The Parents' Review
A Monthly Magazine of Home-Training and Culture
"Education is an atmosphere, a discipline, a life."
The Education of Nervous Children.
by Geo. H. Savage, M.D., F.R.C.P.
[George Henry Savage, 1842-1921, was Senior Physician and Superintendent of Bethlem Royal Hospital in London (a psychiatric asylum nicknamed Bedlam), was editor of the Medico-Psychological Association's Journal, wrote articles about psychology, and treated Virginia Woolf. He was knighted in 1912.]
Paper read before the Finchley Branch of the P.N.E.U.
Having had very special experience of the nervous disorders to which children are subject, I have selected this as the theme of my paper.
First, I would make it clear that I do not believe in any definite standard of nervousness. We have not to consider nervousness, but individual nervous children, and the various symptoms or evidences of nervous disorder which we have to meet and counteract. The individuals do certainly fall into some fairly well marked groups, and I would refer more advanced readers to a series of Gulstonian lectures, recently delivered by Dr. Still, at the Royal College of Physicians, on the various mental disturbances which may occur in childhood. [George Frederic Still, Some abnormal psychical conditions in children, 1902] In these lectures it is clearly pointed out how such disorders may affect the intellectual, the moral, or the social parts of the individual. Some children are found wanting in ordinary mental capacity, and are ranged among the feeble-minded or the idiotic; others seem to be out of place in their present social surroundings, and I have called such "Misfits"; then a still more important group contains the children whose weakness is evidenced chiefly or solely by moral faults. I shall refer to these groups in turn. Now to my subject. Education must be understood to be the developing the various parts of mind and body in such a way as to fit the individual to perform the duties of his station. The mere turning out children with definite amount of the three R's is not what I mean, and in fact many of the children who are nervous are not at all suited for general training of this simple kind. Wholesale teaching is not of much use with specially defective children. The work of specialising and selecting the aberrant children has been steadily going on for some years now. Dr. Warner, of the London Hospital, has spent a great deal of time and attention on the subject, and I served on several committees with him, the result of the work being that over 100,000 children in various schools were examined and the relative numbers of these not fit for general school work were noted, and at the same time certain signs of nervousness were discovered and used as measures of the degree of nervousness present in the children.
In London and several of the larger cities now there are special schools with efficient teachers for the nervous children who are unfit for the ordinary training. It was long ago pointed out that by thus catching the nervous children early, tramps and even criminals were prevented from developing. I merely mention this in passing, to show you how important an element the nervous one is in education.
Before taking special forms of nervous disorder, I must impress on you the importance of what the Duchess of Sutherland [Millicent Leveson-Gower, of the famous John Singer-Sargent portrait] said at a meeting of those interested in the education of the feeble-minded. She pointed out that we must understand at once that though many of those who were weak in one way or another way may be developed to a certain degree, yet that too much must not be looked for. If you expect that the markedly nervous child is certainly by special training to be made like his healthier brothers, you will be disappointed. You must be content with a modified usefulness in many cases.
In each child, then, we have to consider how much good is possible, and aim at a definite end which is not too high. A general principle is that in teaching the nervously weak, the lines of least resistance must be chosen. It will not do always to follow inclination or even capacity without reserve, but the object will be to seek where resistance, organic or moral, is least. It will follow that in some cases where there is precocity it is well to develop the faculty which is present, rather than to attempt to divert it. Precocity may be the prelude to genius, but more commonly it leads only to folly and disappointment. It seems as if there was a blaze which exhausts the nervous material. The whole subject of precocity is too large for me to deal with here. In considering the education of nervous children, one cannot begin too early to observe the child and his surroundings, for in infancy the starting points of evil commonly arise. And therefore children who in infancy have had convulsions, who have suffered severely from infantile complaints, such as whooping cough or measles, or those who have had injuries to their heads, should be watched with great care. No malady is too light to be neglected in the earliest years. The tender plant can resist but little. The child who is backward in walking and in talking should give rise for consideration as to his future training. You will expect me to state when and how the earliest teaching should be begun. In nervous children, or those who have had nervous illness, shocks of the like, formal training should begin later than in ordinary children. Education of a kind begins with the earliest sensory impressions; therefore, as the authoress* of The Mind of the Child makes clear, the surroundings of the child should be healthy from the first, but I fear this is rather more than human. That healthy surroundings and calm tempers, and pleasing, not chastising, influences should drive the machine is evident. I believe in early educating the observing faculties steadily and uniformly. The bright lights, the pleasant smells, the sweet songs, should be associated with the unconscious foundations of mind. I am strongly against the early teaching of reading, and I am rather glad to find the even adults are becoming aware of the easy and pleasant way in which knowledge can be gained through looking at illustrated papers. These were the occasional weekly treat, now they are the daily food. The nervous child may be either precocious and require to be checked and made to live a simple observing life, but more commonly, the class of child with which we are chiefly concerned to-night is backward, and I shall now go more fully into the subject of backwardness.
