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PART II
Click here for part I Click here for part III
Dear Fellow Scientist:
This letter has been around the world at least seven times. It has been to many major conferences. Now it has come to you. It will bring you good fortune. This is true even if you don't believe it.
But you must follow these instructions:
- include in your next journal article the citations below.
- remove the first citation from the list and add a citation to your journal article at the bottom.
- make ten copies and send them to colleagues.
Within one year, you will be cited up to 10,000 times! This will amaze your fellow faculty, assure your promotion and improve your sex life. In addition, you will bring joy to many colleagues. Do
not break the reference loop, but send this letter on today. Dr. H. received this letter and within a year after passing it on she was elected to the National Academy of Sciences.Prof. M. threw this letter away and was denied tenure. In Japan, Dr. I. received this letter and put it aside. His article for Trans. on Nephrology was rejected. He found the letter and passed it on,
and his article was published that year in the New England Journal of Medicine. In the Midwest, Prof. K. failed to pass on the letter, and in a budget cutback his entire department was eliminated. This could happen to you if you break the chain of citations.
1. Miller, J. (1992). Post-modern neo-cubism and the wave theory of light. Journal of Cognitive Artifacts, 8, 113-117.2. Johnson, S. (1991). Micturition in the canid family: the irresistable pull of the hydrant. Physics Quarterly, 33, 203-220.
3. Anderson, R. (1990). Your place or mine?: an empirical comparison of two models of human mating behavior. Psychology Yesterday 12, 63-77.
4. David, E. (1994). Modern Approaches to Chaotic Heuristic
Optimization: Means of Analyzing Non-Linear Intelligent Networks with Emergent Symbolic Structure. (doctoral dissertation, University of California at Santa Royale El Camino del Rey Mar Vista by-the-sea.)
10 Clues That You Are Probably A Psychologist
10. You were trained as a scientist, and your profession's journals reject 80% of submitted manuscripts.
9. You don't dare move out of state for fear that you might not be able to get licensed in the other state.
8. You have just spent $450 on a professional workshop, plus another $650 on travel and hotel expenses to find out what you had hoped you would learn is unethical to do without a two year post-doctoral program.
7. You have a Ph.D. degree but make less than occupational therapists and physical therapists with a bachelors degree. You professional association encourages you to provide free services.
6. Even though you have just completed 6 years of post graduate training, and have a Ph.D. degree, you still need two years of supervision to be allowed to take a licensing examination.
5. Your main competitors for jobs have masters and bachelors degrees.
4. Your colleagues who were appalled at the use of medications to treat behavioral disorders ten years ago are now active advocates of prescription privileges.
3. You are in a doctoral training program that requires an internship and there aren't any.
2. The professors who taught the core content of the background and discipline of your profession publically express serious doubt about whether your applied activities have any validity or merit.
1. Your colleagues have vigorously and publically debated whether schizophrenia really exists for the past 50 years, and your are genuinely perplexed as to why the Alliance for the Mentally Ill is not impressed with psychologists
Useful Research Phrases and what they Really Mean
"It has long been known" . . .
[I didn't look up the original reference.]
"A definite trend is evident" . . .
[These data are practically meaningless.]
"Of great theoretical and practical importance" . . .
[Interesting to me.]
"While it has not been possible to provide definite answers to these questions" . . .
[An unsuccessful experiment but I still have to get it published.]
"Three of the samples were chosen for detailed study" . . .
[The results of the others didn't make any sense.]
"Typical results are shown" . . .
[The best results are shown.]
"These results will be shown in a subsequent report" . . .
[I might get around to this sometime if I'm pushed.]
"The most reliable results are those obtained by Jones" . . .
[He was my graduate assistant.]
"It is believed that" . . .
[I think]
"It is generally believed that" . . .
[A couple of other guys think so, too.]
"It is clear that much additional work will be required before a complete understanding
occurs" . . .
[I don't understand it.]
"Correct within an order of magnitude" . . .
[Wrong]
"It is hoped that this study will stimulate further investigations in this field" . . .
[This is a lousy paper, but so are all the others on this miserable topic.]
"Thanks are due to Joe Blotz for assistance with the experiment and to George Frink
for valuable assistance" . . .
[Blotz did the work and Frink explained to me what it meant.]
