Intensive residential treatment of a nine-year-old girl with an aggressive behavior disorder, petit mal epilepsy and enuresis: Workshop, 1951.

Abstract

BETTY January 1949 with the presenting symptoms of petit ma1 epilepsy and enuresis. She was first referred to Central Clinic for psychiatric study in March 1947, a t the age of 53, with symptoms of extreme stubbornness, destructive behavior, vomiting, soiling, and diurnal and nocturnal enuresis. Practically nothing was known of her early developmental history except that she had always been enuretic. She was the tenth in a family of twelve children. As an infant she was hospitalized several times for enteritis and bronchitis.Her past history revealed that she had two foster home placements, the first beginning a t the age of three years and ten months, when the mother deserted the family. In her own home there were extreme physical neglect and deprivation , evictions for poor housekeeping, several desertions by an immature, unstable and alcoholic father, and finally complete rejection by a promiscuous mother. At the time of commitment of the twelve children to a children's agency, in March 1945, all those of school age had problems of truancy and enuresis. Since then the mother has had two more children. On several occasions she has visited the agency, where she inquires only about her sons, several of whom have been placed in an institution for delinquent boys. Many of the younger children are reported to have made good adjustments in foster or adoptive homes.During the first foster home placement of seventeen months, Betty was "the most difficult child" because of her extreme negativism and constant crying. Following a psychiatric study when she was four years and ten months old, it was recommended that she return to the same foster home in order to avoid further threats to her security and because she had a good relationship with a foster boy whom she enjoyed "mothering." With a continuation of her problems she was finally placed-for a while as an only child, and later with an older siste-in a second foster home for seven months until the time of the first Central Clinic referral.

Narcissistic vulnerability in the hyperaggressive child: The disregarded (unloved, uncared-for) self.

“…Beyond expressing his fear and hypersensitivity, Sam's heated accusation may also have served a defensive function, warding off an even greater anxiety, namely his worry that the nurse might simply be coolly indifferent to him. Krug, Haward, and Crumpacker (1951) reported the case of a 9-year-old girl with an aggressive behavior disorder. When this child's worker turned her attention to another child for a few seconds, the girl began to act out wildly.…”

“…However, whether the child imagines that he is not considered interesting because he is not a girl, a baby, a sexual partner, or whatever, the crucial factor is his belief that he does not have, and never could have, what it takes to secure the adult's interest. The patient of Krug et al (1951) who erupted when her worker momentarily shifted her attention to another child did so after some conversation in which she had accused her worker of preferring boys. While pummeling her worker, the girl insisted that her worker had grown tired of her like some animals who love their babies but get rid of them when they get big.…”

The Emotionally Disturbed Child with a Convulsive Disorder

“…Some cases have been studied on an outpatient basis, but it has been found more fruitful to admit the more difficult diagnostic problems among such patients for a 4-to 8-week inpatient diagnostic evaluation and treatment followed by outpatient psychotherapy. Krug 16 has demonstrated the value in such cases of total residential therapy, dealing with both ego level problems and unconscious conflicts.…”