GROUP TREATMENT, WITH PARTICULAR REFERENCE TO

GROUP PROJECTION METHODS1

MAXWELL JONES, M. R. C. P. E., D. P. M., LONDON, ENGLAND

Since last reporting on group psycho- of him in furthering his own treatment.
therapy in 1942(1), we have greatly widened Part of the success of physical methods can
the scope of our methods. Further, we have be attributed to the fact that an organised
attempted to treat not only effort syndrome treatment r#{233}gimeis being carried out; and
(E. S.) patients but a group of 90 patients although the patient is passive, a definite
of whom about one-third are E. S. patients health goal is envisaged and during his treat-
and the remaining two-thirds mixed neu- ment he is working towards that goal. A
roses; mainly anxiety states and mild depres- similar programme, without a medicinal
sions. The patients are all in the British r#{233}gime, but in its place employing the pa-
armed forces, practically all army cases, and tient as a positive collaborator who partici-
represent the more chronic constitutionally pates in a definite programme of treatment
poorly endowed material, the ‘better’ neu- occupying many hours a week, and with a
roses going to the military neuroses centres. positive goal of recovery in view, is one of
Approximately o per cent of the cases re- the aims. Anyone working in a neuroses
turn to army service and the average dura- centre in war-time must have been struck by
tion of treatment in hospital is 6 weeks. the lack of insight into his neurosis of the
We have aimed at 2 separate goals: (i) average patient leaving hospital; such pa-
To develop specific teaching on the C. N. S. tients typically say they feel somewhat better
so that neurotic patients with somatic symp- for the rest and that they enjoyed the oc-
toms are enabled to evaluate their symptoms cupations or social activities, but seldom give
correctly and so avoid misinterpretation. any evidence of increased insight into their
(2) To give a general education in normal illness since being ‘treated,’ nor indeed do
and abnormal psychology with particular they seem to understand the general aims of
reference to the methods of handling every- psychiatric treatment. Surely such a state of
day problems so that normal standards of affairs cannot be reconciled with an adequate
living can be upheld and the general prin- treatment programme?
ciples of social psychiatry explained.
METHOD
In developing our methods we have had
as our primary aim the treatment of the The group of 8o to 90 patients in the
patients’ neuroses. It is hoped that by gain- wards meet for 6 hours a week-9 to I I a.m.
ing some degree of insight into the somatic on Monday, Wednesday and Friday. The
significance of symptoms and the more ob- activities may be discussed under three head-
vious psychological mechanisms involved in ings (i) Group talks-instruction on the
the production of mental ill-health, the in- structure and function of the central ner-
dividual not only feels that he is given a vous system with particular reference to the
positive role to play in his treatment, but somatic symptoms of anxiety. (2) Group
may be more competent to deal with future projection methods-dramatisation of actual
emotional problems. So far, short term case histories or common and important
in-patient treatment in neuroses centres in social problems. (3) General organization
England has frequently failed to achieve of nurses, patients, etc.
its maximal usefulness because the patient I. Group Talks.-One hour 3 times a week
is devoted to the study of the central nervous
has never really grasped what was demanded
system and its normal and abnormal func-
1 From Mill Hill Emergency Hospital, London, tioning. These talks have been given for the
England. A film of the hospital organization and past 2 years and we are satisfied that they
general plan of treatment was recently shown in
have a positive value. A course of 12 talks
America by Dr. W. S. Maclay, the medical super-
intendent. is given and as this takes i month and the
292
‘944] MAXWELL JONES 293