"A careful analysis of obtainable data" . . .
[Three pages of notes were obliterated when I
knocked over a glass of beer.]
PTSD -- Psychotherapist Trainee Stress Disorder
Symptoms include, but are not limited to...
1.Overwhelming urge to strangle any person who glibly says, "You're having personal problems? YOU should know how to fix them, you're the psychologist, heh heh."
2.When someone accuses you of being "antisocial" because you have to study instead of socialize, you scream, "No, I'm being obsessive-compulsive! If I we're antisocial, I'd beat the crap out of you right now..."
3.Compulsion to diagnose and design treatment plans for TV characters
4.Getting excited about relaxing adventures such as grocery shopping.
5.Playing on the Internet all night to avoid any "productive" (as defined by your professors) activity.
This disorder is caused by...
1.Having to try to reason with people who are totally out of contact with reality -- e.g., professors
2.An average of 3 hours sleep per week
3.Working 2 part time jobs, in addition to classes and training, to pay for your tuition
4.A steady diet of bagels (munched while running from class to job to class) and
chocolate covered espresso beans
5.Stat-ware packages that mutilate your project beyond recognition
6.Family, friends, and acquaintances who assume you'll always be their 24-hr free shrink, and never have any emotional needs of your own
What did the sign on Pavlov's lab door say? Please knock. DON'T ring the bell.
An MIT student spent an entire summer going to the Harvard football field every day wearing a black and white striped shirt, walking up and down the field for ten or fifteen minutes throwing birdseed all over the field, blowing a whistle and then walking off the field. At the end of the summer, it came time for the first Harvard football game, the referee walked onto the field and blew the whistle. The game had to be delayed for a half hour to wait for the birds to get off the field. The guy wrote his thesis on this, and graduated.
~~THE PARENTING TEST~~
"How many times have you heard the comment that people have to take a test to drive a car, but anyone can be a parent? A test is needed. And not one with a bunch of Bozo questions like 'How many servings of vegetables are required for a three-year old female living in Boise who walks 4.3 miles a day?' No, this test will ask the REAL questions. Are you ready to find out if you have the right stuff to be a parent in the 90s? Get those number two pencils ready. And let's keep our eyes on our own papers, people.
** Section One -- Mathematics
For each problem, estimate the total number of times this phrase is used per parent per week. (2 points per question)
I don't care what the other kids get to do. ... and this time I really mean it.
Somebody's going to get hurt doing that.
See, I told you somebody was going to get hurt doing that.
Now we're REALLY going to be late.
One ... I'm counting ... two ... I'm counting ...
Because I'm the Mommy (Daddy).
Let's not discuss that at the dinner table.
Why is your brother (sister) crying?
Okay ... but only five more minutes.
** Section Two -- Fill in the Blank
Write the correct word in the blank. (3 points per question)
Tickle Me ____________.
101 _________________.
The Berenstain _________.
Clifford, the Big _________ Dog.
_______________ Nuggets.
_______________ Meals.
Please won't you be my _____________?
** Section Three -- Matching
Match each vocabulary word with its definition. (4 points per question).
Amoxicillin
Legos
Pull-Ups
Push-Ups
Tubes
A] Small bits of plastic designed to accentuate any style of carpeting.
B] Either a recreational device originally developed for hamsters, but since adapted for use by children in fast food restaurants OR that which is placed in ears when Letter "C" fails.
C] A pink substance which is usually a regular part of a toddler's diet.
D] A frozen food amazingly devoid of any nutritional value.
E] A disposable article of clothing which one swears will only be necessary for a few more weeks.
** Section Four -- Problem Solving
Briefly describe the solution to each problem. (5 points per question)
1] It is 8:50 a.m. School starts at 9 a.m. Where are your car keys?
2] She says that he started it. He says she started it. Who's right?
3] You are attempting to go to the post office with two very large packages, two very small children, zero very close parking places, and one frazzled parent. How will you accomplish this?
4] At 7 p.m., you must be at dance class with Debbie, Cub Scouts with Carl, and soccer with Susie. Without any King Soloman maneuvers, how will this be done?
** Section Five -- Essay
Answer the question and defend your choice. (19 points)
Which of the 'Big V's' has made a bigger contribution to parenting?
