Voices from the past. A developmental psychiatrist considers Still's 'Some abnormal psychical conditions in children'.

Abstract

In March 1902, Sir George F. Still gave a series of three Goulstonian lectures to the Royal College of Physicians in London, the first of which is produced here by kind permission of the Lancet. Still’s aim in these lectures was to propose that ‘an abnormal defect of moral control’ could be identified in some children, whether or not the child is of low intelligence. In Victorian times, when low intelligence/ mental retardation was widely believed to be linked to a more fundamental trait of moral inferiority and degeneration, to make such a proposal was innovative. Still explores his theory with close reference to a large volume of case material collected over a considerable period and here presented in a structured and organized fashion. Indeed, one of the most striking features of the paper is the vivid and descriptive power Still applies to his clinical observations of child behaviour and (what we now call) temperament [1]. In presenting and exploring empirical evidence of his theory in this way, he shows himself to have been an enlightened, entertaining and reforming natural scientist, albeit at some points in the narrative seemingly evidencing mainstream eugenic beliefs of that time, which are quite unacceptable today. In studying this paper, questions began to form in my mind. How would we understand, diagnose, classify or otherwise label the children he describes, today? Is Still here endeavouring to identify psychopathic personality disorder in childhood or at least its temperamental precursors? [2]. Or is his work more relevant to our thinking on disorders such as autism/pervasive developmental disorder or other conditions in which social and inter-personal difficulties arise in childhood, such as ADHD? What is he saying about aetiology—and what would he say about today’s debates concerning the relative contribution of genetic and environmental influences upon childhood psychosocial adjustment? [3]. Or is his way of thinking so different from ours today, such that these questions do not arise? In all of this, we need to start by considering Still himself, his life and work and the influences which were shaping his thinking. Sir George F. Still (1868–1941) was the first Professor of Paediatrics at King’s College/University of London and is recognized as the first full time Paediatrician to have been appointed to the Great Ormond Street Children’s Hospital: the doctors appointed prior to his arrival there having been General Physicians. His most celebrated contribution to medicine resulted from his paper ‘On a form of chronic joint disease in children’ [4], which came to be known as ‘Still’s Disease’—the name now given to a type of juvenile chronic arthritis in