average length of stay in hospital is 6 weeks ately called by the patients. Each study
there are always some men in the group who indicates the main topic of one talk, e.g.,
have had the complete course. This makes it for talk 6 on nervous tension, ‘Nervy Ned’
possible to set the goal to be arrived at by is seen in the consulting room sitting uncom-
discussion, at the beginning of the meeting, fortably on the edge of his chair with all his
and to let the men work out the solution muscles tensed, anxious expression, staring
for themselves with a minimum of help. eyes, etc., and by contrast a composed con-
The subjects of the talks are the following: fident looking doctor, talking to him. The
i. The understanding of the voluntary lectures work from the normal to the abnor-
nervous system and its functions in main- mal (clockwise round the room), while the
taining external harmony, e.g., you find a ‘story of Nervy Ned’ of course goes in the
room too noisy so you get out. counter clockwise direction ending with him
2. The understanding of the internal milieu achieving internal and external harmony.
and the function of the involuntary nervous Captions below the pictures summarise the
system in maintaining harmony. talks and at the same time tell the story of
3. The two parts of the involuntary ner- ‘Nervy Ned.’ The main advantages derived
vous system and possible combinations, i.e., from these talks would appear to be:
the sympathetic acting as a whole and the I. The patient is given an idea of anatomy
para-sympathetic acting in part. and physiology sufficient to allow him to
4. Application of the previous two talks objectify his symptoms.
on external and internal harmony, e.g., it is 2. The discussion of symptoms (which
a hot day so what happens (a) in the think- he may or may not have) in an impersonal
ing part of your brain? and (b) in the auto- manner also tends to produce an objective
matic part? attitude towards his symptoms.
5. The understanding of fear (a) its 3. The conversation being on the patient’s
psychic and somatic aspects; (b) its teleo- favourite topic, i.e., Health, is of great inter-
logical value; (c) its ‘ordinariness.’ est to him.
6. “Nerves.” Nervous tension. Muscle 4. The situation is an informal one, and
tension.
the patients may be less tense than when be-
7. Relaxation. Anxious face. Awkward ing interviewed individually, and may there-
attitude. Restlessness in bed. Action poten-
fore be presumed to be more receptive.
tials and thinking.
5. The group acceptance of a point has a
8. Left chest pain and breathlessness.
strong suggestive value.
9. Circulation, cold blue hands, giddiness,
6. The patient’s self-respect is considered;
fainting, blanching, blushing, etc. Homeo-
to give up his organ neurosis would entail
stases and the efficient distribution of blood.
a loss of prestige in his own eyes and in those
io. Nervous dyspepsia.
of the outside world. This is countered if he
I i. Fatigue, nervous and muscular; f a-
can give a reasonable explanation of the
tigue of activity and of inactivity.
meaning of nervousness, and has a realisa-
12. Depression and insomnia.
tion of the enormous importance of this
The common room in which the talks are
factor in medicine.
held is important. It has been made into the
7. If he genuinely wants help he will be
most attractive room in the unit and com-
relieved to learn that no serious conse-
pletely redecorated and given bright cur-
quences need result from his symptoms.
tains, etc., by the patients and nurses them-
8. The opportunity for raising health prob-
selves. The walls are entirely covered by
15 paintings done by 2 nurses (both fully lems three times a week in open discussion
trained artists) and i patient. Three are leads to less health talk amongst the patients
2 X I yard anatomical studies illustrating themselves and, more important, leads to a
the voluntary and involuntary nervous sys- more critical and informed attitude by his
tems as though ramifying over a transparent audience in the ward.
glass man. The remaining 12 paintings tell 9. After a time the patients come to ap-
the story of ‘Nervy Ned’ as he is affection- preciate the ‘ordinariness’ of their symptoms.
 294 GROUP TREATMENT [Nov.