Many brilliant men have been slow in developing. It is here as in other things in nature, the more elaborate is often delicate and slow in growth. There are several very distinct varieties of backwardness met with as hindrances to education.
First, I frequently see children, generally boys, who have truly outgrown their (nervous) strength. They have big bodies, but the controlling power is wanting or deficient. Such, if not specially looked after, tend to become gross animals, vicious or depraved, but rightly handled they may become some of the most strenuous of the world workers. They require to be fed, exercised, trained to observe and obey, but not to be taught much from books for a time. It is surprising how rapidly such boys pick up when once they have got the right start. I only recently saw the developed result of such a case, and it encouraged me to urge on my present plan of rather neglecting the schooling of such lads.
There is backwardness which depends on past ill health or present bloodlessness, and in such cases there can be only one piece of advice. Let these children run wild, but be careful in selecting the "wild."
Lastly, there is the truly, I would say, organically backward child, who really falls into the class of feeble-minded. Such children may be healthy in body, they may possess their senses, and they may have a pleasant plausible manner, yet they may be hopeless as far as real development is concerned. Though they vary, yet I think the most common form is that in which all grasp of abstract things is wanting. The child may read and write, but he cannot be made to understand the simplest rules and practice of arithmetic.
It would surprise some of you if I were to tell you of the young men and women about whom I have been consulted who have as complete a want of the arithmetical faculty as the blind man has of light. It is simply waste of time and energy to attempt to teach these children anything of that kind, though they manage to get on pretty well without it.
We have thus briefly considered the disorders which may affect development from infancy; and the so-called backwardness, now we come to consider the children who seem to have some special or particular want, and I shall divide these according to the following plan:--(1) Those with defect in receiving capacity, that is, those with defect of the senses and defect of memory; (2) those in whom the defect is rather the logical or associating faculty, those in whom the relation of past to present, between cause and effect, is not properly perceived; (3) those in whom there is some defect in the reaction to the outer stimuli, so that the conduct is not normal, those the perceptions and powers of organising seem normal. In these last we have the morally defective, those in whom the social misfits occur, and who approach the criminal.
It is unnecessary for me to refer to the classes of those who, being deficient as to their senses, need special training; the blind, the deaf and dumb form the chief examples.
First, then, as to defect or peculiarity in the storing capacity, as to the peculiarities of memory. This power differs in degree and in quality to an almost endless extent, and is probably a more constant and unalterable quality than is generally thought. Abstract memory is but slightly improved by exercise, while memory of association is greatly improved. Memory is so clearly connected with interest and attention, that when the power of application or attention is wanting, the memory is necessarily weak. Some of the most useless memories are to be met with in the weak-minded. In such persons there is an accumulation of facts which are of no use for reference or for organisation.
After all, knowledge is the result of forgetting. He knows most who has forgotten most. In some children restlessness is associated with defect of memory. They flit from subject to subject without taking time to form a clear image of what they have seen or heard. In these children, steady, slow application of interest and even lessons in being "still" may be of use. The endless questioning of children is natural enough, but if the child never seems to learn by the answers, I think the best plan is to expect him to be able to repeat the answer to the last question before you reply to his next question. This will check the useless flow of questions and fix attention on some answers.
