Adolescent delinquents: A case study of thirteen treatment referrals to The State Mental Hygiene Clinic by the Probation Department, Los Angeles

Citation preview

ADOLESCENT DELINQUENTS:

A CASE STUDY OP THIRTEEN

TREATMENT REFERRALS TO THE STATE MENTAL HYGIENE CLINIC BY THE PROBATION DEPARTMENT,

LOS ANGELES

A Thesis Presented to the Faculty of the School of Social Work The University of Southern California

In Partial Fulfillment of the Requirements for the Degree Master of Social Work

by Katharine H. Sharfman June 1950

UMI Number: EP66365

All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.

UMI Gi&sertalion Publishing

UMI EP66365 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code

ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346

T h i s the sis, w r i t t e n u n d e r th e d i r e c t i o n o f th e c a n d id a te 's F a c u l t y

C o m m itte e a n d a p p ro v e d

by a l l its m e m b e rs , has been p re s e n te d to a n d a c c e p te d by th e F a c u l t y o f th e G r a d u a t e S c h o o l o f S o c i a l W o r k in p a r t i a l f u l f i l m e n t o f th e r e ­ q u ir e m e n t s f o r th e d e g re e o f

MASTER OF SOCIAL WORK

Dean

0

Thesis

F a c u lty C om m ittee

Chairman

TABLE OP CONTENTS CHAPTER I.

PAGE

INTRODUCTION ...................

1

B a c k g r o u n d ..............

1

Statement of thep r o b l e m ........................

5

Setting

7

........................................

M e t h o d o l o g y .......................................10 Organization ....................................

12

D e f i n i t i o n s .......................................13 II,

PRESENTATION OP C A S E S .............................. 14 —

III.

Case

1 - Samuel

................................14

Case

2 - R i c h a r d .................................. 16

Case

3 - J o s e p h ..................................19

Case

4 - J o a n .................................... 23

Case

5 - E l i z a b e t h ................................27

Case

6 - R o b e r t ..................................30

Case

7 - R o g e r .................................... 34

Case

8 - D a n ...................................... 37

Case

9 - B a r b a r a ..................................40

Case

10 - R a l p h ..................................44

Case

11 - T o m .................................... 46

Case

12 - D a v i d ..................................49

Case

13 - M a n u e l ..................................52

ANALYSIS OP F I N D I N G S ............ Social and psychiatric characteristics ........

55 55

iii CHAPTER

iv.

PAGE Personal d a t a ..............................

55

Social backgrounds ..........

57

Psychiatric symptoms .......................

59

Delinquency reeords

.......................

62

Factors in referral process and use of clinic

65

R e f e r r a l ....................................

65

Use of C l i n i c ..............................

69

sm m m

and c o n c l u s i o n s .......................

71

S u m m a r y ....................................

71

C o n c l u s i o n s ...........................

74

B I B L I O G R A P H Y .............................

78

A P P E N D I X ...............................................

82

CHAPTER I INTRODUCTION BACKGROUND Psychiatric interest in the understanding and treat­ ment of delinquency is of comparatively recent origin*

The

child guidance clinic, as a part of psychiatry, came into being as an expression of this interest.

The first juvenile

court, "an agency in which the relations of a child to society or to his parents are adjusted according to the scientific findings about the child and his environment,”*** was established in Chicago, Illinois, in 1899.

Ten years

later Doctor William Healy ’’first provided the dynamic approach to the understanding of delinquency,”

through the

Juvenile Psychopathic Institute which he founded in that city to serve the court.

The work of this clinic was limited

in the beginning to questions of etiology, diagnosis, and prognosis of cases referred by the court.

Nonetheless, the

1 Martin H. Neumeyer, Juvenile Delinquency in Modern Society (New Yorks D. Van Nostrand Company, Inc., 1949), p. 249. 2 Ben Karpman, ’’Milestones In the Advancement of Knowledge of the Psychopathology of Delinquency and Crime,” Orthopsychiatry 1925-1948 (New Yorks American Orthopsychiatric Association, IncT^ 1948), p. 101. 3 William Healy and Augusta P. Bronner, ’’The Child Guidance Clinics Birth and Growth of an Idea,” Orthopsychiatry 1925-1948 (New York: American Orthopsychiatric Association, Inc., 1948), p. 55.

2 new psychiatric approach it represented aroused much interest, as did Dr. Healy’s publication of his findings in The Indi­ vidual Delinquent in 1915. Expansion of the clinic movement was rapid after this date.

Dr. Healy and his assistant, Dr. Augusta Bronner, a

psychologist, left the Chicago clinic in 1917 to establish and direct the Judge Baker Foundation in Boston, Massachusetts, while Dr. Herman Adler continued their work in Chicago.

In

1917 and 1918 other new clinics were established in Baltimore, Boston, and New York.

The National Committee on Mental Hygiene,

through a Division on Prevention of Delinquency, adopted a plan in 1921 to establish demonstration clinics throughout the country supported by the Commonwealth Fund.

Between 1922

and 1926, clinics were founded under this plan in seven cities, one of which was Los Angeles.

Several other cities also

started clinics at this time although demonstration grants 4 were not available. Although these clinics all started with a focus on the problem of delinquency, their emphasis gradually shifted as a result of experimentation and research.

As they undertook to

provide direct treatment in addition to diagnostic and con­ sultative service, they quickly learned that their most 4 Discussion of the origin and later development of the child guidance clinic movement can be found in* Helen Leland Witmer's, Psychiatric Clinics for Children, and George S. Stevenson and G-eddes Smith’s, Child Guidance Clinics, A Quarter Century of Development.

3 effective work could be done with children who had not yet come before the court#

Therefore, an increasing number of

cases were accepted from other social agencies, and the per­ centage of court referrals declined.

In addition to pre­

delinquents, social agencies began to refer many non­ delinquents with neurotic problems to clinics for treatment. By the end of the demonstration program in 1927 when a new group was being formed to stimulate further expansion of the child guidance clinic idea, the National Committee set up a Division of Community Clinics for this purpose.

The change

in name reflected the change in practice that had taken place. In 1934, Dr. Stevenson defined the function of the child guidance clinic without reference to delinquency as follows: Functionally, it (child guidance clinic) is an agency for bettering the adjustment of children to their im­ mediate environment, with special reference to their social and emotional relationships, to the end that they may be free to develop to the limit of their individual capacities for well balanced maturity.5 The need of the courts for psychiatric study of the eases brought to them remained, however, and clinics attached directly and responsibly to the courts came into being in many cities.

These court clinics tended to provide diagnostic

service as their most important function, relying on other agencies to carry out recommended treatment plans.

The

5 George S. Stevenson and Geddes Smith, Child Guidance Clinics. A Quarter Century of Development (New York: Commonwealth Fund, 1 9 3 4 ) , p. 186.

4 evolution of these specialized clinics resulted in a further decline in the number of court delinquents seen by other clinics.® Today, child guidance clinics, with the exception of court clinics, do not maintain any special relationships with the courts, nor do they recognize any special responsibility to work with delinquents.

The services which they provide

are considered preventive, not only of delinquency, but also of mental illness and other disturbances of emotion and conduct.

But, because of their origin, there is still con­

siderable interest in their contribution to the treatment of court delinquents. In a recent discussion Dr. William Healy commented that these clinics seem to avoid the treatment-of delinquents known to courts because they present more difficult problems than the neurotic child or the child with a simple behavior disturbance.

Several questions might arise as a result of

this explanation: intensity?

Are these problems different in degree of

Are they of a different nature?

What are the

special problems of delinquents? 6 Florence Van Sickle, tfThe Function of the Mental Hygiene Clinic at Juvenile Hall In Los Angeles, California,11 (unpublished Masterfs thesis, The University of Southern California, Los Angeles, 1945), pp. 11-19. 7 William Healy and others, "Psychiatry and Juvenile Delinquency--Critical Evaluation," American Journal of Orthopsychiatry, 19:521, April, 1949.

5 An explanation of another sort might be developed from Dr, Witmer’s statement that: In so far, however, as the clinics specialize in treatment rather than diagnosis, they are inclined to limit their intake largely to cases in which the parents (or the children, especially if they are adolescents) really want their help.8 Do the delinquents referred by courts really want help?

Has

the authority of the court as a referral source an effect on the course of treatment?

These are questions that might also

be posed in relation to clinical treatment of delinquents, STATEMENT OF THE PROBLEM It is the object of this study to examine the relation­ ship between a particular court and a particular clinic. Interest is centered in two aspects of this relationship, that is, in the kinds of cases which are referred, and in the factors in the referral process, The Los Angeles State Mental Hygiene Clinic,

9

from

whose records case material was selected, is an all-purpose psychiatric clinic sometimes used as a treatment resource by the Los Angeles County Probation Department, Juvenile Division,^ 8 Helen Leland Witmer, Social Work (New Yorks Farrar and Rinehart, Inc., 1942), p. 462, 9 The Los Angeles State Mental Hygiene Clinic will hereinafter be referred to as the Clinic. 19 The Los Angeles County Probation Department, Juvenile Division, will hereinafter be referred to as the Probation Department.

for youthful offenders In need of specialized help.

In this

instance, the Probation Department functions as the agent or arm of the Los Angeles County Juvenile Court.

11

The purpose of this study, then, is to examine and evaluate the use which the Court makes of the Clinic as a ' referral resource for the treatment of a selected group of youthful offenders.

Consideration of the services given by

the Clinic to the young people so referred is not a focus of the study, and will be examined only to the extent that an understanding of what happened to the individual referred is essential to an evaluation of the Court’s role.

The questions

which will be answered in relation to the cases selected for \

study are as follows: 1.

What are the family backgrounds, personal histories, social problems, and psychiatric symptoms?

2.

What are the factors in the referral process? (This will Include such Items as the reasons for referral, preparation for referral, attitudes toward referral, participation in referral, and circumstances of referral.)

H The Los Angeles County Juvenile Court will herein­ after be referred to as the Court. The terms Court and Probation Department will be used interchangeably In refer­ ences to the referral source.

7 SETTING The reader is referred to a study by Marguerite McDonald

12

for a detailed presentation of the history, organi­

zation, structure, and function of the Los Angeles State Mental Hygiene Clinic.

A brief survey of the agency will be

presented here, together with information about policies and procedures pertinent to this study. Organized in 1946 as part of the Department of Mental Hygiene of the State of California, the Clinie offers psychi­ atric services, Including diagnosis, consultation, and treat­ ment, to any resident of the state able to benefit from such help.

Under the direct supervision of the Director, a

psychiatrist, all of the professional staff function as therapists.

Treatment methods used include individual and

group psychotherapy, play therapy for children, and environ­ mental manipulation.

Intelligence and personality tests are

given on a selective basis by the .psychologists on the staff. When a request is made for the services of the agency, an intake interview is usually scheduled within three weeks. At that time the services available are explained to the applicant, and an evaluation is made of his need for and ability to use them.

The cost of treatment is determined by

12 Marguerite McDonald, ’’Psychiatric Services for Children at the Los Angeles State Mental Hygiene Clinic,” (unpublished Masterfs thesis, The University of Southern California, Los Angeles, 1949), pp. 14-38.

8 use of a graduated fee schedule which varies from no charge to four dollars per interview based on ability to pay.

After the

Clinic accepts the applicant, his name is placed on a waiting list for assignment to a therapist.