10. There is an enormous economy in these problem situations there is no easy

doctors’ time. solution and the ‘right’ course may demand
2. Group Projection Methods.-We have great personal sacrifice. A neurosis may have
experimented with this form of treatment been avoided by resolving the conflict but
for the past 6 months; 2 hours per week are frequently the patient had not realised that
set aside for this, the first hour being for the price to be paid for mental health was
the nurses production and the second for an obligation to carry a burden-which of
the patients. No stage, curtains or props course is a factor in the formation of his
are used. Some form of short sketch is pre- character.
sented, being either acted or broadcast from Lack of space prevents any description
one room to another with the aid of a micro- of the types of play written by the patients
phone. Each of the 8 wards takes it in turn which usually centred round marital diffi-
to write and produce a play and so far we culties, parent-child relationships and educa-
have had no defaulters. To date our ex- tion.
perience has been that dramatised case his- The nurses weekly play after passing
tories of ex-patients whose subsequent prog- through various experimental phases has
ress is known to have been satisfactory are settled down to 2 separate ‘serials’ which
the most likely to succeed as the men accept run concurrently. The meeting is always
without question the ‘rightness’ of the treat- held on Monday morning and as the nursing
ment as carried out. Sometimes the story staff is divided into 2 ‘shifts’ which inter-
is based on the problem of one of the patients change morning and afternoon duties each
in the ward whose identity of course is not week the same ‘shift’ is on duty every second
disclosed. The standard of production put Monday. One shift portrays a family made
on by the patients varies enormously. The up of a hysterical mother and 3 daughters,
script is always seen beforehand to avoid one a psychopath, another a schizoid and the
any indiscretion, and the men know that youngest a hysteric like her mother. The
what is wanted is a social or personal prob- father (played by one of the doctors) rep-
lem of general interest. The time allowed resents ‘normality,’ but is unable to cope
for the actual production is 10 to 30 minutes with the vagaries of his family. The family
but the theme is never fully worked out; immediately ‘caught on,’ the men delighting
the problem having been raised in the play in the familiar character studies. Every
the audience is asked what they consider to fortnight the family is called upon to face
be the most satisfactory solution. To com- a fresh problem and the different way in
plete the hour the doctor sums up using which each personality type tries to cope
various viewpoints expressed to illustrate with the same problem, and the necessity
the advantages of intelligent assessment of for a group as well as an individual solution,
a problem and pointing out how during the carry an obvious lesson. Incidentally it ap-
play and subsequent discussion new light pears to us that acting this type of family has
was shed on the problem and everyone’s great possibilities in the training of nurses
initial viewpoint modified. Frequently a for psychological medicine. The family is
parallel is drawn between this modification easy to understand and therefore popular
of viewpoint and what happens in an individ- with intelligent and dull patients alike. It
ual psychotherapeutic situation; the doctor has distinct limitations however in that the
tries to understand the patient’s problem and characters are, with the exception of the
in the process hopes that an intelligent patient father, all neurotics and in view of their
will gain insight into his neurosis; the ulti- personalities likely to remain so; there is
mate aim of treatment is not to advise the pa- relatively little scope for serious teaching.
tient regarding his conduct, but to let him see Much more ambitious and potentially thera-
his problem sufficiently clearly to be able to peutic is the psychiatric out-patient clinic as
deal with it himself. When such a state of presented fortnightly by the other ‘shift’ of
mind is reached the individual has a definite nurses. When this ‘clinic’ was started the
course to follow, which for him is ‘right.’ Pa- 8o patients were asked how many had heard
tients are frequently surprised to learn that in of such an out-patient department and only
‘944] MAXWELL JONES 295

3 had done so. The clinic has it seems to us personality comes to the clinic because of
all the prerequisites for satisfactory group depression. Her husband has been discharged
treatment. The setting is authentic and actual from the Army with a neurosis and he now
case histories may be portrayed. The prob- demands that she give up her interesting
lems and personality types are familiar and and profitable work to look after him. This
the patients have no difficulty in projecting she does willingly but the husband next de-
themselves into the situations presented. The mands that she give up her recently acquired
whole machinery of general psychiatry can friends whom he regards with suspicion al-
be condensed and brought into view within though he has never consented to meet them.
the space of a few minutes; case taking, The wife consents because she would do
interviewing with relatives, probation officers almost anything to help him but he does not
and social workers, letters to the court and improve and simply becomes more suspicious
to factory doctors and administrative heads and possessive. She is depressed and the
and all the ramifications of psychiatry into reason is obvious. When however the hus-
education, social life and the home can be band can be induced to come to the clinic
brought out. The progress of a case can for an interview to help his wife, he proves
be followed each fortnight and the audience to be unreasonable and uncooperative. The
given a glimpse of what goes on in the doc- need to treat the husband too then becomes
tor’s mind, as well as what passes at the apparent.
actual interview; this can be done by the 3. General Organization of Nurses, Pa-
doctor chatting with the clinic nurse during tients, Etc.-The unit of 90 beds is made up
the interval between the ushering in of each of 8 wards (one for modified insulin treat-
clinic patient. This is important because ment, one for continuous narcosis treatment
such information can be imparted in play and the remaining 6 for mixed neurotic
form but would be impossible to indicate in material). Ten nurses are divided into two
the course of the usual individual psycho- shifts and all but two of the nurses are
theurapeutic situation. Thus, a woman of probationers. We have been greatly im-
ability who had held a responsible post in pressed by the high standard of work done
her father’s business before his death and by some girls within comparatively few weeks
was called up by the Ministry of Labour of their starting training. Each nurse is
and given factory work to do, might develop given two wards to look after and is ex-
an anxiety state which was treated at the pected to read the doctor’s case notes and
clinic by sedative, discussion and rehabilita- grasp the therapeutic aim in each of her
tion. The situational difficulty could be dis- cases. She is encouraged to spend all the
cussed with her at length but it might be time she can in the ward and, if possible,
desirable to withhold certain aspects of the become an integral part of the ward group.
total situation and these would come to light Up to a point she is prepared to “mother”
during the doctor’s conversation with the the men, buying cake for their evening cup of
clinic nurse after the patient had left. To her tea, etc. No attempt is made to hide the fact
he might indicate that the work recom- that the nurse has a loyalty to the doctor and
mended for her when writing to the factory hospital as well as to the ward group; no
doctor was fairly responsible private secre- difficulty has ever been experienced in this
tarial work, preferably under one of the direction and when, as frequently happens,
company’s minor officials, so that her need a patient is asked to attend a nurses’ ward
for a prop and some form of father figure lecture so that they may learn from his
could be met and at the same time her self- case, he invariably does so willingly. Two
esteem bettered by giving her higher grade nurses’ ward lectures are held each week-
work of a familiar kind. An opportunity is one is purely for teaching, case problems
given for demonstrating failures in treat- being discussed, while the other is a general
ment due to lack of cooperation on the part meeting primarily concerned with policy. At
of the patient. The harmful effect that a the latter meeting constant revision and scru-
neurotic may have on his healthy contacts tiny of group methods by the nurses and
can be demonstrated. Thus a girl of excellent doctors concerned are carried out. The
296 GROUP TREATMENT [Nov.

