Pediatric Annals

EMOTiONAL FACTORS iN pEdiATRiC pRACTiCE

Lee Salk

Abstract

1 Marbe, K. Praktische Psychologie der Unfälle und Betriebsschäden. München-Berlin: R. Oldenbourg, 1926.

2 Fuller. E. Injury prone children. Amer. J. Orthopsychiat. 18 (1948), 708.

3. Birnbach, S Comparative Study of Accident Repeater and Accident Free Children. New York New York University Press, 1948.

4. Fuller, E. and Baune. H. Injury proneness and adjustment in the second grade. Soc/omef/y 14 (1951), 210.

5. Krall, V Personality characteristics of accident repeating children. J. Abnorm. Soc. Psy. 48 (1953), 99.

6. Fitt, A. An analysis of road accidents to children in Great Britain Aust. J Psy 7 (1956). 129.

7. Langford, W. et al. Pilot study of childhood accidents. Pediatrics 11 (1953), 405.

8. Burton, L. Vulnerable Children. New York: Schocken. 1968.

9. Baumrind, D. Child care practices anteceding three patterns of preschool behavior. Genet. Psychol. Monogr. 75 (1967). 43-88.…

Accidents are commonly regarded as events which have occurred by chance, bad luck or misfortune, but in all cases were not the result of a plan perpetrated by any person.

With our greater understanding of psychodynamics through clinical investigation, we have learned that a great majority of so-called accidents are not accidents at all but result from impulses on the part of the victim of which he lacks conscious awareness.

Many people, a large percentage of them children, seem to have a substantial propensity for accidents. These individuals are considered accident-prone. Studies have shown that they are, in a sense, indirectly acting out a subconscious impulse that is socially unacceptable or unacceptable to the person's conscience. By acting out the impulse, they find relief from built-up tension.

Why some individuals express their pent-up or repressed emotions through behavior classified as accident-prone and some find relief in other ways depends to a great extent on childhood experiences.

Considerable psychological research has shown that the frequent sufferer from accidents usually has some active role in their causation. As far back as 1926 Marbe1 demonstrated that a person who has had an accident is much more prone to have another accident than is the person who has never had an accident likely to have his first accident.

Fuller2 in 1947, in a study of nursery school children, found that 50 per cent of the accident injuries to girls occurred in 14 per cent of the girls. She noted that the accident-prone child tended to be impulsive, high strung, overactive, obstinate, aggressive and insolent.

Similar personality profiles of accident-prone children were reported by Birnbach,3 Fuller and Baune,4 Krall,5 Fitt,6 Langford7 and Burton.8

The accident-prone children tended to be concerned with immediate satisfaction and unwilling to put off gratification. They seem to want excitement and adventure, and want it in the present. Planning ahead or preparing for the future is usually absent in their behavior. Perhaps the most interesting feature of the accident-prone person is his unusual resentment against people in authority. He is extremely rebellious against any restrictions, not only externally based restrictions, but he is even intolerant of self-discipline. In a sense, he is rebelling against his own good judgment and self-control.

Before going further into early childhood experiences and parental influences, I would like to focus on another element in the psychodynamics of accident proneness - guilt. The process is as follows: The accident represents a destructive act, in this case, a rebellion against authority. The destructive act is an unconscious attempt to destroy the authority person. For the child, and for most adults as well, the authority is the equivalent of the authoritative parent. Hence, the destructive impulse or wish is directed against the parent, which leads to unconscious guilt feelings. Guilt is a most unpleasant feeling to bear, and suffering is an effective way of expiating guilt. The accident or self-inflicted punishment then serves to express a destructive impulse and at the same time alleviate the guilt for doing so. The child, free of guilt and not having expressed open hostility to the parental authority, can feel that parental love has not been lost or threatened.

Accident-prone children are almost always the product of a strict upbringing or are children who lack affection and have developed a very strong degree of resentment against people in authority. They harbor deeprooted feelings of aggression and have not learned ways of channeling these feelings in a socially useful way.

Studies of the development of aggression in children have shown that maximum aggression occurs where there is permissiveness in conjunction with parental rejection, hostility and periodic but unpredictable episodes of severe parental punishment. The child is left feeling unprotected in a context where there are no adequate controls and where he is unable to identify with his parents.

In a study by Baumrind9 in 1967, there is clear evidence that parental strictness combined with primitive and rejecting attitudes fosters dissatisfaction and displaced aggression in the child. It is precisely this tendency toward the displacement of aggression that makes for accident proneness and self-inflicted destructive actions. While the dynamics of the suicidal person are generally different, there are many individuals who have terminated their own lives through accidents that were unconscious expressions of impulses, which although destructive were not meant to be suicidal.

When accident proneness is recognized in children, psychotherapeutic intervention should seriously be considered. Treatment should focus not only on the child but should definitely involve the parents as well. While this kind of family therapy represents the ideal arrangement, it is often very difficult to set up simply because of the nature of the problem itself. As we have seen, the parental attitudes toward the child combine permissiveness with periodic strictness, rejection, hostility and occasional severe punishment. Such parents are hardly amenable to the idea of psychotherapy and often simply reject any suggestion that there is a psychogenic basis to their child's accidents.

More often than not the accidentprone person does not receive adequate psychological help until he has reached adulthood, when he can make the choice himself and is not at the mercy of hostile, primitive and rejecting parents.

I have observed, over the years, a number of children who were marginally accident-prone - that is, they tended to have episodes when accidents were more frequent. Investigation disclosed that these children were not receiving sufficient positive parental attention and had quickly learned that they could invariably gain their parents' recognition when they were hurt. Often these were the "busy" parents who had little time available except for crises. Their children, picking this up very quickly, couldn't help but accommodate to the situation the parents created. For the child it is far better to gain negative attention than it is to be ignored.

Accident-proneness is a complex problem with serious consequences, but these tendencies can be prevented. The question of permissiveness vs. restrictiveness is not the primary issue. Rather it is the question of warmth and nurturance. They have been the major deficit in the growing child's parental experience. The child who experiences a strict regimen, occasional hostility and severe punishment once in a while need not resort to accident-prone behavior to discharge his pent-up emotions provided he feels genuine warmth in a context where his parents can meet his physical needs and respect his struggle for self-esteem.

BIBLIOGRAPHY

1 Marbe, K. Praktische Psychologie der Unfälle und Betriebsschäden. München-Berlin: R. Oldenbourg, 1926.

2 Fuller. E. Injury prone children. Amer. J. Orthopsychiat. 18 (1948), 708.

3. Birnbach, S Comparative Study of Accident Repeater and Accident Free Children. New York New York University Press, 1948.

4. Fuller, E. and Baune. H. Injury proneness and adjustment in the second grade. Soc/omef/y 14 (1951), 210.

5. Krall, V Personality characteristics of accident repeating children. J. Abnorm. Soc. Psy. 48 (1953), 99.

6. Fitt, A. An analysis of road accidents to children in Great Britain Aust. J Psy 7 (1956). 129.

7. Langford, W. et al. Pilot study of childhood accidents. Pediatrics 11 (1953), 405.

8. Burton, L. Vulnerable Children. New York: Schocken. 1968.

9. Baumrind, D. Child care practices anteceding three patterns of preschool behavior. Genet. Psychol. Monogr. 75 (1967). 43-88.

10.3928/0090-4481-19730101-10

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