Vacuum cleaners 'Velcro' or the VCR
Top 10 Signs a Therapist is Approaching Burn-out
10) You think of the peaceful park you like as "your private therapeutic milieu."
9) You realize that your floridly psychotic patient, who is picking invisible flowers out of mid air, is probably having more fun in life than you are.
8) A grateful client, who thinks you walk on water, brings you a small gift and you end up having to debrief your feelings of unworthiness with a colleague.
7) You are watching a re-run of the Wizard of Oz and you start to categorize the types of delusions that Dorothy had.
6) Your best friend comes to you with severe relationship troubles, and you start trying to remember which cognitive behavioral technique has the most empirical validly for treating this problem.
5) You realize you actually have no friends, they have all become just one big case load.
4) A co-worker asks how you are doing and you reply that you are a bit "internally
preoccupied" and "not able to interact with peers" today.
3) Your spouse asks you to set the table and you tell them that it would be
"countertherapeutic to your current goals" to do that.
2) You tell your teenage daughter she is not going to start dating boys because she is "in denial," "lacks insight." and her "emotions are not congruent with her chronological age."
And, the number one reason a therapist may be burning out....
1) You are packing for a trip to a large family holiday reunion and you take the DSM-IV with you just in case.
When I first started college, the Dean came in and said "Good Morning" to all of us. When we echoed back to him, he responded "Ah, you're Freshmen."
He explained. "When you walk in and say good morning, and they say good morning back, it's Freshmen. When they put their newspapers down and open their books, it's Sophomores. When they look up so they can see the instructor over the tops of the newspapers, it's juniors. When they put their feet up on the desks and keep reading, it's seniors."
"When you walk in and say good morning, and they write it down, it's graduate students."
Patient: Doctor, my wife thinks I'm crazy because I like sausages.
Psychiatrist: Nonsense! I like sausages too.
Patient: Good, you should come and see my collection. I've got hundreds of them
1-800-PSYCH
Hello, Welcome to the Psychiatric Hotline.
If you are obsessive-compulsive, please press 1 repeatedly.
If you are co-dependent, please ask someone to press 2.
If you have multiple personalities, please press 3, 4, 5 and 6.
If you are paranoid-delusional, we know who you are and what you want. Just stay on the line we can trace the call.
If you are schizophrenic, listen carefully and a little voice will tell you which number to press.
If you are delusional and occasionally hallucinate, please be aware that the
thing you are holding on the side of your head isalive and about to bite off your ear.
If you are depressed, it doesn't matter which number you press. No one will answer.
What's the difference between a neurotic and a psychotic?
A psychotic says, "Two plus two is five."
A neurotic says, "Two plus two is four, and I can't stand it."
Neurotics build castles in the sky.
Psychotics live in them.
Psychiatrists collect the rent.
Where to Publish Your Paper
1) If you understand it and can prove it, then send it to a journal of mathematics.
2) If you understand it, but can't prove it, then send it to a physics journal.
3) If you can't understand it, but can prove it, then send it to an economics journal.
4) If you can neither understand it nor prove it, then send it to a psychology journal.
Announcement: the mental-disease-of-the-month club is being disbanded immediately.
The reasons being:
1.During dipsomania month, the club party spent 10 times its budget on refreshments.
2.During kleptomania month, all of the club furnishings were removed, and (as aforementioned) the budget was already spent and gone.
3.During megalomania month, the club organization broke down due to having sixteen claimants to being Club President, etc.
4.During multiple personality month, our club roster roughly tripled in size with no increase in dues.
5.During paranoia month, the inflated roster dropped to zero as each member changed his or her mailing address and left no forewarding address for the club.
You members were obviously out to ruin us; it's all clear now. It took all our remaining personal saving to track you all down. Therefore, here is your last installment: clinical depres sion. Have a nice day."
