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Dr. Bender presents a review of her work with schizophrenic children at Bellevue Hospital over the past twenty years and the theoretical conclusions as to etiology, course, prognosis, and treatment to be drawn from it.
Childhood schizophrenia is a clinical entity occurring before the age of eleven. It is a disease, resembling an encephalopathy, to which persons are predisposed by heredity. The high degree of plasticity in the schizophrenic process gives rise to a variety of clinical pictures and to precocious intellectuality. The schizophrenic infant shows the behavior pattern of an early foetal infant as described by Gesell, characterized by torpor, flaccidity, and primitive homeostatic and muscular control. Anxiety is excessive and easily evoked and gives rise to secondary neurotic defense mechanisms. The precipitating factor of the acute illness is a physiological (not a psychological) crisis, such as birth, especially birth with anoxia, severe illness, accident, and prepuberal and puberal stresses. The relationship between parents and child and the emotional climate of the family help determine the mechanisms of defense and the ability to handle regressive tendencies, impulses, anxieties, and so forth.
It follows that therapy aimed at giving insight is contraindicated since the ego, which is from biological causes weak, can never become normal and so requires neurotic defenses against the anxiety so easily evoked. Treatment should aim at strengthening the defenses. Shock therapy may stimulate processes of maturation. Education may also be of value.