Chapter VI. Ocular Psychoneuroses of Childhood1 [1944]

IT IS EASY to say that a child values sight, or fears blindness, and yet at the same time fail to come to grips with the immensity of the hopes and fears involved.

The fact that ophthalmologists exist who deal especially with children shows that there is a general recognition of the fact that children require a special approach. A knowledge of the anatomy, physiology, and pathology of the eye is of little use to the clinician who cannot get in touch with his child patient; and skill in making contact with a child largely depends on the eye doctor's understanding of a child's feelings and his belief in the child's hopes and suspicions and fears. The child recognizes very quickly whether the doctor believes in him, and usually he allows examinations and even co-operates helpfully. So the doctor who believes in the feelings of children starts off as a good psychologist.

Following up this idea, an enormous quantity of successful psychotherapy is all the time being done by ordinary routine management of cases. On the other hand, harm can be done. As a glaring example, I quote the experience of a friend whose childhood was spoilt by the remark of an eye surgeon to whom she was taken when small. He said to the child's mother, in front of her: ‘She is suffering from retinitis pigmentosa, and will probably go blind when she is older.’ This was, of course, a wrong prognosis, but the point is the surgeon did not know that it mattered, saying this in front of a little girl. The child spent her childhood expecting to go blind, and she forced herself to read everything while she could, and was always testing her eyes. Now at the age of 50 she is beginning to believe that in spite of the doctor's words she may escape blindness. Children quite naturally feel that they are custodians of their eyes, or of any other part of their body, and if they do not keep their eyes healthy they feel they have failed in a trust.