Deborah Blythe Doroshow. Emotionally Disturbed

The decades surrounding World War Two were a “time of optimism” in child mental health, according to Deborah Blythe Doroshow, but it was, she thinks, only a brief interlude (p. 237). In Emotionally Disturbed: A History of Caring for America’s Troubled Children, Doroshow describes a generation of “pioneer” psychiatric professionals who constructed the emotionally disturbed child as a new figure populating the mental health landscape and created a unique space – the residential treatment center (RTC) – in which to treat these seriously troubled children “who couldn’t be managed anywhere else” (p.2 ). Doroshow argues that the development of category and space were co-dependent; each supported the existence of the other. Hers is a rosy picture of the work of the staff in these centers and the experiences of young people who found their way to the milieu therapy that defined the treatment strategy of an RTC. “Milieu therapy,” as Doroshow explains, was the controlled environment in which all aspects of residential care were considered therapy directed toward changing the child’s behavior. But as Doroshow cleverly shows, the optimism motivating this post-war generation of mental health professionals was short-lived. Both the emotionally disturbed identity and the residential treatment space were ill-suited to the cultural, political, and professional landscape that emerged in the 1970s and 1980s. Doroshow finds that the unraveling of emotional disturbance as a diagnostic category has left us today with a troubled group of children and their families but a mental health system that lacks a strategy for treating them. Part historian and part advocate, Doroshow convincingly advocates for a reexamination of the lessons to be learned from residential care as treatment for emotional disturbance that marked the time of optimism.

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