Why God never received a PhD:
1. He had only one major publication.
2. It was in Hebrew.
3. It had no references.
4. It wasn't published in a refereed journal.
5. Some even doubt he wrote it by himself.
6. It may be true that he created the world, but what has he done since then?
7. His cooperative efforts have been quite limited.
8. The scientific community has had a hard time replicating his results.
9. He never applied to the ethics board for permission to use human subjects.
10. When one experiment went awry he tried to cover it by drowning his subjects.
11. When subjects didn't behave as predicted, he deleted them from the sample.
12. He rarely came to class, just told students to read the book.
13. Some say he had his son teach the class.
14. He expelled his first two students for learning.
15. Although there were only 10 requirements, most of his students failed his tests.
16. His office hours were infrequent and usually held on a mountain top.
17. No record of working well with colleagues.
Frequently Asked Questions About Managed Health Care By David Lubar
Q. What does HMO stand for?
A. This is actually a variation of the phrase, "Hey, Moe!" Its roots go back to a concept pioneered by Doctor Moe Howard, who discovered that a patient could be made to forget about the pain in his foot if he was poked hard enough in the eyes. Modern practice replaces the physical finger poke with hi-tech equivalents such as voice mail and referral slips, but the result remains the same.
Q. Do all diagnostic procedures require pre-certification?
A. No. Only those you need.
Q. I just joined a new HMO. How difficult will it be to choose the doctor I want?
A. Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors who were participating in the plan at the time the information was gathered. These doctors basically fall into two categories -- those who are no longer accepting new patients, and those who will see you but are no longer part of the plan. But don't worry -- the remaining doctor who is still in the plan and accepting new patients has an office just a half day's drive away!
Q. What are pre-existing conditions?
A. This is a phrase used by the grammatically challenged when they want to talk about existing conditions. Unfortunately, we appear to be pre-stuck with it.
Q. Well, can I get coverage for my pre-existing conditions?
A. Certainly, as long as they don't require any treatment.
Q. What happens if I want to try alternative forms of medicine?
A. You'll need to find alternative forms of payment.
Q. My pharmacy plan only covers generic drugs, but I need the name brand. I tried the generic medication, but it gave me a stomach ache. What should I do?
A. Poke yourself in the eye.
Q. What accounts for the largest portion of health care costs?
A. Doctors trying to recoup their investment losses.
Q. Will health care be any different in the next century?
A. No, but if you call right now, you might get an appointment by then.
Freud on Seuss
a book review by Josh LeBeau
The Cat in the Hat
by Dr. Seuss, 61 pages. Beginner Books, $3.95
The Cat in the Hat is a hard-hitting novel of prose and poetry in which the author re-examines the dynamic rhyming schemes and bold imagery of some of his earlier works, most notably Green Eggs and Ham, If I Ran the Zoo, and Why Can't I Shower With Mommy? In this novel, Theodore Geisel, writing under the pseudonym Dr. Seuss, pays homage to the great Dr. Sigmund Freud in a nightmarish fantasy of a renegade feline helping two young children understand their own frustrated sexuality.
The story opens with two youngsters, a brother and a sister, abandoned by their mother, staring mournfully through the window of their single-family dwelling. In the foreground, a large tree/phallic symbol dances wildly in the wind, taunting the children and encouraging them to succumb to the sexual yearnings they undoubtedly feel for each other. Even to the most unlearned reader,
the blatant references to the incestuous relationship the two share set the tone for Seuss' probing examination of the satisfaction of primitive needs. The Cat proceeds to charm the wary youths into engaging in what he so innocently refers to as "tricks." At this point, the fish, an obvious Christ figure who represents the prevailing Christian morality, attempts to warn the children, and thus, in effect, warns all of humanity of the dangers associated with the unleashing of the primal urges. In response to this, the
cat proceeds to balance the aquatic naysayer on the end of his umbrella, essentially saying, "Down with morality; down with God!"
After poohpoohing the righteous rantings of the waterlogged Christ figure, the Cat begins to juggle several icons of Western culture, most notably two books, representing the Old and New Testaments, and a saucer of lactal fluid, an ironic reference to maternal loss the two children experienced when their mother abandoned them "for the afternoon." Our heroic Id adds to this bold gesture a rake and a toy man, and thus completes the Oedipal triangle.
Later in the novel, Seuss introduces the proverbial Pandora's box, a large red crate out of which the Id releases Thing One, or Freud's concept of Ego, the division of the psyche that serves as the conscious mediator between the person and reality, and Thing Two, the Superego which functions to reward and punish through a system of moral attitudes, conscience, and guilt.
Referring to this box, the Cat says, "Now look at this trick. Take a look!" In this, Dr. Seuss uses the children as a brilliant metaphor for the reader, and asks the reader to re-examine his own inner self.