doctor must be prepared to give in to the value of such methods properly applied to
wishes of the nurses when occasion arises the teaching of school children in the prophy-
because it is keenly felt by all that unless laxis of psychiatric disorders. But even here
the staff morale is high the whole practice the resulting benefit might prove to be dis-
of group treatment must fail no matter how appointingly small; e.g., there is no reason
sound the method. The nurses conduct a to think that adolescents at secondary schools
dancing class for beginners twice a week but are less prone to neuroses than adolescents
no pressure is brought to bear on non-danc- who have had only an elementary schooling;
ers whose temperament makes them unfitted education, by widening the subject’s horizon,
for this type of social activity; every fort- at the same time increases his personal re-
night the men act as hosts at a dance given sponsibilities and increases potential sources
in the ward to a group of 30 girls from a of conflict. In connexion with ‘prophylactic
nearby instrument factory and it is inter- teaching’ in schools, it must also be borne
esting to note how much better the men in mind that the adolescent is not ready
respond to these “normal” girls than they for certain information, e.g., while a certain
do when in the company of the female amount of sex education might profitably
neuroses patients at the weekly hospital be given to adolescents there is much teach-
dance. ing which is better withheld until the infor-
Redecorating the wards with the .iurses, mation is needed; only then can it be prop-
the nurses’ visits to the patients’ occupa- erly assessed by the individual. To teach
tions departments, the informal discussion contraception to an adolescent girl might
of the morning’s group talk or play in the invite harmful emotional conflicts and later
wards that evening and the active interest frigidity, whereas such information given
shown in the patients’ home life by the at the right time might have just the opposite
nurses, all contribute to a positive group effect. Adult education is a problem which
atmosphere in the wards. The group spirit no country has yet tackled seriously in a
is confined mainly to the ward and does not coordinated way. We believe that school
noticeably extend to the unit as a whole. education and adult education are both neces-
Lastly, one hour a week is set aside for sary if the fullest possible attempt at pro-
a general meeting of the entire ward-pa- phylactic psychiatry is to be made at the
tients, nurses and doctors. The men are present time; whether the need for adult
encouraged to suggest improvements in the education in this sphere will ever be elimi-
ward organisation, raise criticisms, and if nated is an open question. It is fully realised
possible their suggestions and difficulties are that a psychiatrist has far less qualification
dealt with on the spot, so that they are given for adult education than an educationist but
an immediate feeling of accomplishment, or he has his own specific contribution to make.
their idea is rejected without delay. Such a The system of group treatment outlined
meeting of the ward group with everyone above does not lend itself to an analysis into
present and decisions quickly made and acted its various component parts. Needless to
on does something to combat the patients’ say it has a different significance for differ-
inertia, which in a neurotic ward is the big- ent patients depending on their intelligence,
gest single obstacle to treatment. This oc- interest, personality and nature of their emo-
casion is also used for raising any difficulties tional difficulties. The following is the gen-
the nursing staff may be having with the eral aim of this form of treatment bearing
patients, and for making announcements of in mind that it in no way obviates the need
general interest. for individual psychotherapy.
The group talks developed in response to
DISCUSSION a definite need for factual education on the
The methods of group treatment described C. N. S. and the nature of vegetative symp-
aim at educating the subject. The question toms. The patients were at first all effort
immediately arises as to what are the pos- syndrome patients and they appear to us to
sibilities of educational methods in the treat- form the group ‘par excellence’ for this type
ment of the neuroses. None would deny the of explanatory approach; their vegetative
‘9441 MAXWELL JONES 297

