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IN THIS PAPER I shall try to show that some degree of psychosis in childhood is common, but it is not noticed because of the way in which the symptoms are hidden in the ordinary difficulties inherent in child care. The diagnosis is made when the environment fails to hide or to cope with distortions of emotional development, so that the child needs to organize along a certain defensive line which becomes recognizable as a disease entity. This theory assumes that the basis of the mental health of the personality is laid down in earliest infancy by the techniques which come naturally to a mother who is preoccupied with the care of her own infant. I shall make a brief sketch of the tasks involved in the early stages of the emotional development of the infant, tasks which cannot be accomplished by the infant except in an emotional environment that is good enough.
There are two methods by which the subject of childhood psychosis can be attacked. By one method mental disease organizations that are well known in adult psychiatry can be described as occurring before puberty and in the years of early childhood. Creak (1952) takes one type of psychosis in which there is an organized introversion, with consequent bizarre behaviour patterns and secondary disturbances of physical functioning, and she clearly describes a type of child that must be well-known to all child psychiatrists and to paediatricians. In the same way it would be possible to take melancholic states, manic-depressive mood swings, hypomanic restlessness, various kinds of confusional states, and to trace their common occurrence in childhood; the material for such a study is abundant.
I have chosen another method, perhaps because I wish to speak as a paediatrician who is in the habit of thinking of the developing child and indeed of