The children, unable to control the Id, Ego, and Superego allow these creatures to run free and mess up the house, or more symbolically, control their lives. This rampage continues until the fish, or Christ symbol, warns that the mother is returning to reinstate the Oedipal triangle that existed before her abandonment of the children. At this point, Seuss introduces a many-armed cleaning device which represents the psychoanalytic couch, which proceeds to put the two youngsters' lives back in order.
With powerful simplicity, clarity, and drama, Seuss reduces Freud's concepts on the dynamics of the human psyche to an easily understood gesture. Mr. Seuss' poetry and choice of words is equally impressive and serves as a splendid counterpart to his bold symbolism. In all, his writing style is quick and fluid, making The Cat in the Hat impossible to put down. While this novel
is 61 pages in length, and one can read it in five minutes or less, it is not until after multiple readings that the genius of this modern day master becomes apparent.
To: Editor, Archives of General Psychiatry
Dear Sir, Madame, or Other:
Enclosed is our latest version of MS #85-02-22-RRRRR, that is, the re-re-re-revised version of our paper. Choke on it. We have again rewritten the entire manuscript from start to finish. We even changed the goddamned running head! Hopefully we have suffered enough by now to satisfy even your bloodthirsty reviewers.
I shall skip the usual point-by-point description of every single change we made in response to the critiques. After all, it is fairly clear that your reviewers are less interested in details of scientific procedure than in working out their personality problems and sexual frustrations by seeking some sort of demented glee in the sadistic and arbitrary exercise of tyrannical power over hapless authors like ourselves who happen to fall into their clutches. We do understand that, in view of the misanthropic psychopaths you have on your editorial board, you need to keep sending them papers, for if they weren't reviewing manuscripts they'd probably be out mugging old ladies or clubbing baby seals to death. Still, from this batch of reviewers, C was clearly the most hostile, and we request that you not ask her or him to review this revision. Indeed, we have mailed letter bombs to four or five people we suspected of being reviewer C, so if you send the manuscript back to them the review process could be unduly delayed.
Some of the reviewers comments we couldn't do anything about. For example, if (as reviewer C suggested), several of my ancestry were indeed drawn from other species, it is too late to change that. Other suggestions were implemented, however, and the paper has improved and benefited. Thus, you suggested that we shorten the manuscript by 5 pages, and we were able to do this very effectively by altering the margins and printing the paper in a different font with a smaller typeface. We agree with you that the paper is much better this way.
One perplexing problem was dealing with suggestions #13-28 by reviewer B. As you may recall (that is, if you even bother reading the reviews before doing your decision letter), that reviewer listed 16 works the he/she felt we should cite in this paper.
These were on a variety of different topics, none of which had any relevance to our work that we could see. Indeed, one was an essay on the Spanish-American War from a high school literary magazine. the only common thread was that all 16 were by the same author, presumably someone reviewer B greatly admires and feels should be more widely cited. To handle this, we have modified the introduction and added, after the review of relevant literature, a subsection entitled "Review of Irrelevant Literature" that discusses these articles and also duly addresses some of the more asinine suggestions by other reviewers.
We hope that you will be pleased with this revision and finally recognize how urgently deserving of publication this work is. If not, then you are an unscrupulous, depraved monster with no shred of human decency. You ought to be in a cage. May whatever heritage you come from be the butt of the next round of ethnic jokes. If you do accept it, however, we wish to thank you for your patience and wisdom throughout this process and to express our appreciation of you scholarly insights. To repay you, we would be happy to review some manuscripts for you; please send us the next manuscript that any of these reviewers sends to your journal.
Assuming you accept this paper, we would also like to add a footnote acknowledging your help with this manuscript and to point out that we liked this paper much better the way we originally wrote it but you held the editorial shotgun to our heads and forced us to chop, reshuffle, restate, hedge, expand, shorten, and in general convert a meaty paper into stir-fried vegetables.
We couldn't or wouldn't, have done it without your input. Sincerely,
Dear Dr.
Thank you for your thoughtful response to my decision letter concerning the above-referenced piece of excrement.