Great difference of opinion has arisen in regard to verbal memory and its place in education. For it there are, no doubt, arguments such as the storing the mind with good ideas well expressed, also that it leads to exactness of expression, but I find that the children who can learn verbally rapidly do not store; they forget almost as rapidly as they learn, and that their memories are not really strengthened. On the other hand, many children are absolutely without this type of memory, and I believe the original minds are not as a rule good at verbal learning, and the struggle to learn by heart is great, and I do not think the result compensates for the pain. I think the method by which "Kim's" memory was tried and trained was a good one. The placing of many various things before a child, and getting him to recall accurately their number and forms is of much more service, and I think is more suited to many of the rather peculiar and restless children of whom I am speaking. As when speaking generally, so in detail, I would impress on you that memory varies with physical conditions, and I constantly meet with children whose memories are weak because their bodies are badly nourished, and a cup of cocoa or a piece of chocolate may be more efficient than a cane.
Now as to evening preparation, I am rather in favour of it, so that the child, if nervous, does not go straight to bed from his books. It is certain many lessons half known at bedtime are known in the morning, after good healthy sleep, but I think the child should not be over tired, and a few minutes' play and a little food is good before bed. Sleep, as the hypnotists have shown, is a great fixer of good resolutions.
Next, as to defects in the organising and arranging of experiences. Many weak-minded children fail to connect sequence facts. They do not connect cause and effect, and fail to appreciate the painful impression associated with punishment following faults. In such cases, if there is physical illness or backwardness, this may pass off, but in most such cases the defect is organic, and cannot be got over. Children with this failing may be incorrigible, they may be selfish pilferers or impulsively injurious, or they may even pass for quiet good-natured children, who are easily led into mischief. If they are not physically weak, some sort of punishment or corrective must be tried, and the only thing to do in this way is to be consistent and persistent, so that the punishment follows without anger, but as a constant result; the repetition of correction in some cases has the desired effect, some nervous children requiring many repetitions, while the healthy child would only need one or two. I admit that from time to time I meet with children who seem to be beyond the sane pale, their actions appearing to have no relation to their surroundings or their experience.
The last group is that in which the children have normal experiences. Their senses are normal; their memories appear also natural; they are able to judge of cause and effect; yet they are morally incapable of doing right. It has long been a question whether there should be recognised any class between the sane and the criminal, which should include such persons as these. I have no doubt from a very large experience that there are certain children who may be called morally imbecile, just as there are elder persons who are morally insane. In a later part of this address I shall speak more of these.
Before going further, I think it well to introduce the general causes of nervousness which are met with in children. First, it may be an inherited organic defect, or it may be acquired in early years. In this class we have illnesses in early years as a starting point. Fright, injury to the head, or shock may cause the trouble. The more definite the cause of the nervousness, that is, the more evidently it depends on an organic brain defect, the less is the hope of doing any real good. That nervousness is transmitted makes it pretty certain that it is harmful to bring up nervous children at home. The nervous mother accentuates the nervousness in her daughter, and I would still more strongly urge the importance of not bringing up a nervous child with his brothers and sisters. Nervousness may be developed, almost caught, by relationship with nervous children. Among the signs of nervousness which are commonly transmitted are tricks of manner and slight habits. I think it is well not to make much fuss about these unless they interfere with the comfort of the child or his parents. It is noteworthy that though genius is rarely passed from parent to child, slight tricks and habits are. It is the slight variations which seem easily transmitted. Nervous children may show their weakness by various alterations in their food appetites. I look upon it as a serious symptom when a child has marked fads about his food. I have known children who from the earliest months seemed to have no longing for food, no instinct for eating. I think it should be recognised, too, that in eating we readily see the presence or absence of the finer conventions of social being. If a child of five years cannot be made to eat and drink like a civilized being, but persists rather in following the ways of lower animals, the prospect of doing him good is slight. In such cases generally there are other signs of mental weakness. In a similar way, the child may be wanting in general ideas of cleanliness. The unregenerate boy does not take to water naturally, and some never can be taught the difference between cleanliness and dirt. Girls, on the other hand, exhibit not infrequently an exaggerated tendency to washing, and unless guarded against, a distinct morbid habit may arise. I say that cleanliness may be next to godliness, but that immoderate washing is like over-conscientiousness, a morbid unhealthy sensitiveness. So it must be remembered that the simple conventions of society may help us to judge of the nervous defect which is present in a child, and the neglected habit may grow into a vice or an insanity.
