is medical psychology or psychiatry – ‘a name with a very unwholesome association in the public mind’. It had been claimed that ‘children would be psychoanalysed against their parents' will’ and one leading article had described the clinic as ‘Psycho-absurdity’. Such fears were not only present in the popular mind. Those in related fields – medical, educational or social – were also unsettled by the new arrival.Footnote ¹⁰⁸ The vast majority of British child guidance practitioners thus rejected any suggestion that they were engaging in the psychoanalysis of their child patients. Instead, transactions between psychiatrist and child were relatively straightforward and uncomplicated. So, for instance, one psychiatrist told an audience in 1932 that ‘psycho-analysis plays no part in our work’. ‘A child's mental conflicts’, he continued, ‘are immediate and on the surface, and they must be dealt with on a commonsense basis’.Footnote ¹⁰⁹ Its avowedly scientific approach notwithstanding, British child guidance eschewed more intense versions of psychiatric theory. This confirms Lawrence and Weisz's observation that holists in Britain pursued a strategy of ‘pragmatic reformism’.Footnote ¹¹⁰

Ambiguity and self-criticism over the degree to which its methods and achievements were scientific preoccupied supporters of child guidance. Unsurprisingly, ambiguity was also explicitly and implicitly present in external criticisms. Three examples illustrate the point. First, the professor of education at the University of Birmingham, C. W. Valentine, agreed that child guidance clinics had done some good work with ‘problem’ children. He counselled, however, against ‘fallacious inferences’ from such success. Chief among these was that the ‘peculiar methods of a particular Clinic’ must be the main cause of any ‘cure’. Valentine pointed out that different clinics used different techniques but with similar results, and even, citing evidence from the child guidance movement itself, that ‘recovery rates’ of ‘treated and untreated groups’ were ‘regrettably similar’.Footnote ¹¹¹ Such arguments can be read as a critique, itself employing scientific method, of the scientific pretensions of child guidance.

Second, the London County Council subcommittee responsible for supporting child guidance clinics reflected in 1936 on the latter's achievements. It had been claimed, the subcommittee noted, that of the cases referred to the London child guidance clinic some forty-five per cent had been successfully dealt with. But it was ‘undoubtedly’ the case that in certain instances ‘the root of the trouble and a recommendation for treatment could have been reached without the elaborate technique of child guidance’.Footnote ¹¹² The issue here was more to do with selection than with treatment, but again the clear implication is that child guidance was making claims which in reality could not be fully justified.

Third, there were those within the psychiatric profession who took a very different view of how children should be dealt with. One example is provided by Melanie Klein and her followers. Their approach can be discerned from the 1936 volume edited by the psychiatrist John Rickman, the significantly entitled On the Bringing Up of Children. Consider Rickman's Preface, where he noted that Sigmund Freud, in the course of his work with neurotic adults, had devised a ‘new instrument of research’. The latter was crucial and genuinely ‘scientific’, because ‘the distinguishing feature of a scientific concept’ was that it could be ‘detached from the particular circumstances for which it was first made and be used in other situations that have the same kind of inner relationship’. So it was that ‘progress in one branch of science enriches and may even revolutionize another’. This ‘instrument of research’ was analysis, which had, inter alia, given the insights of education and child welfare ‘greater definition and exactness’. More importantly, it had shown that the growth of the child's mind was a ‘far more complicated process than was once supposed’ and hence that ‘much harm may be done to that growth if a method of upbringing is adopted which underestimates the complexities’.Footnote ¹¹³ Common sense, clearly, was not enough.

In a key passage Rickman continued,

This was both untrue and a disservice to parents and children alike. It obscured the ‘importance of the child's own intricate mental activities’ and so regarded him as ‘a piece of inactive plastic material’.Footnote ¹¹⁴ It is difficult not to see this as an attack on child guidance philosophy and practice, an attack which based itself on scientific grounds and thereby sought deliberately to undermine any scientific credentials child guidance might claim.

Conclusion: child guidance and science reconciled?

British child guidance claimed scientific status but this was challenged from within and without. Two further points need to be made. One of these is contextual, while the other returns to the particular form of psychiatry embraced by child guidance.