Psychiatrists, psychiatric

social workers, and psychologists are all assigned eases on a routine rotation basis. study

13

During the period covered by this

the waiting period between acceptance and the beginning

of treatment varied from two to five months. Immediate responsibility for treatment rests with the individual therapist who may, at any time, present for staff discussion a case with which he wants help.

Each social worker

and psychologist has a specific psychiatrist to whom he goes for consultation on the management of his cases.

Conferences

between therapists are scheduled for all joint cases.

At the

time of discharge the therapist records the diagnosis for each case in accordance with an official classification list used throughout the Department of Mental Hygiene.

An evaluation of

the results of Clinic service is also made by the therapist. He records his estimate of improvement in the patient's social adjustment and mental condition at closing. The customary procedures outlined above are occasionally modified by the elimination of the intake interview for cases referred by other agencies.

Also, those cases in which the

13 The calendar year 1949 is the period covered by this study.

9 applicant considers his problem emergent are seen without the usual waiting period. - 14 At the present time about one third of all persons served by the Clinic are children under eighteen years of age. Social agencies and medical personnel refer approximately one half of all cases.

Approximately 10 per cent of those

accepted for treatment do not return after the intake inter­ view; nearly 40 per cent are seen at least two times in treatment.

15

Although the Clinic is the source from which material for this study is taken, it seems pertinent to consider as also part of the setting, the relationship between Court, Probation Department, Juvenile Hall, and Juvenile Hall Clinic. The Probation Department and the Court, both in existence for more than forty years, are administered individually but function in close cooperation.

The Court uses a socialized

procedure in dealing with alleged delinquents toward a goal of rehabilitation.

Probation, one form of disposition made

by the Court, is carried out by the Probation Department through intake, placement, and field work with probationers, and the maintenance of forestry camps.

1c

Juvenile Hall,

14 The estimates which follow were made by the Director and the intake worker in April, 1950. 15 This estimate compares favorably with McDonaldfs data showing that out of fifty-one cases, twenty-five were seen two times or less. McDonald, op. cit., p. 79. 16 Neumeyer, op. cit., pp. 260-61.

10 another County institution, is used by Court and Probation Department when detention facilities are needed.

When

psychiatric diagnosis is desired, both agencies utilize the Juvenile Hall ‘Clinic.

This clinic offers treatment only in

emergency situations.

In general it makes recommendations

for appropriate care to the referring agency.

17

METHODOLOGY The case study is the method followed in this thesis to analyze the use of one agency, the Clinic, by another agency, the Probation Department, in relation to a specific group of adolescent offenders referred for treatment.

The

files of the Clinic were the sole sources of case material; Court and' Probation Department data was obtained only as it could be found In Clinic records.

'

/

The limitation of time to be given this project made it necessary to limit the number of cases selected.

The

calendar year 1949 was chosen as a base period., and only cases referred during that time were considered.

Since a

full evaluation could not be made of cases open at the time of the study, selection was limited to cases closed prior to March 1, 1950.

In selecting only those records which contained

a written summary from the Probation Department, an effort was made to guarantee the availability of some information about 17 Van Sickle, o£. cit., pp. 58-68.

11 the referral.

The scope of the study was limited further by^

the choice of adolescents, at least twelve but not yet eighteen years old at the time of referral, who were sent for treatment only.' V

A total of seven hundred twenty-six new cases were

opened at the Clinic during 1949, of which ninety-five belonged to the adolescent age group*

Seventy-four cases,

or 78 per cent of the adolescent group, were closed before March 1, 1950.

Of these, thirteen were found which fulfilled

the criteria established above.

Each of these records was

analyzed according to a schedule 18 designed to provide answers to^ the 'two: questions mentioned earlier. It is important here to note some limitations of the procedure just outlined.

The narrow definition of the Courtrs

use of the Clinic’s services, considered only with respect to the treatment of adolescent offenders, requires that caution be used in evaluating the results.

Not only are diagnostic

and consultative services excluded from this examination, but also all services to children under twelve.

Another factor

which should be noted because of its possible modification of results is the use of recorded material only from the Clinic files.

The referral summaries from the Probation Department

varied in length from three to thirty-five pages among the thirteen cases, averaging ten to twelve pages. IB See Appendix.

Several

12 summaries included carbon copies of the reports from schools and other agencies as well as the probation officer's social history, the Court brief, and the Juvenile Hall Clinic report. In some records, however, most of this data was missing. Also, in none of the records was-indication given of the preparation of the delinquent for the referral.

The possi­

bility that access to the files of the Court and the Probation Department might produce new information which would qualify the findings derived from Clinic records should be recognized. ORGANIZATION Each of the thirteen case histories studied is summarized and presented in narrative form in Chapter II. The descriptive abstracts include pertinent data about family and personal history, Court experience, and Clinic contact for each delinquent.

They are all( written from the point of

view of the Clinic contact as the present to make for easier reading.

Direct quotations are made from both the Clinic

records and the Probation Department summaries. In Chapter III ,the analysis of the records is set forth under two main headings:

social and psychiatric

characteristics, and factors In referral process and use of the elinic.

Under the first division the personal data,

social backgrounds, psychiatric symptoms, and delinquency records are summarized.

The referral process and use of the

13 clinic are presented in the second section* Chapter IV contains a summary of the project and the conclusions which could be drawn on the basis of the findings. definitions

The following terms are defined to insure common under­ standing between author and reader as to their meaning in this study. Delinquent♦

The term ’’delinquent” refers to young

people under eighteen whose actions would be considered criminal if committed by an adult, or whose pattern of behavior includes antisocial activities peculiar to childhood, such as truancy, waywardness and incorrigibility. Adolescent. of at least

In this study, an ’’adolescent” is a child

twelve but less than eighteen years in age.

This

definition is used in classifying cases in the Clinic. Patient.

In the Clinic the term ’’patient” is used with

respect to an applicant accepted for service. Mental condition and social adjustment.

These two

terms are found on the ’’Report of Discharge, Outpatient” form used In the Clinic.

Improvement in mental health and in

social relationships by a patient on discharge is recorded under these categories.

CHAPTER II PRESENTATION OP CASES CASE 1 - SAMUEL Identifying Information.

Age:

15

School grade: Religion: Color: Family and personal history.

10

Jewish

White

Both parents are

allegedly mentally deficient and have been known to social agencies for many years.

Father, sixty years old at the

time of Clinic contact, immigrated to America as a young adult, and shortly thereafter deserted a wife and child to begin a ten year period of roaming the country as a hobo. Mother was raised in a state training school and had had two children by a previous marriage when she met and married father in 1933.

Samuel is the oldest of five children born

from this marriage.

Father has never worked regularly and

the family has depended on public assistance for support much of the time. Court contact.

An assistance worker noted "disturbed,

aggressive behavior" in Samuel when he was five, and referred 1 Names and other identifying characteristics in each case are disguised.

15 him to the Court for study.

Considered a neglected child he

was placed in a supervised boarding home.

Two years later

the four younger siblings were also removed from parents! custody because father was committed to a County institution and mother was judged inadequate to the responsibilities of their care and supervision.

Samuel apparently adjusted quite

well in the several foster homes in which he lived during the next seven years.

He is known to have made a fair school

record; no unusual behavior was exhibited and his grades were in line with his average ability.

Samuel and the other

children were restored to their parents in 1946 by the Court. Though the other children apparently accepted the limitations of their home, Samuel rebelled almost at once, and repeatedly requested a group placement.

Father "overtly

rejected him,” frequently treating him in a harsh, abusive manner, yet refused to consent to placement.

After two years

Samuel was again brought before the Court, this time because of "minor delinquencies" including fire-setting, disobedience, and running away from home.

He was placed on probation and

sent to an institution from which he escaped after several months of disruptive activity.

After two months of detention

in Juvenile Hall he was re-placed in another institution. Psychiatric study of Samuel at the Juvenile Hall Clinic as well as observation in his several placements indicate "a deep-seated hostility and guilt in relationships with adults."

16 He uses many negative attention-getting mechanisms with other children and is generally rejected by his companions. Recently, he has developed morbid ideas and suffers from occasional periods of amnesia.

Because of his f,schizoid

traits and paranoid ideas,11 the Probation Department referred Samuel to the Clinic for treatment early in 1949. Clinic experience.

Three months after referral Samuel

was seen by a therapist at the Clinic.

He was resentful and

sullen about the referral, having been given no advance notice.

During a two month period he was interviewed twice,

and in both sessions his reactions were hostile and defensive. Therapist concluded that his behavior is "an inevitable result of his background” and recommended that therapy could best be given by caseworker in the institution and by probation officer.

He also recommended that pressures for

conformance and educational achievement be reduced.

Samuel

was discharged with a diagnosis of ”Primary Behavior Disorder-Conduct Disturbance.”

His mental condition and

social adjustment were considered improved. CASE 2 - RICHARD Identifying information.

Age:

12

School grade: Religion: Color:

6

Protestant

White

17 Family and personal history.

Not much is reported

about father, who died in an accident a few months after Richard’s birth.

Mother was an only child who married at

seventeen immediately after graduation from high school. Three years later when Richard was two, mother married again. The stepfather, eleven years older than mother, formally adopted Richard, and brought the family to his small ranchfarm in a Los Angeles suburb.

The family barely managed to

make a living from this farm, and for the past five years has been living in the city where mother works as a bookkeeper to supplement their income.

At the time of Clinic contact,

the housing shortage had brought about a separation of the family for several months.

Vtfhile stepfather returned to live

on his ranch, Richard and his mother stayed with maternal grandmother in the city.

Stepfather planned to sell his

property, move to the city, and obtain employment there. Mother’s salary and grandmother’s old age assistance grant provided the entire family income. Richard, a short, slight, good-looking boy, has always been regarded as a normal, average child by his parents.

He

suffered no illnesses other than the usual childhood infections.

With an intelligence quotient of 110

2

he was con­

sidered bright at school, did excellent academic work, and 2 All intelligence quotient ratings, henceforth referred to as I.Q.'s, are taken from the Juvenile Hall Clinic’s reports based on individual testing.

18 was never a behavior problem. never violent.

Though quick-tempered, he is

He apparently enjoys the company of his few

friends as well as solitary pursuits.

Richard worked one

summer as a grocery clerk, and has held a regular newspaper route for the past year and a half. Court contact.

Richard's case came to the attention

of the Court when the school reported him as an habitual truant in the fall of 1948, charging that for six months, in contrast to his previous excellent record, Richard has been truanting excessively.

The family ignored the first Court

hearing held on this charge, and at the second explained that his absences were solely due to illness.

The Court

placed Richard on probation and for several months he again attended regularly.

In the spring of 1949 the school again

complained, and again the parents claimed that illness was the cause of the b o y ’s absences.

At this time, however,

Richard stated to the Court that he had intentionally truanted because "he feared he had fallen so far behind in his work that he could never make it up."

The Court then

ordered a psychiatric examination at the Juvenile Hall Clinic. The findings of their examination were that Richard had experienced "early maternal rejection and paternal abandonment," resulting in an insecure personality structure. "His attempts to win love by being passive and submissive

19 produce inner anxiety, and his marked dependency traits are offset by a reaction formation whereby he asserts his inde­ pendence of other people,”

Because of these evidences of ”a

deep-seated neurotic character disorder,” treatment at the Clinic was recommended. Clinic experience.