I have already said that delay in learning to speak is associated with nervousness in children, and further, it must be recognised that nothing is more common than to meet with some affection of speech in such children. This may be anything from a slight arrest in articulating words to extreme stammering. It is certain that such speech defect should be definitely taken in hand, fairly early. If thus met, it will almost certainly be cured. Nervous children are supposed to be emotionally unstable, to form as it were the starting points for hysteria, and there are special forms of emotional weakness which must be considered. First, then, the so-called "rages." I have known very young infants, the children of neurotic parents, who seemed from their earliest years, almost months, to be subject to causeless and impotent passion. I have known such infants, if in any way interfered with, as in their feeding, pass into a rage, which seemed to be in danger of ending in a convulsion; then almost as suddenly the storm passed, and the child, now smiling placidly, may fall asleep. I do not wonder that some mothers have told me they believed their infants were possessed by the devil. In some of these children these rages occur for many years, and may become habitual, the slightest cause producing a storm of alarming aspect. I think there are two distinct types of this disorder. In the one the child outgrows the fits of passion--the disorder may be called functional, in the other the fits are nearly allied to epilepsy, and are very hard to deal with. It is no good punishing, physically, children for such outbreaks, and it is equally useless and harmful to put the child in a dark room. A calm attitude and judicious neglect are the best means. If the parent or nurses get into a panic, it is certain the child will become worse. I believe in treating these conditions as illnesses, and just as if the child were threatened with a convulsion, a hot bath might be given, so with all ceremony I would have a warm bath prepared for the child in a rage. In the more grave cases, some drug, such as bromide, may be of service if medically directed. I have met with children who in these rages are really dangerous, and would kill or injure those about them. Allied in some way to these conditions may be mentioned the cruel tendencies of some children. We most of us know the pleasure of power, and this, unrestrained, may lead to cruelty. Though I oppose as a rule corporal punishment, yet in cases of cruelty I believe in making the sinner suffer. Here again let the punishment be judicially applied--I have even suggested a kind of grace before punishment. Cruelty in nervous children may be the outcome of ignorance, or it may be the result of nervous terror. Probably no greater cruelty is done than by those who are in a panic. A child's healthy tone can be judged greatly by its social qualities. The healthy child is companionable, gregarious, while the morbidly nervous child seeks solitude. I constantly have to advise about children who, like [Percy Bysshe] Shelley, prefer to be left all alone, to read and contemplate. One of the dangers which children who are crippled, like Byron, or are disfigured run, is that they are isolated. Of course, in the earlier years, such shy, nervous children are not fit for the life of large or public schools. They require slowly accommodating to wide surroundings. Another of the dangers which the solitary child runs is the habit of constant reading of books. Like the child who in earlier years does nothing but ask questions, so the solitary child is given to reading without digesting. In some of these I have seen the reading degenerate into little more than a constant stimulation of the eyes, the absence of a book being felt as a want, just as removal of air, which leaves the terrible feeling of anxiety. I believe the best plan with the solitary children is to try to find one or at most two companionable children, and, as it were, link them, giving special individual rivalry as the stimulus to work. In these children, as they grow older, it will be found that racquets or tennis, rather than football or cricket, help in developing the social instincts.