symptoms characteristically appear on phys- plaints will at least prevent mis-interpreta-

ical exertion and involve the circulatory and tion of symptoms. However we do not think
respiratory systems mainly and are fre- that the method has anything more than a
quently misinterpreted as heart disease, etc. limited value, and should be used along with
Simple reassurance is not enough. The pa- individual treatment, group projection meth-
tient has to be given sufficient knowledge to ods, etc.
enable him to believe that he understands the Group projection methods as we are em-
situation rather than simply asking him to ploying them aim at doing more than the
accept the doctor’s reassurance about his group talks. Like the latter, they aim at
heart, etc., especially as this information giving factual knowledge, in this case about
frequently appears to the patient to conflict various aspects of psychiatry particularly
with other more gloomy opinions expressed social psychiatry (the clinic) and personality
by other doctors. To quote from a report types (the family). But their main value is
on group treatment written by one of the in therapy. Most neurotics have immature
patients: personalities, and we believe that even in
the short space of 6 weeks something can be
The amount of detailed information absorbed is
very scanty, but the general impression which the done to alter some of the patients’ attitudes
men grasp is obviously quite important to their towards the basic problems of life. This
treatment. The general impression, often expressed might be done equally well if time permitted
in these words is that “All these left chest pains,
by individual interviews, but we feel that
dizzy turns and so on can be put down to nerves.”
This is eventhally accepted by all but a tiny minor- there is a specific value in group methods.
ity. (This minority consists in the main of those To discuss a problem personally with an
who have had some ‘practical’ demonstration of an individual is a different thing from open
organically weak heart, and who talk learnedly discussion of the same problem when the
about electro cardiographs, etc.) This certainly
does lead to an effective diversion of ward conver- individual has become part of a group and
sation away from symptoms. New patients arrive when the problem itself has been dramatised.
at Central ward full of their symptoms, the num- This applies particularly to problems (and
ber of hospitals they have been in, what various these are in the majority) which have signifi-
doctors have said and so on. Little interest is
shown by the old hands, and after a few days the cance only in relation to society; this type of
new patient is absorbed into the fuller ward life. problem is best considered in the form in
which it actually occurs in real life, and in
The earliest use of group psychotherapy
the presence of a group of people. The
as such appears to have been in Boston where
individual is now in the most favourable
in 1905 Pratt(2) started a class for TB.
position to project himself into the situation
patients who were being treated at home. He
portrayed, and at the same time can contrast
has developed his method considerably since
his reactions with those of the group. At
that time and now endeavours to treat va-
first he may identify himself wholly with a
rious functional disorders by such a class
character, but much more frequently the
method. Excellent results are claimed by
patient’s identity is retained, and he con-
Pratt (3) and 68 per cent of all patients at-
trasts the behaviour of the character in the
tending are helped. The methods employed
play with his own usual standards.
are different from ours and as the class is
made up of out-patients and meets only once Then follows the discussion in which his
a week, there is little attempt at specific edu- own evaluation of the situation is contrasted
cation. Good fellowship, communal discus- with that of other speakers, and inevitably
sion of problems, and the use of ‘cured’ pa- his own viewpoint is ranged against many
tients to encourage the newcomers are the other contrasting viewpoints.
main objects of the meetings. Much more Finally, comes the summing-up by the
specific teaching was attempted by Chappell doctor, and an attempt made to take what
et al. () in treating cases with peptic ulcer is best in the various viewpoints expressed
by group methods. It seems to us that the and to formulate a solution which is reason-
main value of such class methods is in deal- able and, if possible, satisfactory to the group
ing with psychosomatic complaints, where a as a whole. The patient who is actively
proper understanding of the somatic com- cooperating is forced to review his own con-
 298 GROUP TREATMENT [Nov.