I have asked several experts who specialize in the area of research you dabble in to have a look at your pathetic little submission, and their reviews are enclosed. I shall not waste my LaserJet ink reiterating the details of their reviews, but please allow me to highlight some of the more urgent points of contention they raise:
1. Reviewer A suggests that you cite his work EXCLUSIVELY in the introduction. He has asked me to remind you that he spells his name with a final "e" (i.e., Scumbage), not as you have referenced him in the last version.
2. Reviewer C indicates that the discussion can be shortened by at least 5 pages. Given the fact that the present Discussion is only three pages long, I am not certain how to advise you. Perhaps you might consider eliminating all speculation and original ideas.
3. Reviewer D has asked that you consider adding her as a co-author. Although she has not directly contributed to the manuscript, she has made numerous comments that have, in her view, significantly improved the paper. Specifically, she believes that her suggestions concerning the reorganization of the acknowledgments paragraph were especially important.
Please note that she spells her name with an em-dash, and not with the customary hyphen.
4. Reviewer B has asked that I inform you that, even though his suggestions were not mentioned in my decision letter, this doesn't mean that he is an imbecile.
5. My own reading of the manuscript indicates that the following problems remain:
a. By "running head," we do not mean a picture of your son's face with legs attached. Please provide a four- or five-word title for the paper that summarizes the report's most important point. May I suggest, "Much Ado About Nothing"?
b. Please make certain that you have adhered to APA stylebook guidelines for publication format. Please direct your attention to the section entitled, "Proper Format for an Insignificant Paper" (1995, p.46).
c. Please submit any revision of the paper on plain, blank stationery. Submitting the article on Yale University letterhead will not increase your chances of having the article accepted for publication.
d. Please doublecheck the manuscript for spelling and grammatical errors. Our experience at the Archives is that "cycle-logical" slips through most spell-check programs undetected.
e. Although I am not a quantitative scientist, it is my understanding that the "F" in F-test does not stand for "f___ing". Please
correct the manuscript accordingly.
Yours sincerely,
Prof. Art Kives
If your original submission had been as articulate as your most recent letter, we might have avoided this interchange. It is too bad that tenure and promotion committees at your university do not have access to authors' correspondence with editors, for it is clear that you would be promoted on the basis of your wit alone. Unfortunately, it's the publication that counts, and I'm sorry to say that the Archives is not prepared to accept this revision. We would be perfectly ambivalent about receiving a ninth revision from you.
Case example: Dorothy, Scarecrow, Tin Man, Lion, Toto
Rationale: This group of four individuals and a little dog is being denied in one paragraph since their reports were submitted together; we concluded that none have conditions requiring medical treatment, and that all of them would be considered prime examples of "worried well" individuals who are constantly in search of some kind of magical solution to their problems.
While the little girl who ran away from her Aunty Em's home may have a conduct disorder (after all, she did kill the so-called wicked witch whose assertiveness she found threatening), we would point out that running away from home, singing and dancing, hanging around with peculiar, oddly attired friends with grandiose expectations, and occasionally indulging a fetish for fancy footwear are all normative among adolescents, just as among
psychologists attending out-of-town meetings.
...Finally, we feel that the most cost-effective alternative for the little dog, Toto, is that he be put to sleep.
Excerpted from articles appearing in the Journal of Polymorphous Perversity. Copyright 1986, 1988, 1994, 1997 by Wry-Bred Press, Inc. All rights reserved.
THE ETIOLOGY AND TREATMENT OF CHILDHOOD
Jordan W. Smoller
University of Pennsylvania
Childhood is a syndrome which has only recently begun to receive serious attention from clinicians. The syndrome itself, however, is not at all recent. As early as the 8th century, the Persian historian Kidnom made references to "short, noisy creatures," who may well have been what we now call "children." The treatment of Children, however, was unknown until this century, when so-called "child psychologists" and "child psychiatrists" became common. Despite this history of clinical neglect, it has been estimated that well over half of all Americans alive today have experienced childhood directly (Suess, 1983). In fact, the actual numbers are probably much higher, since these data are based on self-reports which may be subject to social desirability biases and retrospective distortion.