Two months after Bichard was

referred by the Probation Department the whole family, mother, stepfather, and patient we're seen at intake

3

Bichard seemed indifferent to this referral,

in the Clinic. just as he had

been to the Juvenile Hall Clinic examination.

Both parents,

however, were indignant and resentful, and vehemently ex­ pressed their hostility toward the school, the Court, and the Clinic.

Adamantly they rejected the offer of service.

After

this single contact, patient was discharged with a diagnosis of "Primary Behavior Disorder-Conduct Disturbance,” with both mental condition and social adjustment unimproved at closing. The Probation Department was notified of the termination due to parents’ refusal to accept treatment. CASE 3 - JOSEPH Identifying information.

Age:

15

School grade: Religion: Color:

9

Protestant

Negro

3 At intake, the same therapist interviews parent and child,

20 Family and personal history.

The Andrews family came

to Los Angeles from Michigan when Joseph was ten years old. Father had been born and raised in the South, the "spoiled youngest child in a family of nine."

After completing an

eighth grade education, father was trained in a skilled trade at which he has always had steady employment.

Mother, the

middle child in a family of six, was shunted from relative to relative following her parents 1 accidental death when she was ten.

At an early age she began working at various jobs

to contribute toward her support, and after her marriage at the age of nineteen, organized a real estate business which she has continued to manage successfully. Los Angeles,

Since coming to

the family has purchased a comfortable home.

Joseph has one sibling, a sister two years older than he, with whom he is in "intense rivalry,"

Father definitely

favors the boy, while mother is firm and harsh with both children.

There is no history of marital conflict; mother

is "obviously the dominant person in the family constellation." Though Joseph has had no health problems for the past several years, he suffered a severe infection with a resulting enlarged heart as a child.

Until he was ten he attended a

special school and was prohibited from engaging in active sports.

Joseph has better than average intelligence and had

a good school record in all respects until his first contact with the Court.

His only work experience was managing a

21 newspaper route for several months*

He has always had friends,

leading an active social life and participating in church clubs and sports.

Recently he has become interested in girls

and has frequent dates.

His parents think of Joseph as quick­

tempered and nervous, shy with strangers and forward with friends.

He has always bitten his nails, but has no other

nervous habits. Court contact.

Joseph came to the CourtTs attention

one year prior to his referral to the Clinic.

He had been

out with a friend in the park when the friend got into a fight with a white boy who was refusing to repay a loan.

Though

Probation Department records indicate Joseph was a bystander in this situation, he was detained two weeks in Juvenile Hall and placed on probation, treatment which he felt was un­ justified.

Apparently as a result of his resentment, his

behavior at school and at home deteriorated.

Within a few

months the school reported him their worst behavior problem, but the probation officer discounted this, feeling "he has been marked by his Court experience and is being blamed in­ discriminately for all difficulties in the school."

The

parents, shocked and humiliated by his Court experience, placed severe restrictions on him, to which he reacted with wilfull disobedience.

Six months after his first hearing, he

was arrested by police while riding with a friend in a stolen

car the friend had borrowed*

Though Joseph claimed he did

not know the car had been stolen, and friends corroborated his story, he was again detained in Juvenile Hall, this time for three weeks.

Testing and examination during this period

revealed much ’’inner insecurity” and ’’tendencies toward impulsivity” and ’’withdrawal from frustration.”

Treatment

at the Clinic was recommended based on a diagnosis of ’’Schizoid Personality with Behavior Disorder. ” Clinic experience.

Two months after the referral from

the Probation Department was received at the Clinic, Joseph and mother were seen by different therapists.

Joseph ex­

pressed no resentment regarding the referral, seemed concerned about his part in his troubles, but stated that he felt that he was being unduly punished.

He thought that many of his

difficulties had arisen through poor choice of companions, that he was improving in this respect, and that further treat­ ment at the Clinic would be unnecessary. and fearful about Joseph’s future.

Mother was upset

Though she saw no real

problems, she indicated a willingness to cooperate with the Clinic recommendations.

Mother was reassured that patient’s

misbehavior did not mean he was irreversibly launched on a career as a delinquent. demands on him.

It was suggested that she relax her

Patient’s rebelliousness at home was

explained to her as ’’his attempt to differentiate between

himself and his sister,” and as his reaction to the Court’s treatment.

In this way her anxiety as to the outcome of his

behavior was alleviated.

Environmental manipulation was

recommended to the Probation Department and to mother in the form of a change of school placement.

Since neither patient

nor mother recognized any emotional problem with which the Clinic could offer help, and since the patient’s adjustment had apparently improved in the interim between his Juvenile Hall contact and his interview at the Clinic, further treat­ ment was not suggested and patient was discharged as unimproved in mental condition and social adjustment as a result of this one interview.

His diagnosis was ’’Primary Behavior Disorder-

Conduct Disturbance.” CASE 4 - JOAN Indentifying information.

Age:

14

School grader Religion: Color: Family and personal history.

9

Protestant

White

Mother is a thirty-four-

year-old woman, who was divorced by her husband when Joan was four.

She worked in an office to support herself and daughter

until she suffered an incapacitating injury one year before referral.

Since that time the family has been sustained by

24 public assistance grants.

They live in a small but comfortable

cottage in a residential area.

Mother is not interested in

remarriage, stating that "she prefers to devote her life to daughter."

Father has remarried, lives in Middle West and

maintains sporadic contact with Joan. Joan is a plump, attractive girl, physically mature and appearing at least eighteen. nesses.

She has had no serious ill­

Before mother*s accident she had always done school

work commensurate with her intellectual ability, which is average; her behavior in school and at home had been acceptable. She has never worked outside the home. At the time of mother’s accident, Joan was visiting father for first time.

Because mother was still hospitalized

when Joan returned, she was temporarily placed in a strict boarding school.

She ran away from this school, impulsively,

after several weeks. Court contact♦

Joan was brought into Court as a result

of her involvement in a sexual relationship with an older man during her absence from boarding school.

Though at first

reluctant to testify against him, she came to enjoy the notoriety resulting from her testimony.

She was placed on

probation, but her conduct rapidly deteriorated.

When she

began attending junior high school she was soon considered an inveterate liar and a nuisance generally, because of her

indifferent and insolent attitude, and her seductive behavior toward boys in her classes. she seldom truanted,

Joan quit studying and, although

she often came to school "so sleepy that

she had to be permitted to rest half a day.11

She became com­

pletely incorrigible at home, and mother who had invariably been over-indulg©nt and over-protective of Joan, found the girl eager to thwart her.

Her only interests outside of

school were boys and "unusual social activities."

She began

to stay out late at night, to smoke excessively and to refuse to help with the housework.

A re-study of her case by the

Court indicated "severe emotional maladjustment" on Joan's part and "neurotic mismanagement" of her by mother.

Treat­

ment at the Clinic was recommended. Clinic experience.

Three months after referral, Joan

and mother were seen at intake in the Clinic.

Joan was tense

and frightened; she expressed some bewilderment at the referral and stated that she came only because she had been told she was required to as a condition of probation.

Mother

was gratified by the opportunity to explain her martyr role, and showed interest in using the Clinic to control daughter. Psychiatric appraisal by the therapist concluded that patient felt guilty because of her preference for father and hostility toward mother, and therefore was acting out toward all adults. It was planned that Joan be given an opportunity for a good

26 relationship with an adult as well as counseling on school and social adjustment problems.

Mother was to be seen only

on occasion, as it was deemed impossible to modify her attitude in the Clinic,

Mother was seen three times, patient

four times by different therapists during the three months in which the case was open.

Though mother kept all her

planned appointments, frequently calling about patient’s, Joan cancelled two appointments, was one and one half hours late for another and, finally, did not appear at all for two scheduled interviews.

After these two failures,

the

probation officer was notified and the case was closed as not amenable to treatment on an out-patient basis.

Patient’s

diagnosis was ’’Primary Behavior Disorder-Conduet Disturbance with Delinquent Behavior,” and both her mental condition and social adjustment were unimproved at closing. During the course of clinic contact with Joan, three lengthy telephone conversations were held with the probation officer.

Although the possible placement of Joan with her

father or in an institution was discussed, the Clinic made no specific recommendation.

In her four interviews, Joan spoke

superficially about home, school and social problems, indi­ cating a desire to change herself.

She was suspicious

throughout of a possible connection between the Court and the Clinic, and at no time felt free to speak frankly about herself.

CASE 5 - ELIZABETH Identifying information.

Ager

17

School grader Religion: Color: Family and personal history.

12

Protestant

White

Father, alcoholic and

tubercular, was described in records as a mean, cruel person. He died when Elizabeth was six, at which time mother, a seclusive and disturbed woman, released Elizabeth and an older daughter for adoption. son.

She kept with her a younger

Elizabeth was adopted after one year in an orphan

asylum.

Adoptive mother’s background is unknown.

Adoptive

father, an easy-going, placid person who worked as a mechanical engineer, suffered a severe heart attack shortly after the adoption, and in recent years has become a semi-invalid. Though the family’s economic position has never been secure, Elizabeth was given many material advantages and, according to the family, was showered with love and affection. Slender, sweet-looking, and almost six feet tall, Elizabeth was happy and well-adjusted both in and out of the home until she was twelve. height.

She then shot up to her present

She entered junior high school at this time, was

elected vice-president of her class and became the object of frequent ridicule as a result of the bizarre contrast between

herself and the short, stocky class president*

There followed

a swift decline in her school behavior, previously superior, and in school work which had reflected her I.Q. of 134*

At

home, Elizabeth became moody and irritable, withdrawing more and more to herself.

Parents placed her in a strict Catholic

school when she was nearly thirteen, with the consequence that her behavior deteriorated further.

She began bed-wetting

there, and her enuresis continued from that time until the beginning of Clinic treatment.

After nearly two years at the

school, Elizabeth became increasingly abusive to her parents, threatened them with physical harm unless they permitted her to leave.

Parents removed her from the institution arid re­

placed her in a cottage-type home.

There, she involved

herself with some other girls in petty shoplifting, and was removed after six months. Court contact.

Elizabeth’s petty thievery brought her

to the attention of the Court when she was almost fifteen. She was placed on probation, but her provocative behavior at home and her temper tantrums only increased.

The school

began to complain of her poor work and neglect of intellectual and artistic talents.

Elizabeth protested that she felt

inferior to schoolmates because of her height, that she dreaded mixing with them.

She was avoiding all school activi­

ties and alienating herself from her few friends.

She did,

29 however* obtain summer factory employment and made a good work adjustment.

Nonetheless, her hostility at home grew

more acute and her attitude came to be one of "resentment of the world.'1

Parents tried private psychiatric treatment, but

Elizabeth refused to return after four interviews, that it was parents who were in need of help.

insisting

Finally,

parents in desperation called in the Probation Department and a re-study was ordered by the Court.

Due to "evidences of

considerable neurotic conflict," Elizabeth was referred to the Clinic for treatment and for possible consideration of plans for emancipation from foster parents. Clinic experience.

After the referral was made to the

Clinic three months passed before treatment began.

Elizabeth

came willingly so long as her mother accompanied her.

She

recognized no problems of her own, but felt that mother was too narrow and exacting and needed help with her own problems. Mother revealed that both she and adoptive father had become somewhat disgusted with patient's behavior.

Both parents

placed all the blame for patient's difficulties on the trauma and instability of her first seven years of life.

Mother

came only because patient would not come without her.

During

ten and one half months of Clinic contact, Elizabeth was seen ten times, mother five times by separate therapists.

