PSYCHIATRY I N SECONDARY SCHOOLS‘ L. CLOVIS RIRNING

Katonuh, New York

Recently I received a letter from Dr. Stogdill, psychiatrist to the schools of Toronto and a pioneer in school psychiatry. I had written him complimenting him on his excellent review of school mental health in the January 1965 issue of the Journal of the American Psychiatric Association. I pointed out, however, that unfortunately, most of the articles on school mental health cited in his review were written by school mental health workers other than psychiatrists. In the letter he wrote back he used the touching phrase: “we are still so few. . . .”

I am troubled that educational psychiatry has shown such a slow development, especially in the public secondary schools. And the fault certainly does not lie entirely with the public school educators. The welcome that my activities as a psychiatrist have received among educators makes me think that psychiatry as a profession is very much a t fault for the paucity of psychiatric services in public secondary schools.

I think it is significant that this meeting is practically the only one on psychiatry in the secondary schools at this APA conference. Recently I had occasion to review two books published by the American Psychiatric Association in 1964. One was entitled Career Training in Child Psychiatry. The other was entitled Training the Psychiatrist to Meet Changing Needs. In neither book was there any delineation of the work a psychiatrist can do in schools in collaboration with the school staff members. In the rather meager discussion on preventive work for the child psy- chiatrist in the book on child psychiatry, school psychiatry was not even mentioned.

In the volume on training to meeting changing needs, neither under “Public Health” nor under “Child Psychiatry” is educational or school psychiatry men- tioned. Even under the content of “orientation in child psychiatry” where the need “for collaborative work with community facilities involved with problem children and their families” is emphasized-no mention is made of the school as a community facility. Under “Public Health” there is mention of the “concept of preventive psychiatry,” but there is no mention of the school as a logical focus of preventive psychiatric effort. The importance of psychiatrists engaged in forensic psychiatry having some understanding of the law is emphasized, but since school psychiatry is not even mentioned, there is of course no similar concern for psychiatrists working in schools to know anything about education.

The crying need it seems to me is to help psychiatrists understand their poten- tial usefulness as school consultants. At Teachers College, Columbia, we are plan- ning, if we get the NIRlH help we have applied for, to conduct a seminar in school mental health entitled “The Practice of School Psychiatry”-for psychiatrists. I have been inspired to think that much preventive psychiatry of the future will take place in the schools as part of school mental health programs and that psychiatry, especially child psychiatry, will take its proper place in playing a leading role in this important development.

There are many areas of activity in school mental health needing the help of the psychiatrist working in the schools with pupil personnel staffs especially in the

’Comments following the symposium, “Psychiatric Programs in Secondary Schools” a t the American Psychiatric Association meetings in New York in May, 1965.

PSYCHIATRY IN SECONDARY SCHOOLS 29

now burgeoning field of special education for children with brain-injury and/or emotional problems that interfere with their education in the regular classes. Ed- ucators will need help with neuropsychiatric evaluation of these children and in- service training of staff, to develop appropriate programs for this kind of special education.

The help of the educational psychiatrist in the education of members of the school pupil personnel services st.aff is essential for sound, well-rounded development in psychiatric insights and neuropsychiatric understandings. Education in psy- chiatric insight which is basically psychoanalytic is needed to supplement the often nonclinical, neobehavioristic approach of educational psychology.

I have been concerned for several years at Teachers College, Columbia, and at the William A. White Institute with seminars in psychosocial dynamics for school guidance counselors. These people have an important role to play in preventive psychiatry in that they are in a unique position to see so many children in the first instance and not only by referral. They are therefore in a unique position to sort out the nature of the child’s problem and make the first and often crucial decision as to the handling of that problem. They can play this important role in preventive psychiatry only if they have been adequately trained in being able to sort out the nature and severity of the child’s problem. This adequacy comes only with knowl- edge of the psychosocial dynamics of school mental health problems.

It is interesting to note-and I see evidences of it again this evening-that psy- chiatry developed first in colleges as far back as the late thirties and in secondary schools it developed first in college preparatory schools. As a psychiatrist in private practice, I cannot help but note the tremendous difference between what happens to children in preparatory schools with psychiatric services and what happens to chiIdren with problems in preparatory schools without such services. Indeed, judg- ing from some of the cases that have come my way from such schools, I take a dim view, especially of boarding schools without such services. Many of these schools are being spoiled by a glut of too many applicants. So they take only the cream and then make short shrift of any deviant or nonconforming youngster who has happened to slip through or develops a problem while in school. I have had occasion to talk a t some independent schools and I’d like to pass on what I’ve said to them to you this evening. I have challenged them to live up to their (‘manifest destiny”--pro- tecting and fostering the creative nonconformist instead of working so hard to de- velop dead-level conformity and mediocrity. In this area of preventive psychiatry the psychiatric consultant in the independent schools has an important role to play. And he should adopt the premise that every nonconformist is potentially a creative one.

REFERENCES HIRNING, L. C. ;dental health role of the school counselor. Science Research Associates Newsletter,

HIRNING, L. C . Some experiences in school psychiatry. Teachers College Rewrd, October, 1964. November, 1963.