I shall only have time to refer casually to the moral defects which may be evidence of nervous weakness in children. I would repeat that there may be every degree of moral defect associated with every degree of mental ability. Lying is a common fault of the normal and the nervous child, but it is remarkable in its degree in many of the nervous children. I think the romantic lying which is frequent is a kind of tentative growth of the imaginative faculty, and need not cause much anxiety. It is nearly always outgrown. Judicious neglect or amused scorn will be efficient in killing this. I have on several occasions met with children who with recurring physical illness have developed the habit of romancing. It may thus be interestedly related to delirious conceptions. The boy or girl who is not a romantic but a malignant liar is generally more nearly allied to the degenerate or the criminal, and is altogether different. With such children, consistent firmness, with judicious punishment, are indicated. Lying may be the outcome of nervous weakness and a general dread of consequences. In such cases one can only do one's best to give confidence by encouragement rather than punishment. Pilfering and thieving are more often met with in the nervous than the healthy child, and here again I have met with honest-minded boys who have for a time become pilferers as the result of physical weakness and nervous exhaustion, due to improper or over-work. Some are romantic thieves, stealing not for their own gratification, but to give away to others. They, too, have a sense of the pleasure of power. They like to communicate and appear important. I have known the romantic thief develop into the confirmed habitual kleptomaniac. In a few cases I have known boys at public school accept a whipping and make a fresh start, and live down their evil reputation. It is a risky business, but if a boy leave a public school as a thief, he cannot go to the University, and he is damned for English life; if he happen to be punished, and afterwards behaves well, especially a manly sport-loving boy, he may, as I have seen, outgrow the evil and its results. In treating children accused of moral faults, there must be no doubt about the evidence against the culprit. I have known terrible results following false accusations. Steady, consistent treatment, rather than punishment, are indicated.
One of the most important elements in normal child development is healthy sleep, and nervous children frequently show their weakness in defective or disordered sleep. Sleep is for the brain what food is for the body. The nervous child should have some light warm food just before going to bed. In some wakeful children I have seen good results follow what may be called domestic hypnotism. The mother or nurse gently pressing on the eyeballs of the child, and softly repeating "now go to sleep." Thus the eye pressure with the lullaby are combined, and though half an hour may be required at first, soon the time is shortened, till I have known it only to require a moment's suggestion and sleep follows. Many nervous children dread being left in the darkness, and I think it is best to allow a small light for some time, and then slowly try to reduce the time it is used till in the end it is discontinued, or, what is equally good, the child is shown that the light, unlighted, is ready if required at any moment. The nervous child often is subject to dreams of an alarming nature, and it is therefore well to have someone sleeping in the same or an adjoining room. It is best rather to ignore the dream fancies of the child, otherwise they begin to look for and cherish these. Nervous children are readily upset and liable to have light delirium from slight causes, and some, in the half waking moment, have visual hallucinations. In such cases, the child had better be awakened rather earlier than his usual time for a short period, so as to break the habit. Talking in the sleep is more common and more habitual among nervous than among healthy children, but may be ignored, except that it is better that a child who talks much in his sleep should have a room to himself.
Somnambulism [sleep-walking] is also a common symptom, and must be guarded against, the windows being barred or the bedroom being on the ground floor. Fortunately, in most cases the habit of somnambulism is outgrown. Plenty of fresh air night and day, simple food, and restfulness before bedtime are the best means for insuring sleep with nervous children.
The subject of precocity, to which I have already referred, is too large for me to treat tonight. It is commonly developed along the musical, artistic, or memory sides; it may appear in a calculating prodigy. I think means should be first tried to develop other parts and interests along with the special gift, but in some cases all this fails, and you will have to educate along the special lines or not at all. This, of course, involves special training, for no schools are fitted for prodigies. In bringing this discursive paper to a close, I would wish to impress on you the necessity of calculating in each individual child the amount of good which training can effect. Nervous children need to be taught in smaller groups rather than in classes; in many cases two is the best number. Having decided how much is to be expected, a definite line must be selected and stuck to, for no good can come of constant or frequent change of plan in these children. They are inconstant themselves, and need steady, consistent, and persistent effort. One must never forget that there may be some temporary and removable physical hindrance to development, and this must be first treated. I believe much more in the leading in good paths rather than punishing for straying into bad ones. Many nervous children are sensitive plants containing in their readily reacting natures great capacity for good as well as frequent tendency to evil. As much depends on the teacher or parent as on the child in many cases.
* [The "authoress" of "The Mind of the Child" is unknown. This article was published in 1902.
Typed by happi, Jan. 2021; Proofread by LNL, Apr. 2021
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