Patient

came with some regularity every two weeks until the summer of

30 1949.

In the fall, she returned twice at mother’s insistence.

Though both mother and patient cancelled several appointments and came late for most interviews, mother often telephoned for help while refusing to come in.

Contact was terminated

when patient began rejecting appointments, stating that she could see no problems.

Patient was discharged with a

diagnosis of “Character Neurosis.”

Though her social adjust­

ment was thought to be improved, her mental condition was un­ changed.

As a result of treatment, mother seemed to gain

some insight into patient’s problems, but did not appear to be able to apply it.

Patient was defensive and resistive

throughout her contact.

She tried to conceal all conflicts

and was unable to admit having emotional problems.

Her

rebellion against parents became less violent, though the relationship remains negative.

Despite some slight insight

developed through therapy, patient’s “adjustment is highly precarious.“ CASE 6 - ROBERT Identifying information.

Age:

12

School grade: Religion: Color: Family and personal history.

8

Protestant

White

The family were Oklahoma

farmers who migrated to Los Angeles in 1941, following a siege

31 of severe deprivation and near starvation.

Father- has been

an alcoholic for seven years, and his drinking produces belligerant behavior and a defensive attitude toward his poor work habits, which prevent his obtaining employment at his own skilled trade. his alcoholism.

He has refused any kind of treatment for

Mother is nervous, ineffectual; she quarrels

with him constantly over his harsh discipline of the children. Mother fears father who occasionally beats her severely when drunk.

Nevertheless, she usually tends to dominate the home.

The family lives in a crowded apartment in a poor residential neighborhood and is partially dependent on public assistance for support* Robert suffered from malnutrition as a child and, though he is now large for his age, he is easily fatigued. He usually gets along well with his two younger brothers, although he is apt to tease and torment them.

He is his

father’s favorite, while mother prefers the younger boys, Robert has always been restless, likes to be on the go.

From

an early age he was independent at home, going his own way and staying out late at night. when frustrated.

He quickly becomes irritable

Around other children, he tends to be a

follower and is easily influenced by any playmates. Robert has an I.Q. of 104 and, until one year ago, had consistently done average work in school.

He never liked

school, and as a child truanted occasionally.

His adjustment

32 difficulties began upon his entering junior high school, when he fought with older Mexiean-American boys and truanted regularly. Court contact.

Robert was brought to Court because

he permitted an older neighbor to perform a homosexual act on him about eight months before he was seen at the Clinic. He stated that this act of fellatio occurred only once. However, Court study of his case disclosed that for several months prior to the incident Robert had also been engaging In petty.burglary with other children as well as excessive truanting from school.

He had run away from home twice,

though no complaints were filed on these charges.

In exami­

nation and testing it was found that "Roberta personality structure is poorly organized with considerable disturbance In sexual identification.’1 Robert mentioned that he was worried about his father’s drinking.

Juvenile Hall Clinic

prognosticated ’’further paranoid aggressive delinquency” if intensive treatment were not undertaken.

Referral to the

Clinic as an out-patient was recommended. Clinic experience.

A three month interval elapsed

between the recommendation for treatment and the first inter­ view at the Clinic.

Patient cooperated superficially; his

only expressed anxiety concerned possible placement away from the home.

He indicated that his one homosexual experience

33 had been an impulsive act which he would not repeat.

Mother

was totally bewildered by patient's troubles, by his Court experience and by the present referral.

She became belliger-

ant when the family's role in patient's problem was discussed. Arrangements were made to administer a Rorschach test at the Clinic a few weeks after patient's first interview.

The

results showed "much insecurity, undifferentiated inner re­ sources, compulsivity, and little capacity for deep emotional relationships.”

Two weeks after testing, patient was caught

in the act of car theft with an older gang, and was returned to Juvenile Hall.

Mother, confused by this, failed to keep an

appointment scheduled to interpret test findings to her.

In

a telephone conference with patient's probation officer, institutional placement was recommended by the therapist in view of Robert's ’’extreme emotional deprivation” and the inability of an inadequate mother and an alcoholic father to provide proper supervision.

Termination of the case after a

two month contact was therefore agreed to by the Clinic. Patient's mental condition and social adjustment were un-' improved.

His diagnosis was ’’Primary Behavior Disorder-

Conduct Disturbance.”

34 CASE 7 - ROGER Identifying information.

Age:

16

School grade: Religion: Color: Family and personal history.

9

Christian Science

White

Father, though an alco­

holic for ten years until his death, managed to provide ade­ quately for the family through his work as a cameraman in the studios.

A cold, harassed woman of forty-one, mother has had 4 many financial problems, depending mainly on an ANC grant for support since father’s death when Roger was thirteen.

She had

six children, all close together in age, but lacking in affec­ tion for one another.

Roger, a middle child, was profoundly

impressed with the experience of a brother four years older who spent two years at Preston Industrial School for theft. Brother was placed there when Roger first got into trouble and later tried to dissuade Roger from delinquent activities, conveying a strong distaste for his experience at Preston. Slight and good-looking, Roger has always been an out­ going, impulsive boy, quick tempered and easily provoked. He bites his nails, walks in his sleep and has never stopped bed-wetting.

Despite his I.Q. of 86, his school record up to

the fifth grade was excellent. 4 Aid to Needy Children.

Dating from that time, he has

developed Into a ”smart-aleck and disrupter” in his classes. He is irregular in attendance and his work is barely passing. He enjoys all sports; for four years he has held a paper route regularly. Court contact.

At twelve Roger was picked up by the

police because of

"mischievous behavior at a golf course.”

He was not placed

on probation but, henceforth,

hebegan to

run away from home on an impulse every so often, staying away for a day or two.

Mother sent him to live with’paternal

grandmother, a stern, forbidding woman at whose home Roger improved.

On returning to his mother, however, he resumed

his practice of running away, and for this reason was brought before the Court in 1947. tution from which home.

The

Court placed him

he escaped a few months later

inan insti­ toreturn

There, he began stealing from department and drug

stores with some companions.

He was replaced in another

group setting, but refused to stay.

A complete study was

ordered on his return to Juvenile Hall*

He was so "argumen­

tative, non-conforming and defiant” during his detention there that on his sixteenth birthday his transfer to an adult facility was ordered.

The psychiatric study of Juvenile Hall

Clinic recommended placement in a State Hospital due to "EEGindications of cerebral disrhythmia,” his many "neurotic traits” and their diagnosis of "incipient paranoid schizphrenia

36 When overcrowding prevented Rogerfs admission, placement in paternal grandmother’s home was ordered, and out-patient treatment at the Clinic recommended.

Roger adjusted very

well to a full time job found for him in a grocery, although he was fired when he asked for time off to take the EEG. Clinic experience.

Roger and mother were both seen

at intake in the Clinic three months after referral was recommended.

Dating his trouble to the time of his father’s

death, Roger expressed his conviction that "everyone has it in for m e.”

He could not see that

he needed treatment.

Mother explained Roger’s difficulties in terms of bad com­ panions.

She did not seem resistive to the idea of treatment,

but appeared to be confused and unable to understand the meaning of his behavior.

Roger was given another appointment,

while mother was considered untreatable and no provision was made for her return.

Prior to the patient’s second appoint­

ment, the probation officer telephoned to report that the patient had committed a theft and was again in trouble.

The

second appointment was cancelled and patient was discharged with a recommendation for re-application for hospitalization. Both social adjustment and mental condition were unimproved at closing, and the diagnosis of ’’Primary Behavior DisorderConduct Disturbance” was made.

37 CASE 8 - DAN Identifying information.

Age:

16

School grade: Religion: Color: Family and personal history.

11

Protestant

White

Both parents were born

in the South, were raised on neighboring farms there, and after receiving some grade school education, worked for a time in the mills.

After marriage, they moved to Los Angeles

where father has had fairly regular employment at hard physical labor.

Short, ill-tempered and accustomed -to

excessive drinking, father is ’’self-willed and brutal” toward children.

Mother is somewhat more affectionate but

is limited in mental capacity.

Since 1942 when Dan was nine,

mother has held a full time factory position, leaving Dan to the care of one of his older sisters.

The family includes

five sisters older than Dan, all of whom are married. were always indulgent and motherly toward Dan.

They

Dan is most

attached to one sister who lives with family while her husband recuperates in a tuberculosis sanitarium.

Parents

resent D a n ’s preference for this sister and complain that the older girls have spoiled him.

Nothwithstanding the employment

of both parents, the family’s economic status is only marginal and their apartment is so crowded that Dan, sister and her

58 baby have shared a room for several years. Dan is a slight, good-looking, effeminate boy who has never been ill. school work.

His I.Q. of 82 is reflected in below average

He finds it "trying to remain seated for any

length of time” and commenced truanting at an early age. Until he was seven Dan had frequent temper tantrums and he was enuretic until the age of eight. nightmares between eight and nine.

He was subject to A nervous infant, Dan

has always bitten his nails and he began stammering at eleven.

The sight of his father drunk was invariably u p ­

setting to Dan; he would react by running to his mother or sisters for reassurance.

He has never played well with

other children, wanting to be boss, and preferring the company of his sisters in any case.

Until he was eight or

nine he frequently amused himself by dressing up in his sistersf clothes.

He enjoys roller skating and does have

some friends with whom he skates regularly.

At ten he

developed an interest in cooking, and it is the only school subject in which he takes pleasure.

For several years he has

held occasional odd jobs in the neighborhood to earn spending money.

Because of his "nervous and intractable behavior at

home and in school," Dan was treated for a few months at a school guidance clinic when he was ten. Court contact.

When he was fourteen Dan was brought

into Court on two charges, a school complaint about his

truancy and a charge of forgery made by the police,

Dan had

signed his parents 1 name to a $25 check to pay for roller skates.

Three years earlier a complaint against him on the

basis of petty theft had been dismissed.

In Juvenile Hall

Dan was unpopular because of his feminine mannerisms.

He

was placed in a sister’s home on probation due to the in­ adequacy of his own home.

He could not adjust there, however,

and ran away repeatedly, so several foster home placements were attempted with similar results.

Finally Dan was sent to

a forestry camp where he remained some seven or eight months. His record at the camp was poor.

After experiencing rejection

by the other boys as ”a queer,” he became aggressive and assaultive in ’’attempts to deny his feminine interests.”

His

involvement in considerable homosexual activity at the camp was deemed ”a sign of sexual immaturity” rather than a homo­ sexual trend.

After discharge from forestry camp, Dan was

returned to his home and a recommendation was made for him to undergo intensive psychotherapy at the Clinic, "since no other treatment had helped.” Clinic experience.

Dan and his mother were seen

immediately after referral to the Clinic,

Dan felt that he

was getting along well enough and saw no need for treatment. In m ot h e r ’s opinion, since run-aways ended, Dan no longer had any problems.

She was unwilling to take time off from work

40 to come in herself, but agreed to insure D a n ’s presence if it were required,

A staff meeting considered D a n ’s case, and

after discussion concluded that he was a nfeeble-minded delinquent homosexual," whose present adjustment was fairly adequate.

Mother was dismissed, but plans were made to see

Dan on a friendly, guidance basis every two weeks to supple­ ment the inadequate supervision he received at home,

Dan

came late to his second appointment, held himself aloof and unbending during the interview, and failed altogether to observe his third appointment,

No effort was made to bring

him in and he was discharged with a diagnosis of “Primary Behavior Disorder-Unspecified (Defective Delinquent),”

No

improvement had taken place in his social adjustment or mental condition at closing, CASE 9 - BARBARA Identifying information.