The growing acceptance of childhood as a distinct phenomenon is reflected in the proposed inclusion of the syndrome in the upcoming Diagnostic and Statistical Manual of Mental Disorders, 4th edition, or DSM-IV, of the American Psychiatric Association (1990). Clinicians are still in disagreement about the significan clinical features of childhood, but the proposed DSM-IV will almost certainly include the following core features:
1.Congenital onset
2.Dwarfism
3.Emotional lability and immaturity
4.Knowledgy deficits
5.Legume anorexia
Clinical Features of Childhood
Although the focus of this paper is on the efficacy of conventional treatment of childhood, the five clinical markers mentioned above merit further discussion for those unfamiliar with this patient population.
CONGENITAL ONSET
In one of the few existing literature reviews on childhood, Temple-Black (1982) has noted that childhood is almost always present at birth, although it may go undetected for years or even remain subclinical indefinitely.
This observation has led some investigators to speculate on biological contribution to childhood. As one psychologist has put it, "we may soon be in a position to distinguish organic childhood from functional childhood" (Rogers, 1979).
DWARFISM
This is certainly the most familiar marker of childhood. It is widely known that children are physically short relative to the population at large. Indeed, common clinical wisdom suggests that the treatment of the so-called "small child" (or "tot") is particularly difficult. These children are known to exhibit infantile behavior and display a startling lack of insight (Tom and Jerry, 1967).
EMOTIONAL LABILITY AND IMMATURITY
This aspect of childhood is often the only basis for a clinician's diagnosis. As a result, many otherwise
normal adults are misdiagnosed as children and must suffer the unnecessary social stigma of being labelled a "child" by professionals and friends alike.
KNOWLEDGE DEFICITS
While many children have IQs with or even above the norm, almost all will manifest knowledge deficits.
Anyone who has known a real child has experienced the frustration of trying to discuss any topic that requires some general knowledge. Children seem to have little knowledge about the world they live in. Politics, art, and science--children are largely ignorant of these. Perhaps it is because of this ignorance, but the sad fact that most children have few friends who are not, themselves, children.
LEGUME ANOREXIA
This last identifying feature is perhaps the most unexpected. Folk wisdom is supported by empirical
observation--children will rarely eat their vegetables (see Popeye, 1957, for review).
Now that we know what it is, what can we say about the causes of childhood? Recent years have seen a flurry of theory and speculation from a number of perspectives. Some of the most prominent are reviewed below.
Sociological Model
Emile Durkind was perhaps the first to speculate about sociological causes of childhood. He points out
two key observations about children:
1.the vast majority of children are unemployed, and
2.children represent one of the least educated segments of our society. In fact, it has been estimated that less than 20% of children have had more than fourth grad education.
Clearly, children are an "out-group." Because of their intellectual handicap, children are even denied the right to vote. From the sociologist's perspective, treatment should be aimed at helping assimilate children into mainstream society. Unfortunately, some victims are so incapacitated by their childhood that they are simply not competent to work. One promising rehabilitaion program (Spanky and Alfalfa, 1978) has trained victims of severe childhood to sell lemonade.
Biological Model
The observation that childhood is usually present from birth has led some to speculate on a biological
contribution. An early investigation by Flintstone and Jetson (1939) indicated that childhood runs in families. Their survey of over 8,000 American families revealed that over half contained more than one child. Further investigation revealed that even most non-child family members had experienced childhood at some point. Cross-cultural studies (e.g., Mowgli and Din, 1950) indicated that family childhood is even more prevalent in the Far East. For example, in Indian and Chinese families, as many as three out of four family members may have childhood.
Impressive evidence of a genetic component of childhood comes from a large-scale twin study by Brady and Partridge (1972). These authors studied over 106 pairs of twins, looking at concordance rates for childhood.
Among identical or monozygotic twins, concordance was unusually high (0.92), i.e., when one twin was diagnosed with childhood, the other twin was almost always a child as well.
Psychological Models
A considerable number of psychologically-based theories of the development of childhood exist. They are too numerous to review here. Among the more familiar models are Seligman's "learned childishness" model.
According to this model, individuals who are treated like children eventually give up and become children. As a counterpoint to such theories, some experts have claimed that childhood does not really exist. Szasz (1980) has called "childhood" an expedient label. In seeking conformity, we handicap those whom we find unruly or too short to deal with by labelling them "children."