First, developments in the natural sciences were a contributory factor to the high status science enjoyed in the period after the First World War and form a crucial backdrop to the advance of child guidance from the mid-1920s onwards. We have already encountered the critique of modernity by child guidance advocates and the claims by historians of psychiatry that during the inter-war era Britain became a ‘neurotic nation’. Such analyses are further enhanced when seen in the light of the concept of ‘uncertainty’. This was introduced into late 1920s physics and mathematics and contributed to a more general cultural sense of anxiety and concern for the future.Footnote ¹¹⁵ Feelings of unease also reflected concerns over socio-economic instability and the rise of consciously antirationalist political movements such as fascism. The intellectual climate was, in addition, increasingly influenced by the work of Freud, with all its disturbing implications for emotional development and disquiet. One of his most pessimistic works, Civilization and Its Discontents, sold out its first edition of 12,000 copies within one year.Footnote ¹¹⁶ The normal but potentially unstable child thus existed in a wider environment that was itself unstable, and increasingly seen to be so. Indeed, if problems were left untreated, in later life the unstable child could contribute further to social instability. Child guidance therefore forcefully presented itself as a particular solution to broader societal problems. This was an approach consonant with the aspirations of academic medicine and psychiatry. Child guidance saw itself as informed by the broader intellectual and scientific currents of the time.Footnote ¹¹⁷

Second, it is necessary to return to the principal form of psychiatric medicine used in child guidance. We have noted the psychiatrist Gillespie's dismissal of mind–body dualism and its involvement in a broader trend led by Meyer towards psychobiology. In 1932 a child guidance clinic opened in Manchester. The city's school medical officer used the occasion to comment that it was increasingly realized that in child development ‘the physical and the mental are not separated; one reacts upon the other’. All development was thus ‘physico-mental’ and to concentrate simply upon the physical, ‘either in health or disease, gives a lop-sided view of the child’.Footnote ¹¹⁸ Such views were repeatedly expressed by proponents of child guidance. In turn, this prompted the chief medical officer of the Board of Education to claim that ‘Neuro-pathic malady is gravely on the increase in modern nations’. This was a further instance of the perceived tensions of modernity in the inter-war era. It was held that one way of countering this was for school doctors and teachers to become ‘psychiatrically-minded’.Footnote ¹¹⁹

Here is further evidence of a key aspect of child guidance – the need for a holistic approach to child emotional and psychological well-being. Christopher Lawrence and George Weisz note that in Britain and America holist sentiments became stronger in the wake of the First World War.Footnote ¹²⁰ For leading figures such as Meyer, the unification of the biological and social sciences was a desirable aim. It is thus significant that after 1918 such protagonists sought more fully to establish themselves in response both to the perceived crisis of modernity and to the apparent explanatory success of the natural sciences.Footnote ¹²¹ This proposed relationship with the social sciences included psychiatry's use of concepts that had originated in functionalist social anthropology. Miller's comments on child development in primitive and civilized societies are pertinent here. The most obvious idea taken by child guidance from this form of anthropology was that of ‘maladjustment’. As Stephen Cross and William Albury suggest, in psychiatry ‘adjustment’ defined the ‘psychobiological premises of personality theory’. This in turn stimulated ‘practical programs of social engineering’, one instance of which was ‘the mental hygiene movement of the 1920s’. Child guidance is an equally valid example and in any event formed part of the wider mental hygiene movement. Cross and Albury also point to the importance of organic, holistic approaches as a response to the inter-war crises and the perceived need for ‘scientific social management’.Footnote ¹²²

Child guidance was a key example of such approaches and of such a response. In its commitment to medical holism it actively participated in this particular form of medical science. It was, furthermore, organized on the basis of hierarchical teamwork and a highly specialized division of medical labour. The knowledge the team acquired through observation and analysis was collectively pooled to enable diagnosis and treatment. The child guidance clinic was, moreover, a location for scientific research. A new body of medical knowledge was thus being created, derived from the ‘systematic and rational investigation of the underlying causes and processes of health and disease’ identified by Sturdy and Cooter as central to the claims of the laboratory sciences. Such knowledge would, in turn, be used to inform future practice and to develop the field.

The leading figure in the clinic was the medically trained psychiatrist. Psychiatry was then seeking to expand its professional remit and become more fully integrated and associated with the scientific claims of the laboratory sciences and academic medicine. As part of its contemporary ambitions to broaden its professional embrace, psychiatry played a major role, through child guidance, in the ‘problematisation of the normal’ and in contributing to the rise of ‘surveillance medicine’ identified by Armstrong. In so doing, both psychiatry and child guidance distanced themselves from moralistic approaches to mental disorders and from mere empiricism. British child guidance thus promoted its scientific vision for cultural and intellectual reasons. It sought to gain professional and public acceptance through science's high contemporary status. But through its insistence on such themes as its capacity to address social problems and a particular form of organization it also took sides in the debates of the inter-war period between academic medicine and more individualistic and empirical clinical practice.

British child guidance between the end of the First World War and the end of the Second World War developed rapidly, initially through voluntary support and then, increasingly, through state support. Its claim to scientific status was not unproblematic. On occasion it was the subject of internal unease as well as of external attacks. But this claim is better understood and substantiated by the movement's underlying holistic philosophy and clinical and organizational approach. Analysis of the early history of British child guidance and of its claims to scientific status thus adds to our knowledge of the contemporary transformation in perceptions of childhood. It shows how these perceptions interacted with changes in medicine and science and illuminates the intellectual and cultural weight of science in this period.