Age*

17

School grader Religion: Color: Family and personal history.

None

Church of Christ

White

The parents, Italian-born

workers, are illiterate and do not speak English.

Until 1945

the family lived in Michigan where the father earned low wages as a common laborer.

He suffered a serious injury as a result

41 of a work accident in 1948, and has been totally unemployed since then.

The family subsists on workmen's compensation

and state aid.

Mother has always been afflicted with poor

health, suffering from diabetes and an extreme arthritis that required many operations.

The family is very religious

and conforms rigidly to the demands of their church for ascetic behavior. Born fourteen years after the brother nearest her in age, Barbara is the youngest of four siblings.

All of the

other children are married and away from the home yet remain closely tied to the parents and treat them with deference and respect.

Barbara is the only American-born child.

The

family personality is characterized by their ’’lack of humor, sober propriety and fanatic rellgiouslty•”

Dancing, movies,

smoking, etc. are condemned as sinful. A short, stocky, dull, and unattractive girl, Barbara is anemic and has-had many minor illnesses.

Her Intelligence

is better than average, and during her high school attendance of two years, she maintained an excellent record.

She never

participated in any social activities at school or elsewhere. Barbara was always a serious, brooding person.

Limited by

family restrictions on her freedom, she led a solitary exis­ tence until she left school to go to work. Barbara worked for one year as a hospital aide in spite of parents 1 disapproval, and there met a boyfriend, twice her

42 age, with whom she began an affair.

She was discharged from

her job because hospital policy did not permit employees to engage in outside social relationships. that father had his accident.

It was at this time

Disturbed by the accident,

Barbarafs depression was lessened on obtaining new employment and making plans to marry her boyfriend.

One week before the

marriage was scheduled to take place, the boyfriend called it off on the basis of their religious differences.

Patient

became acutely depressed and was given a leave of absence from work.

She moped about home for several weeks and

finally, in two hysterical episodes, attempted suicide. Court contact.

Barbara’s suicidal attempts brought

her to the attention of the Court, and intensive study of her situation was ordered.

Juvenile Hall Clinic found her to be

a "severe psychoneurotic, hysterical type."

They recommended

a change in residence and planned to maintain close contact until treatment at the Clinic could begin, because of her critical mental condition. Clinic experience.

Both Juvenile Hall and the Clinic

concurred that no changes could be expected in the attitudes of either parent.

Therefore, Barbara was seen alone for

treatment one month after the referral.

She was pathetically

grateful for the opportunity for treatment,

regarding it as

her only chance to gain strength for continued living.

43 Though Clinic psychiatric appraisal found some evidences of incipient schizophrenia, It was planned only to help Barbara with her confusion about the events of the past year, and to try to alleviate her feelings of guilt and depression through regular weekly interviews*

Throughout a four month contact,

patient was seen eight times, keeping all appointments punctually*

She was given help in securing a new job in a

sanitarium by referral, with Probation Department approval, to another division of the Department of Mental Hygiene. After her eighth interview, Barbara telephoned several times, explaining her difficulty in finding time to come to the Clinic, indicating her desire to end the relationship. Barbara’s whole appearance had altered; she looked brighter and more appealing, and was active in a number of social functions that, with her new work, afforded her satis­ faction.

Though many deep, underlying conflicts had not been

resolved, she was able to handle herself situationally and the case was closed with a diagnosis of "Mixed Psychoneurosis." Treatment had effected an improvement in mental condition and social adjustment.

Therapist felt that patient had made

tremendous progress In achieving a good superficial adjustment and in gaining some insight into her feelings.

44 CASE 10 - RALPH Identifying information.

Age:

17

School gradeI

10

•*

Religion: Colors: Family and personal history. Angeles from Oklahoma in 1942.

Protestant

White

Family migrated to Los

Both parents had come from

large, poor farm families and had lived as sharecroppers. Self-employed in the building trades since his arrival in Los Angeles, father is an alcoholic, quick-tempered and violent.

He has never earned an adequate yearly income,

although his wages during periods of employment are high. Ralph was the last of four siblings; all of the others are married and live in Oklahoma. than the previous child.

He is twelve years younger

Born during the depression, Ralph

was unwanted by either parent.

Father has overtly expressed

his resentment and rejection of Ralph, ignoring him completely. Mother makes an effort to compensate for father but is overprotective.

The relationship between parents is poor, as

father runs around with other women and is physically abusive toward mother when drunk. Ralph, a tall, slightly built boy, is effeminate in appearance.

Born with twisted feet, he was enabled to walk

as a result of two years of massage, but his gait is like

that of a spastic. tible to colds. tied to her.

All his life he has been frail and suscep­

Ralph was babied by mother and is now closely

He has few friends, is nervous and restless.

He has only borderline intellectual capacity with a reported I.Q. of 76.

Though the school classes him as an

emotional

and moral weakling,tf his record there has generally been satisfactory.

He enjoyed helping on the farm, his only work

experience• Court contact.

Ralph first became known to the Court

when he was charged with burglary at the age of fourteen.

In

the next two years he appeared in Court twice for similar delinquencies.

At fifteen, when his adjustment did not seem

to improve thrpugh probation at home, he was placed in a forestry camp.

There the boys ganged up on him and forced

him to engage In homosexual relationships with them.

As a

result his sojourn at the camp lasted only one week.

His

experience had a depressing effect and he requested permission to return to Oklahoma and work on brother’s farm.

The request

was granted but financial conditions necessitated his return after a few months. for help because,

Ralph contacted his probation officer

three months later, he found himself in­

volved in homosexual activities which he could not control. A re-study of his case was conducted and testing revealed a ’’deep-seated emotional disturbance,” with ’’characteristics of

46 schizophrenia.”

In accordance with his voluntary appeal for

help, Court recommended intensive psychotherapy on an out­ patient basis* Clinic experience.

Three months elapsed between date

of referral and beginning of treatment.

Ralph no longer

spoke of needing help with his homosexual impulses, which he believed were under control. were mainly vocational.

He felt that his difficulties

Mother, seen by a separate therapist,

similarly thought that patient’s only problem was his need for a job.

Mother and patient were interviewed twice during

a two month contact.

In the opinion of the Clinic, neither

could profit'from further visits.

Institutionalization was

recommended to the Probation Department as an essential step before therapy could be effective.

Patient was discharged

with a diagnosis of ’’Primary Behavior Disorder-Conduct Disturbance;” his mental condition and social adjustment were unimproved. CASE 11 - TOM Identifying information.

Age:

17

School grade: Religion: Color: Family and personal history.

None

Protestant

White

When Tom was ten, family

moved to Los Angeles from previous home in Texas.

Father was

47 youngest of ten siblings in a poor farm family.

He is an

easy-going, placid, compliant person who enjoys social pastimes but foregoes these at mother!s insistence.

Careworn

and serious, he works hard, if unsteadily, at his trade as a carpenter and provides his family with a marginal living. Mother tends to domineer, is opinionated, nervous and irritable. f,She prefers her home to other social outlets,11 Following a serious operation two years after family migrated to the West Coast, she became a semi-invalid. Tom is one of eight children.

Four older sisters are

married and away from home, and two younger sisters attend grade school.

Tom and a brother ten months older than he

were thought of as twins by the family.

They were always able

to get along well together. Although tall and underweight, Tom nonetheless is healthy, strong and energetic.

His intellectual capacity is

considered to be on the dull normal level and he has never liked school. however.

His record and behavior there were satisfactory,

After failing to pass at fifteen, Tom left school

and worked steadily on a farm during the summer and with his father in the winter.

He enjoys working.

Considered an

average child by his parents, Tom has consistently had friends, enjoyed sports, movies and other social activities, as well as helping in the house with the care of his younger sisters.

His disposition is cheerful and unruffled; he is

48 seldom angered and seems ’’satisfied regardless of his situ­ ation.”

In groups Tom seeks the approval of others, is

easily influenced, and does not express his own opinions. Court contact.

Tom came to Court as a result of a

series of burglaries committed in the company of a friend when he was sixteen.

Shortly before he became involved, his

brother left home for the service.

Father then suffered a

serious accident and was denied compensation, necessitating temporary dependency for the family.

Tom was laid off from

his job at this time, and he stole to obtain spending money. The Court did not feel that the but was

delinquent acts were serious,

concerned by his ’’bland and distant manner,’1and his

’’facile acceptance of punishment.”

Testing was ordered and

it uncovered a ’’marked infantilism, confusion as to sexual role,” and a ’’dangerously passive attitude.”

Tom was placed

on probation and referred to the Clinic for treatment. Clinic experience. once at

Tom and his father were both seen

the Clinic three months after referral.

new joband was working regularly at the time.

Tom had a Both he and

father, who was seen separately, had no doubts that his adjustment was satisfactory.

Father demonstrated an accep­

tance of T o m ’s limitations and a grasp of his problems.

Since

neither wanted to lose time from work for further interviews, and since it was felt that T o m ’s adjustment was satisfactory,

49 the case was closed with a diagnosis of "Primary Behavior Disorder-Conduct Disturbance."

A staff discussion of the

case concluded that patient might be a "simple schizophrenic" with an inadequate mental endowment, but that treatment in the Clinic could not provide help in this respect.

Social

adjustment and mental condition were both thought to be im­ proved at closing. CASE 12 - DAVID Identifying information.

Age:-

16

School grade: Religion: Color: Family and personal history.

10

Protestant

White

This Mexican-American

family presents a confused social background with intricate interrelationships.

David was four at the time of parents ’

separation, blamed by father on mother's interest in another man, and by mother on father’s alcoholism.

Shortly after

separation, father entered into a common law relationship with another woman.

Though he has several children by this

woman, father has maintained an interest in mother and their four children, of whom David is the youngest, and has con­ tributed to their support regularly.

Mother established a

common law relationship with a man described as an irrespon­ sible drunkard and gambler for nine years, and gave birth to

50 three more children.

For the past two years she has been

living with another man, steady, sober and conscientious, and has a new infant. receives state aid.

This man is unemployed and the family The many half-siblings of these relation'

ships all apparently get along well together.

Mother seems

ineffectual in her ability to supervise, however, and the children all look after one another. David is a bright boy, slim, dark, prepossessing in appearance.

He is healthy, artistically talented, and has a

superior school record.

When he was fourteen he began doing

odd jobs around the neighborhood to earn clothing money, and in the summertime he accompanies the family to farm areas to work as a picker.

He has some friends in the community, but

he is more often quiet and withdrawn, with occasional moody spells.

From an early age his interest in religion has been

fanatical; he attends church daily, listening intently to the fundamentalist preaching of the minister. Court contact.

David was brought into Court four

months before referral when he was discovered in a hotel in the company of an elderly man with whom he had been carrying on a homosexual relationship for a week.

Examination in

Juvenile Hall Clinic disclosed that David had been seduced by mother's first common law husband when David was six, and that he had engaged in homosexual activities since that time.

51 Though he did attend church regularly, it was found that he had frequently masked his homosexual practices by claiming to have been in church.

He expressed considerable guilt at

the divergency between his religious beliefs and his sexual acts, but declared that he could not control himself.

Court

felt that David needed intensive psychotherapy due to his fllong history of sexual deviancy,” and referred him to the Clinic.