Efforts to treat childhood are as old as the syndrome itself. Only in modern times, however, have human and systematic treatment protocols been applied. In part, this increased attention to the problem may be due to the sheer number of individuals suffering from childhood. Government statistics (DHHS) reveal that there are more children alive today than at any time in our history. to paraphrase P.T. Barnum: "There's a child born every minute."
The overwhelming number of children has made government intervention inevitable. The nineteenth century saw the institution of what remains the largest single program for the treatment of childhood-- so-called "public schools." Under this colossal program, individuals are placed into treatment groups based on the severity of their condition. For example, those most severely afflicted may be placed in a "kindergarten" program. Patients at this level are typically short, unruly, emotionally immature, and intellectually deficient. Given this type of individual, therapy is essentially one of patient management and of helping the child master basic skills (e.g. finger-painting).
Unfortunately, the "school" system has been largely ineffective. Not only is the problem a massive tax
burden, but it has failed even to slow down the rising incidence of childhood.
Faced with this failure and the growing epidemic of childhood, mental health professionals are devoting increasing attention to the treatment of childhood. Given a theoretical framework by Freud's landmark treatises on childhood, child psychiatrists and psychologists claimed great successes in their clinical intervention.
By the 1950's, however, the clinicians' optimism had waned. Even after years of costly analysis, many
victims remained children. The following case (taken from Gumbie and Poke, 1957) is typical.
Billy J., age 8, was brought to treatment by his parents. Billy's affliction was painfully obvious. He stood only 4'3" high and weighed a scant 70 lbs., despite the fact that he ate voraciously. Billy presented a variety of troubling symptoms. His voice was noticably high for a man. He displayed legume anorexia, and, according to his parents, often refused to bathe. His intellectual functioning was also below normal--he had little general knowledge and could barely write a structured sentence. Social skills were also deficient. He often spoke inappropriately and exhibited "whining behaviour." His sexual experience was non-existent.
Indeed, Billy considered women "icky." His parents reported that his condition had been present from
birth, improving gradually after he was placed in a school at age 5. The diagnosis was "primary childhood."
After years of painstaking treatment, Billy improved gradually. At age 11, his height and weight have
increased, his social skills are broader, and he is now functional enough to hold down a "paper route."
After years of this kind of frustration, startling new evidence has come to light which suggests that the
prognosis in cases of childhood may not be all gloom. A critical review by Fudd (1972) noted that studies of the childhood syndrome tend to lack careful follow-up. Acting on this observation, Moe, Larrie, and Kirly (1974) began a large-scale longitudinal study. These investigators studied two groups. The first group consisted of 34 children currently engaged in a long-term conventional treatment program. The second was a group of 42 children receiving no treatment. All subjects had been diagnosed as children at least 4 years previously, with a mean duration of childhood at 6.4 years.
At the end of one year, the results confirmed the clinical wisdom that childhood is a refractory
disorder--virtually all symptoms persisted and the treatment group was only slightly better off than the controls.
The results, however, of a careful 10-year follow-up were startling. The investigators (Moe, Larrie, Kirly, & Shemp, 1984) assessed the original cohort on a variety of measures. General knowledge and emotional maturity were assessed with standard measures. Height was assess by the "metric system" (see Ruler, 1923), and legume appetite by the Vegetable Appetite Test (VAT) designed by Popeye (1968). Moe et al. found that subjects improved uniformly on all measures. Indeed, in most cases, the subjects appeared to be symptom-free. Moe et al. report a spontaneous remission rate of 95%, a finding which is certain to revolutionize the clinical approach to childhood.
These recent results suggests that the prognosis for victims of childhood may not be so bad as we have feared. We must not, however, become too complacent. Despite its apparently high spontaneous remission rate, childhood remains one of the most serious and rapidly growing disorders facing mental health professionals today. And, beyond the psychological pain it brings, childhood has recently been linked to a number of physical disorders. Twenty years ago, Howdi, Doodi, and Beauzeau (1965) demonstrated a six-fold increased risk of chicken pox, measles, and mumps among children as compared with normal controls. Later, Barby and Kenn (1971) linked childhood to an elevated risk of accidents--compared with normal adults, victims of childhood were much more likely to scrape their knees, lose their teeth, and fall off their bikes.
Clearly, much more research is need before we can give any real hope to the millions of victims wracked by this insidious disorder.
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