cept of behaviour in the circumstances under present a problem of importance to them-

consideration. As Schilder(5) points out, selves for discussion; sometimes a patient
the socially unadapted individual is particu- writes up his own problem. Further, the
larly prone to premature solutions which have production itself requires about a week to
been built up in childhood and retained ever prepare, and in the process the men not only
since, although they cannot stand the test have to think about the problem themselves,
of intelligent scrutiny. It is hoped that one but are active members of a group; usually
can give the patient insight into his own they co-opt one or several nurses to help
arrested development; now, what had always in the play. To some of the patients at least
seemed to him to be a commonplace attitude this type of presentation has a more specific
might owe its origin to some childhood fear therapeutic value than the nurses’ produc-
or frustration, and be impossible to defend tions, but as there is no subsequent meeting
when contrasted with a more reasonable devoted to the problem raised-the patients
adult viewpoint. This sudden insight seems are in hospital only about six weeks, and the
to us to be the most important single factor group is large, the method cannot be used
in group treatment as we practice it, and is for developing a group analytic technique as
one form of learning. Ideally, the old im- has been attempted by Wender(7) and
mature attitude is supplanted by a more Schilder(6). Our belief is that the main
evolved attitude, which appears both right value of the patients’ productions is derived
to the individual and is in conformity with from the projection and evaluation of per-
the group’s considered opinion. Admittedly, sonal beliefs in much the same way as is
a change of attitude may occur without the done by the nurses’ productions. To quote
individual having any insight into the change; again from a patient’s report on the value of
when, in this case, the same problem recurs, group treatment:
the individual viewpoint is found to be
Each problem has as many solutions as observers,
changed although he himself may believe that
but the pooling of solutions during discussion re-
the new viewpoint has ‘always’ been his. sults in a social or group solution which represents
Another point to be considered is that for each individual in part his own solution and in
communal discussion of problems may rob part the group solution. I have several times ques-
them of much of their painful significance tioned men on what was happening when they made
their contribution to the discussion or to the ward
for the individual when he discovers that
‘post-mortem.’ Many times, as if in a flash, it has
he has them in common with many other
spontaneously dawned on them that they were not
people. Schilder(6) expresses this very talking about a hypothetical character in the drama
clearly. but, as they say, ‘I was talking about myself.’ This
insight augments the value of the subsequent
Feeling of guilt results from sexual drives and
dramas.
actions and from aggressiveness. Both seem to
excommunicate the individual from a society that Another patient volunteered that what
sets up for him a system of ideals that cannot be
fulfilled. Mothers are supposed always to love the plays had done was to make him think
their children, and children are expected always to about his own problems more although none
love their parents. There should be no destructive of the problems presented really concerned
impulses against anyone; good deeds from the in-
him. After some discussion, however, he
dividual are not enough-the demand is also that he
think only good thoughts. The unwritten ideologies gained more insight into the nature of his
and prejudices, the demands of misunderstood projection, and said:
morality, are much more tyrannical than written
laws, since the former punish for thoughts. I have just realised that for years before I
Thoughts must come out into the open quite in the joined the army I was unconsciously resisting my
same way as ideologies if individuals are to be wife’s independent life, and that I was jealous
liberated from their feelings of guilt. In a group, when she tried to establish it. Now I see that I
the patients realise with astonishment that the shall have to reorientate my attitude towards my
thoughts which have seemed to isolate them are wife’s personal interests and hobbies.
common to all of them. This enables them to see
their aggressive instincts and social conduct as To summarise, the main value of group
compatible. projection methods of treatment seems to
The patients’ productions are important lie in the opportunity afforded for insight
in that the men are given an opportunity to into basic problems, for examining one’s
 1944] MAXWELL JONES 299

attitude towards such problems, and, if pos- BIBLIOGRAPHY

sible, achieving a more adult outlook on i. Jones, Maxwell. B. M. J., 2:276, ia.
such problems. It seems to us that emotional 2. Pratt, J. H. Johns Hopkins Hosp. Bull., x:
‘40. Discussion i8; 1906.
difficulties may produce arrest of psycho- 3. Pratt, J. H. Internat. Clinics, : I; 1934.
sexual and social development, but even with- 4. Chappell, M. N., Stafano, J. J., Rogerson, J. D.,
out treatment designed specifically to over- and Pike, F. H. Am. J. Dig. Dist. and Nut., 3:813,
come the emotional difficulties which cause ‘937.
5. Schilder, P. J. Soc. Psychol., z: 83, 1940.
the arrest, much can be done by teaching to#{149} 6. Schilder, P. Ment, Hyg., 23:87, 1939.
achieve normal adult development. 7. Wender, L. Psychiat. Quart., i: 708, iwo.