Because of illegal relationship of mother and present

common law husband, David was not permitted to live at home but was placed with a married sister. Clinic experience. was seen at Clinic.

Two months after referral, David

Since he was no longer at his m o t h e r s

home, she was not called in.

Though David was apparently

very much interested in psychotherapy at the time of referral, when seen at the Clinic he felt that he had achieved a measure of control through will power and was certain he could sustain it with the help of the church. further visits were necessary.

He did not consider that He came in three times during

the one month contact, on each occasion expressing his lack of interest in continuing.

The psychiatric appraisal con­

cluded that there probably*was "an underlying schizophrenia” and that direct interview therapy could be of no assistance unless patient wanted it.

The case was closed after a

telephone consultation with probation officer, in which

therapist and officer both agreed that objective, environ­ mental influences on patient, the church, his sister and officer himself, would all be likely to serve as a stronger deterrent to further homosexuality than treatment at the Clinic,

Diagnosis at closing was ’’Psychopathic Personality

with Pathological Sexuality, ” and social adjustment and mental condition were both considered improved, CASE 13 - MANUEL Identifying information.

Age:

16

School grade: Religion: Color: Family and personal history.

9

Catholic

White

Mother died at Manuel’s

birth, and father immediately remarried.

He is an immigrant

from Mexico, semi-literate, hard working and rigid in his attitudes and in ambitions for his children.

He demands that

his authority be respected, is deficient in warmth or under­ standing.

He has always had steady employment in the building

trades and despite low wages has provided adequately for his family’s material wants.

Stepmother is a lenient, affectionate

person, ignorant but sympathetic.

She has acted as a buffer

between children and father, who is a stern disciplinarian. Ma nue l’s three older sisters, now married and out of the home,

53 were all known to the Court during their adolescence for habitual running away. Short, slender, and young-looking, Manuel has a serious hearing defect.

He has had two illnesses which the

family,assumed were heart attacks, but which were medically diagnosed as anxiety attacks, an interpretation that was never accepted by the family, never done well in school.

Manuel's I.Q, is 83 and he has

His poor record there is thought

to be due as much to language handicap and hearing difficulty as to deficient capacity.

Though he likes school, he began

truanting at the age of twelve, in dread of children from another neighborhood who would frequently beat him,

Vtfithout

many friends, he was always "solemn, withdrawn and shy,” preferring to be alone rather than with a group. swimming are his favorite pastimes.

Movies and

He has enjoyed working

summers for his father, performing his tasks well. Court contact,

At fourteen Manuel appeared briefly

before the Court charged with burglary and with '’threatening other boys at school with a knife,” proven and he was released.

Neither charge was

In the following two years, he

began running away from home for days and weeks at a time. After five escapes, he was again brought before the Court, Psychiatric testing and examination indicated that Manuel was subject to many obsessive fears and frequent anxiety attacks

54 which he made an effort to conceal at home*

His behavior

during the examination was excessively ingratiating and sub­ missive*

Treatment at the Clinic was recommended to correct

"severe personality maladjustment, and possible incipient schizophrenia*11 Clinic experience *

Two months after the referral,

Manuel and father were seen at intake in the Clinic*

Manuel’s

attitude was obsequious, though he saw no reason for the referral and came only because he felt compelled to do so* Father seemed interested in helping the patient, but his rigid ideas prevented him from seeing what the b o y ’s needs were or what family’s role in the problem might be.

The conclusion

of Clinic therapist was that ’’neither father nor son are amenable to treatment.”

A further appointment was scheduled

with father to recommend environmental manipulation, change of schools and reduced pressure at home.

Father did not

observe the appointment, probation officer was notified, and the case was closed with a diagnosis of ’’Frimary Behavior Disorder-Conduct Disturbance.”

No improvement had taken

place in mental condition and social adjustment.

CHAPTER III ANALYSIS OF FINDINGS Two central questions have been raised in this study of thirteen adolescent offenders referred by the Probation Department to the Clinic for treatment in 1949, questions are;

These

what are the social and psychiatric character­

istics in each case and what are the factors in the process of their referral to, and use of the Clinic?

To answer them

adequately, the thirteen cases presented in narrative form in the previous chapter will be examined and analyzed in detail to select the common factors in the items of interest indi­ cated in the Introduction, SOCIAL AND PSYCHIATRIC CHARACTERISTICS Personal data.

The age range of the adolescents

Included in this study, b y 'definition, is from twelve to seventeen years.

Both sexes are included but examination

reveals that the majority are older adolescent boys.

Only

three girls, one fourteen, and two seventeen, were found who belonged In this group.

Among the ten boys, sixteen was the

most common age, four of them being In this group'.

Of the

remaining six, two were twelve, two fifteen, and two seventeen. Dividing the age range into equal halves,

twelve to fourteen

and fifteen to seventeen, it can easily be seen that only

three fit in the first category, the rest in the older group. All of the children are white in color except for one Negro youth.

Religious preference is predominantly Protestant.

There is one Jew and one Catholic; two minor Christian sects are also represented. Eleven of the thirteen attended school on a full-time basis at the time of referral. left school permanently.

Two seventeen-year-olds had

The school grade placement varies

from the sixth grade achievement of one of the twelve-yearolds, to the twelfth grade position of the seventeen-year-old girl.

Most of the children are in either the ninth or tenth

grades, four in the former, and three in the latter.

One

child is in the eleventh grade, and one is in the eighth. The range of school achievement as compared with age level can best be understood by noting the intellectual capacity of the children.

An I.Q. rating is given in

Probation Department records for seven of the delinquents; for the rest, estimates based on test results are recorded. Seven are in the average or bright-average range, four in the dull-normal group, and one in the border-line area.

One of

the girls has a superior rating. Nine of the reports mention some work experience on the child*s part, ranging from newspaper routes to full-time jobs.

In four of the cases there is no mention of any

employment outside the home.

57 Social backgrounds. native-born Americans.

All thirteen adolescents are

Eight were born in'Los Angeles,

three

lived their early years in the South, two in the Mid-West. All had been living in Los Angeles at least four years at the time of referral.

Both parents of eight of the delinquents

were also native-born. known.

The background of two families is not

Three were foreign-born.

The existence of cultural

conflicts, either within the home or between family standards and those of the community is explicitly indicated in seven cases; four are from Southern "poor white" families, two are of Mexican-American descent, and one is Italian-American. Some minority tension is, of course, implicit in the case of the one Negro family. The economic position of the thirteen families is in all cases either marginal or dependent.

None of them has

ever achieved a comfortable financial status; in two cases severe destitution in earlier years is indicated.

At the

time of referral seven of the families were dependent in whole or in part on others for financial support. Of the thirteen families, only in six are both parents living together, with their children.

Of the remaining seven,

three are situations where divorce or separation has broken the home.

In two others, the child lives with one parent and

a step-parent.

One of the delinquents was an adopted child,

having been placed by a still-living mother.

In the last

58 case the parents lived together, but the child was placed in foster homes and institutions from an early age, living together with parents for only a short time. Little is indicated in the records about the family affectional relationships.

In five families, it is stated

that one parent is dominant, the other passive. between parents is mentioned in four records.

Quarreling Physical abuse

of mother by father occurs in three of the homes.

The parent-

child relationships are also not explicitly mentioned in most of the histories.

However, six parents are cited for their

harsh, domineering attitudes; two are considered to be overtly rejecting of their children. Three delinquents are only children; the rest come from sibships ranging in number from two to eight.

In general it

might be said that the delinquents came from large families since eight had at least three siblings.

It is Interesting

to note that while the relations between siblings were not often recorded,

there are four cases in which affectionate,

cooperative feelings predominated and only one in which hostile rivalry was noted. Among the many social problems of the families,

the

most prominent was alcoholism, which occurred in six families. Severe health problems,

chronic illness or Incapacitating

injuries occur in five homes.

Irregular employment of father

Is also mentioned in five histories.

Other social handicaps

59 which are observed are inadequate housing in four families, employment of mother in three, and inadequate mental capacity of one or both parents in two.

It is surprising that there

is no mention of crime or delinquency by any parent, with the exception of one situation in which father was labeled a "feeble-minded psychopath.11

Siblings of two of the delin­

quents were found to have been known to the Court for anti­ social actions. Psychiatric symptoms.

The indications of psychiatric

problems noted in the thirteen records varied considerably, ranging from a few words to several repetitive pages.

Some

social histories and referral summaries included statements from the parents, the family.

the child, and other agencies working with

A few contained only the probation officer !s

report to the Court in dry, legal terminology.

For these

reasons the summarizing of emotional difficulties presented by these children was rendered difficult.

In the narratives

of Chapter II it was necessary to eliminate some redundancy, while retaining all significant items. To analyze adequately the many indications of malad­ justment, some classification was necessary.

For this purpose

the writer used the list of ,fsymptoms at referral" compiled by Marguerite McDonald

i

in her examination of sixty-four

1 Marguerite McDonald, "Psychiatric Services for Children at the Los Angeles State Mental Hygiene Clinic," (unpublished Master!s thesis, The University of Southern California, Los Angeles, 1949), pp. 42-43.

60 children’s cases seen at the Clinic in the fall of 1948.

Of

the thirty-three symptoms she isolated in her study, four do not appear in any of these cases.

They are as follows;

’’soiling,’1 ’’masturbation,” ”thumb - suc k ing, ” and ’’reading disability.”

Their non-appearance in this group is probably

due to the fact that Miss McDonald’s unit included children under twelve. The symptoms listed frequently coincide with the delinquent behavior which brought the child into Court. Though they are included here for discussion, the delinquent acts will be isolated for separate examination in the next section.

It is also necessary to note that Miss McDonald’s

list was compiled on the basis of symptoms mentioned at in­ take or first interview.

In analyzing these cases, any

reference to the existence of a symptom, whether in the past or present life of a delinquent, has been noted.

The symptoms

observed In psychiatric examination at Juvenile Hall Clinic and the emotional disturbances revealed through testing are not included, but will be separately analyzed. The most common symptom was ’’stealing,” being a factor in seven cases.

’’Disobedience, rebelliousness and non­

cooperation” and ’’running away” were 't h e .two next in frequency, occurring six times each.

’’Sexual difficulty” was remarked

In five cases, as were "nervousness” and ’’withdrawn, timid.” Five boys were considered ’’retarded,” the same five with

61 I.Q.!s below the average range*

These are the seven most

re gular i t ems * ’’Belligerent behavior,” ’’truancy,” and ’’fears, obsessions, phobias” each are present in four of the case histories*

Three of the children are reported as having

”poor relationships with children; ” three als.o have an ’’inability to conform to school routine.”

The neurotic

traits of ’’nail-biting” and ’’enuresis” are both symptoms of three delinquents.

’’Provocative attention-getting behavior”

and ’’excessive day-dreaming, morbid fantasy” both occur twice. Two of the offenders have ’’physical symptoms.” following p e

mentioned, in one case:

Each of the

’’lying,” ’’fire-setting,”

’’sibling rivalry,” ’’destructive behavior,” ’’sensitiveness,” ’’poor relationships with adults,” ’’suicide attempts,” ’’ideas of persecution, self-pity, inferiority,” ’’lack of sustained interest, poor attention span,” ’’sleep-walking, ” ’’stammering” and ’’not performing at capacity.”

Two symptoms of emotional

disorder not included on Miss McDonald’s list were mentioned. These are spells of amnesia and anxiety attacks, each noted once. Analyzing the presence of psychiatric problems in a different way, to show how many of the above-mentioned traits each delinquent is credited with, seems to have, some value. D a n ’s case is most conspicuous with sixteen items. is next with nine items.

Manue l ’s

Elizabeth and Roger both have eight,

and Samuel, seven.

Six symptoms were indicated in the

records of Barbara and Ralph, while only five were found in the case histories of Joan and Robert,

David and Joseph were

found to have three and four problems respectively.

Two

symptoms only were noted in regard to Richard and Tom. Many indications of neurotic instability or mental disturbance are recorded only in the results of psychological testing done at Juvenile Hall Clinic.

In some instances

these test indications support the evidence from social ,histories and from clinical observation.

In other situations

the testing seems to reveal problems which had previously been unknown.

Among the many test findings, those which seem

significant are as follows:

schizoid traits, in four cases;

paranoid ideas, in one; disturbed sexual identification, in four; neurotic character disturbance, in three; and inner anxiety and insecurity, in five. Delinquency records.

Of the thirteen delinquents,

none had a long Court record, nor did any commit one of the more serious crimes against person or property such as murder or armed robbery.

The charges against the boys and

girls ranged from burglary to incorrigibility and disobedience. Pour were charged with running away.

Three others were

accused of burglary and shop-lifting, but in no case was the value of the stolen property great, nor were any guns or

63 other weapons used.

Two of the boys were charged initially

with homosexuality,

though one was later discovered to have

been engaging in undetected burglary prior to his arrest. Two were brought before the Court as habitual truants, though one of the truants was simultaneously charged with forgery. Incorrigibility and disobedience were two other complaints filed against these children; there was one fire-setting allegation. In Joseph’s case, the charges are not explicitly stated, except for his involvement as an apparent bystander in a fight.

That this is the case of the only Negro among

the thirteen, indicates a factor which may have been signifi­ cant in his being adjudicated a delinquent without the formu­ lation of any direct charge against him.

Barbara became

involved with the Court because of a suicidal attempt.

Laymen

might hesitate to accept the delinquent label for this girl. However, she clearly can be so considered for our purposes here.

The number of charges ahove total more than thirteen

since several were held on more than one complaint. The only delinquent in the group with a long record was plaeed on probation four years before referral.

Charged

at that time with incorrigibility and running away, he later became involved in burglary, for which he was twice returned to the Court.

Five of the offenders had their first experience

in Court two years prior to their referral.

One boy, who had

64 been a ward of the Court as a dependent child prior to that time, was believed to have committed his offenses in an effort to obtain placement away from home.

His delinquencies

were not repeated; his referral to the Clinic was based on other factors in his adjustment*

Of the other four, three

continued the delinquent acts which had originally brought them trouble; one girl did not repeat her offense, but engaged in many other kinds of antisocial behavior* Three children first came before the Court one year before their referral,

Hone of them continued in the wayward

acts that had gotten them into difficulty, but two of them developed other patterns of antisocial behavior. The four remaining offenders all were referred to the Clinic within one year of their Court hearings*

The girl

who attempted suicide was referred within a month.

Referred

nine months after having been heard on a truancy charge, one lad was given a second hearing on the same count, four months before referral.

Two young men, both guilty of homosexual

offenses, were referred after eight and four months respec­ tively.

Both had discontinued their previous sexual conduct

upon apprehension by the police. probation at the time of referral.

Each of the children was on As has been shown,

probation was used as a treatment method for varying lengths of time in several situations prior to the referral.

In four

cases other treatment methods, such as selective placement,

65 were also used by the Court prior to, and in one case con­ current with, the referral. To summarize, the length of time during which these thirteen offenders had been known to the Court before referral varied from one month to four years..

One had a

four year history of contact and five had two year records. Three were known for only one year, and four for less than that time.

Five repeated the offenses with which they were

originally charged following their first Court contact; four discontinued the practices which had brought them before the Court, but engaged in other forms of antisocial behavior. The behavior of the remaining four was considered satisfactory after their initial Court experience. FACTORS IN REFERRAL PROCESS AND USE OF CLINIC Referral.

Referral to the Clinic was made either at

the recommendation of the Juvenile Hall Clinic or on the basis of Probation Department reports in all cases.

In

neither circumstance could It be determined how much delay, if any, there was between the recommendation and the receipt of the referral summary at the Clinic.

However, the time

lapse between such receipt and the initiation of treatment, varied from four months in one case,- to one month in another. Seven waited three months, and four were given appointments in two months.

Five of the boys improved in conduct in the

66 interim between referral and treatment, but these changes were not related to the length of the waiting period. Only four delinquents went through the customary in­ take process at the Clinic; the remainder were seen directly by therapists at their first interview.

In seven cases both

mother and child were seen at least once; in three the offender only was seen.

Two minors participated with their

fathers; in one family, father, mother, and child all were seen.

In no case did family income warrant charging a fee. The reasons for referral by the Probation Department

in each case were related to the psychiatric symptoms and emotional problems which the delinquent presented.

In some

instances the evidence of disturbance was obvious from the nature of the offense.

In three cases the emotional malad­

justments Indicated by disturbed, though not always unlawful, actions were stated as the reasons for referral.

These situ­

ations were almost solely direct aeting out of conflicts. However, it should be noted that the severe neurotic con­ flicts underlying their conduct were recognized in two cases two years before referral for treatment.

No apparent

deterioration brought about the eventual referral, but rather the consistent failure of improvement to occur. The three boys charged with homosexuality were also apparently assumed to be in need of treatment because of the nature of the overt problem.

While two of them had been

67 known to the Court less than one year at the time of referral, one record was more than two years old.

This lad had been

introduced to the practice of homosexuality in a traumatic experience while institutionalized on Court order. The referrals of three others were made almost solely on the basis of their performance on projective tests.

They

had all been on probation for one or two years when, as a result of continued wayward actions, testing was ordered.

A

diagnosis of incipient schizophrenia and other inner conflicts was the basis for each of these referrals. Of the remaining four, the many neurotic traits in the history and present behavior of two, whose antisocial activi- . ties were continuing despite two to four years of probation, resulted in their referrals.

The severe depression suffered

by the suicidal girl, known only a short time at Court, and the excessive fearfulness of one young truant, known less

.

than one year, induced the last two referrals. None of the offenders with the exception of one girl recognized any need for treatment in the Clinic for their own problems.

The four whose behavior had progressed remarkably

between referral and therapy interviews,

simply expressed

their feeling of having no problems and, therefore, no need for help.

The parents who accompanied the minors in three of

these cases agreed with their children in denying problems. One of them who was seen alone, had been referred on the basis

68 of his long-standing homosexuality which he felt he had "conquered.r!

The others, referred for homosexuality, neuroti-

cism, and schizoid traits, had all been previously engaged in either theft or forgery, but had ended such behavior. Of the three children referred because of emotional maladjustment reflected directly in their disturbed relation­ ships with others, one boy, seen alone, was resentful and sullen, and came because he understood he had to.

One girl,

tense and frightened during her interview, also came because of the probation officer’s exercise of authority.

Her mother

welcomed the chance for Clinic appointments, but only as an opportunity to talk of her feeling of martyrdom.

In the

third situation both the delinquent and her mother felt Clinic therapy was necessary for the other, and each came only to Insure the other’s presence. The two habitual run-aways referred because of neuroticism and schizoid personality reacted to their referrals differently.

One offender and his mother were hostile, pro­

jecting all his difficulties onto others; the other behaved In an obsequious manner, while his father appeared to be too rigid to understand what was involved. Three of the delinquents, though all basically rejecting of service, reacted toward the referral in a manner that seemed related to their parents’ attitudes.

When the parents were

violently indignant the boy himself was cooly indifferent.

One mother, upset and humiliated, wanted to cooperate, and her s o n Ts expression of concern about his part in his problems reflected her anxiety.

Yet his feelings were mixed

since he also thought his punishment unjust and his referral unnecessary*

Another mother, of limited capabilities, was

bewildered by the whole affair and the child also seemed not to understand, expressing his concern only about possible placement• Use of Clinic.

Only four of these delinquents and .

their families came for more than two psychotherapeutic interviews*

One girl whose contact with the Clinic lasted

ten and one half months was seen ten times during that period, her mother, five times. was seen eight times.

In a four month period another girl

The third girl had four interviews,

her mother three during a three month contact*

One boy had

three weekly appointments, after which he stopped altogether. Of the nine other delinquents, four came two times and five came for only one interview.

Only one of their parents came

twice, five others came one time only. Environmental therapy, one of the services of the Clinic, was provided for seven of the delinquents. patient was helped directly by social manipulation.

Only one However,

in six of the other cases direct recommendations were made to the Probation Department.

Three telephone consultations

70 between therapist and probation officers about the patients f problems are recorded*

In nine cases the Probation Department

was notified of the outcome of the contact and the recom­ mendations, if any, by letter*

There is no mention of contact

after referral was completed in three case records. Terminations were initiated by the child or his parents in nine cases*

Four endings were jointly arranged.

Though

all the others terminated without plan, the endings in four situations were thought by the therapist to be justified as probably not amenable to treatment* At the time of discharge five showed improvement; the rest were unimproved*

Ten were diagnosed at closing in the

category o f “Primary Behavior Disorder-Conduct Disturbance.” Two of the girls were considered ’’neurotic,11 one boy a ’’psychopathic personality.”

CHAPTER IV SUMMARY AND CONCLUSIONS Summary.

The child guidance clinic movement origin­

ated as a result of psychiatric interest in the causation, treatment, and prevention of delinquency.

The early clinics

functioned in close relationship with juvenile courts, pro­ viding service mostly for court-referred delinquents.

With

the shift in emphasis as the clinic idea expanded from diagnosis to treatment, there was a parallel change of intake focus.

More and more pre-delinquents and non-delinquents

with behavior disorders or neurotic conflicts began to be seen.

To meet the courts1 needs for psychiatric services,

specialized clinics evolved, but their function was primarily diagnostic• Clinics serving children are often used by juvenile courts as treatment resources today.

The percentage of court

cases to the total clinic intake in most cases, however, is small.

One factor, which may be a partial explanation for

this, is the idea that court delinquents have special problems which are different and more difficult to treat than other kinds of cases.

Another reason suggested is the attitude of

court delinquents toward receiving a helping service; they frequently do not see any need for treatment. This study is concerned with the problem of relationship

72 between court and clinic*

The analysis of the use which one

court makes of one clinic in reference particularly to the kinds of cases referred and the factors in the referral process is the problem which was studied. The Los Angeles State Mental Hygiene Clinic, a public psychiatric clinic organized in 1946 to serve both children and adults, analyzed.

is the agency whose records provided the material The Juvenile Division of the Probation Department,

serving as an agent of the Juvenile Court of Los Angeles County was the referral source whose use of the Clinic for a specified group of adolescent offenders was examined. The case records of thirteen delinquents referred during the year 1949 for treatment at the Clinic were analyzed and brief abstracts of each record were presented. As a group, the thirteen were found to be predominantly Protestant white males, in the older adolescent age range; most of them still attended school though they had some work experience.

The majority were of average intellectual

capacity, though estimates of intelligence varied from the borderline range to the superior. All of the group were native-born Americans; only a few had foreign-born parents.

None of their families

achieved more than a marginal financial status.

Broken

homes, large families, and disturbed family relationships were characteristic of the group.

At least one third

73 personally knew the effects of some of the nation's major economic and social ills:

i.e., alcoholism, chronic illness,

irregular employment, low wages, and inadequate housing. "Fearfulness," '’belligerency," and "sexual difficulty" were the categories of symptoms of emotional disorder most common in the group.

"Stealing," "disobedience," "truancy,"

and "running away" were the antisocial activities in which the majority engaged.

None of the children had long -delin­

quency records, nor had any committed a serious crime against person or property. Referral of these thirteen to the Clinic was based on indications of their need* for psychiatric help obtained in reports of probation officer's investigation, clinical observation, or the psychological testing at Juvenile Hall* Clinic.

There was no indication of preparation for the

referral in any record.

After waiting an average of two and

one half months after referral for appointments, most of the delinquents, and those parents who were also interviewed, expressed no interest in obtaining treatment for themselves. In some instances the attitude of parent and child toward treatment seemed to be related to the lapse of time between referral and treatment in which significant changes in behavior had occurred.

Other factors which seemed to be

'X

\

involved were the life-long existence of some of the neurotic^ character disturbances, the complementariness with a parent's

74 apparent emotional immaturity, and the unconscious nature of those problems and conflicts revealed only in testing. Most of the patients were seen at the Clinic one or two times, after which they terminated the contact.

In

addition to psychotherapeutic interviewing, recommendations for environmental manipulation were made by the Clinic in one half of the cases. were diagnosed,

At closing, the overwhelming majority

"Primary Behavior Disorder-Conduct Disturbance.11

One third were considered improved in social adjustment and mental condition at discharge. Conclusions.

The central problem in this study, the to

examination of the use of the Clinic by the Court as a treatment resource for adolescent offenders, has been dealt with by answering the questions posed earlier.

The con­

clusions which can be drawn from these findings will now be indicated. The treatment referrals of the Court to the Clinic were not made with respect to any one hind of offender, nor any one kind of problem.

The thirteen delinquents studied

are a heterogeneous grouping whose personal and social back­ grounds, while not necessarily typical of the delinquent group as a whole, included most of the social problems and personal maladjustments commonly associated with delinquency. Their unifying characteristic is the fact of their referral,

75 and their response to it.

Nearly all expressed the same

essential rejection of the service offered, and the same attitude of non-recognition of the problems for which help was thought necessary.

As a result, the treatment they

received at the Clinic tended to be of short duration and produced few beneficial changes.

Recommendations for environ­

mental therapy were made in a number of the cases but the intent of the Court to use' the Clinic for intensive treatment was clearly indicated by their stated reasons for referral. It can be seen that the Court uses the Clinic as a resource for the treatment of delinquents with a variety of psychological and emotional problems.

In a few instances it

was the acting out of these emotional problems which was the reason for the chil d’s being known to the Court.

More often,

however, the problems were expressed more indirectly in symptoms, or were revealed through testing. be seen in the sexual deviation.

Some could only

What is common to all these

delinquents is their failure to recognize their problems as problems for which they wanted help. The significance of this negative attitude toward the referral, apparently seems to be a reduction in the usefulness of the Clinic’s treatment services for court delinquents. Prom the point of view of the Clinic, it would be interesting to study the process in treatment interviews to determine whether or not ways of working can be developed to meet this.

76 It is possible that the failure to recognize these problems, or see a need for help with them, is inherent in the nature of the problems themselves. be answered here.

This is a question which cannot

The recommendations of Clinic therapists

for environmental, rather than clinical treatment, were apparently based, in part, on this assumption. It should be noted, however, that most of these delinquents were studied by the psychiatric clinic in Juvenile Hall prior to referral.

This clinic has a responsi­

bility to recommend the most suitable plan of treatment to the Court.

The dilemma facing a court which follows the

recommendation of one clinic, only to be given a contradictory recommendation by another clinic, is a serious consequence of failure to meet the challenge In relationship. This study, based on Clinic records, can only raise questions about the appropriateness of the Court referrals, and the manner in which these referrals are made.

However,

some of the findings suggest that examination of these two aspects in projects of broader scope and different focus would be rewarding.

The major problem identified has been

the negative attitude of the delinquents toward the referral and their need for help.

Without material from the Probation

Department, it is only possible to speculate on the effect of preparation or lack of preparation for the referral on this attitude.

It would be interesting to study this question,

77 which seems to have so much significance.

It would also be

valuable to consider whether delinquents, referred solely on the basis of emotional disturbance revealed through psycho­ logical testing, have different attitudes toward treatment. In a large series of oases, some significant observations might also be made on the effect of delay between commission of offense and referral for treatment. Child guidance clinics, originating in relationship with juvenile courts, but developing their skill in helping through other focuses, need to re-examine this relationship and clarify their services for offenders, if the court is to make meaningful use of their service and if they are to validly accept court cases for treatment.

BIBLIOGRAPHY

79 BIBLIOGRAPHY A.

BOOKS AND PAMPHLETS

Aichhorn, August, Wayward Youth, 1938. 236 pp.

New York: The Viking Press,

Allen, Frederick H . , Psychotherapy with Children. New York: W. W. Norton and Company, Inc., 1942. 311 pp. Brill, Jeanette and Enoch George Payne, The Adolescent Court and C^ime Prevention. New York: Pittman, 1938. 230 pp. Eissler, K. R . , editor, Searchlights on Delinquency. New York: International Universities Press, Inc., 1949. 456 pp. Fleming, C. M., Adolescence. New York: International Uni­ versities Press, Inc., 1949. 262 pp. Friedlander, Kate, The Psycho-Analytical Approach to Juvenile Delinquency. New York: International Universities Press, Inc., 1947. 296 pp. Hamilton, Gordon, Psychotherapy in Child Guidance. Columbia University Press, 1947. 340 pp.

New York:

Healy, William and Agusta F. Bronner, f,The Child Guidance Clinic: Birth and Growth of an Idea,” Orthopsychiatry 1925-1948. New York: American Orthopsychiatric Associ­ ation, Inc., 1948. Pp. 14-49. Karpman, Ben, "Milestones in the Advancement of Knowledge of Psychopathology of Delinquency and Crime,” Orthopsychiatry 1923-1948. New York: American Orthopsychiatric Associ­ ation, Inc., 1948. Pp. 100-189. Kaufman, S. Harvard, "The Psychiatrist and the Delinquent Child,” Redirecting the Delinquent, 1947 Yearbook. New York: National Probation and Parole Association, 1938. Pp. 138-59. Lippman, Hyman S., "Treatment of Juvenile Delinquents,” Proceedings of the National Conference of Social Work, 1945. New York: Columbia University Press, 1945. Pp. 314-23.

80 Neumeyer, Martin H . , Juvenile Delinquency in Modern Society. New York: D. Van Nostrand Company, Inc., 1949. 335 pp. Mental Health and Child Guldance Clinics. Report No. 10 of the National Conference on Prevention-and Control of Delinquency. Washington, D.C.: United States Government Printing Office, 1947. 14 pp. Plant, James Stuart, ’’The Psychiatric Clinic and the Juvenile Court,” National Probation Association Yearbook, 1929. New York: National Probation Association, Inc., 1930. Pp. 195-201. Stevenson,. George S. and Geddes Smith, Child Guidance Clinics, A Quarter Century of Development. New York: Commonwealth Fund, 1934. 186 pp. Witmer, Helen Leland, Psychiatric Clinics for Children. York: Commonwealth Fund, 1940. 437 pp. _______ , Social Work. 1942. 539 pp. B.

New

New York: Farrar and Rinehart, Inc.,

PERIODICAL ARTICLES

Adelson, Edward T., C^.rl Sugar, and S. Bernard Wortis, ”A Sociopsychiatric Study of Twenty-five Young Offenders,” American Journal of Psychiatry, 105:619-22, February, 1949. Allbright, S., and H. Gambrell, ’’Personality Traits as Criteria for the Psychiatric Treatment of Adolescents,” Smith College Studies in Social Work, 9:1-26, September, 1938. Bromberg, Walter, ”A Psychiatric Study of the Adolescent Offender,” American Journal of Psychiatry, 100:452-55, December, 1944. _______ , and Terry C. Rodgers, ’’Authority in the Treatment of Delinquents,” American Journal of Orthopsychiatry, 16:672-86, October, 1946. Coleman, Jules V., ’’The Child Guidance Clinic and the Community Mental Hygiene Program,” Mental Hygiene, 32:539-48, October, 1948.

Gitelson, Maxwell, "Character Synthesis: The Psychotherapeutic Problem of Adolescence,11 American Journal of Orthopsychi­ atry, 18:422-51, July, 1948. Healy, William and others, "Psychiatry and Juvenile Delinquency--Critieal Evaluations," American Journal of Orthopsychiatry, 19:317-41, April, 1949. Henry, George William and Alfred A. Gross, "Social Factors in Delinquency," Mental Hygiene, 24:59-78, January, 1940* Thom, Douglas Armour, "Sociological Changes Predisposing Toward Juvenile Delinquency,11 American Journal of Psychiatry, 100:52-55, July, 1944. C.

UNPUBLISHED MATERIAL

Faraday, Marjorie, "Referral by Authority as a Factor in Case Work with Adolescents." Unpublished Master’s thesis, The University of Southern California, Los Angeles, 1949. 96 pp. McDonald, Marguerite, "Psychiatric Services for Children at the Los Angeles State Mental Hygiene Clinic." Unpublished Master’s thesis, The University of Southern California, Los Angeles, 1949. 104 pp. Van Sickle, Forence Perrigo, "The Function of the Mental Hygiene Clinic at Juvenile Hall In Los Angeles, California. Unpublished Master’s thesis, The University of Southern California, Los Angeles, 1944. 84 pp.

APPENDIX

83 SCHEDULE USED IN ANALYSIS Case name IDENTIFYING INFORMATION 1.

Age

2.

Sex

3.

Color

4.

Nationality

5.

Religion

6.

School grade

7.

Present whereabouts

8.

Previous residences

9.

Appearance

FAMILY HISTORY 1.

Father

2.

Mother

3.

Other family in home

4.

Number of siblings

5.

Ordinal position

6*

Economic status

7.

Occupations of parents

8.

Housing

9.

Social agency activity with family

10*

Family relationships (social and affectional)

84 PERSONAL HISTORY 1.

Medical (physical and mental) history

2•

Educational history

3.

Occupational history

4.

Social adjustment-personality-sexual history

5•

History of maladjustment and previous treatment

COURT HISTORY 1.

Delinquency record (with dates)

2.

Gourt action

3.

Juvenile Hall Clinic examination

4.

Reason for referral

CLINIC HISTORY 1.

Time lapse between referral and treatment

2.

Intake interview and fee charged

3.

Patientfs attitude toward referral (need for treatment)

4•

Family's attitude toward referral (need for treatment)

5.

Psychiatric appraisal and treatment plan

6*

Duration of contact

7,

Number of interviews: other

8.

Services other than psychotherapeutic interviews

9.

Regularity and promptness in treatment

10.

Diagnosis

Patient, mother, father,

85 11.

Mental condition

12.

Social adjustment

13.

Reason for termination (how initiated)

14.

Contacts between Clinic of after treatment

15.

Therap i s t s impression of changes in symptom, attitude, or behavior in patient or family at discharge

and Court

u m v e r c * * or S ia u u w n C a lifo rn ia UJm * * *

during