Hospitalism

No statement on group care of children can be complete without reference to the catastrophic consequences some institutions have had for very young children. Early in the 20th century the professional and public consciences were stirred by some well-documented reports that foundling homes of that period commonly lost through death about three-quarters of their infants. That these revelations had and should have had enormous shock quality goes without saying, but not until the appearance of Spitz's work in the 1940s did the full effect register, for Spitz added to the evidence in two important ways. First, he showed that high mortality was not the only negative consequence of certain institutional programs: cognitive and psychosocial retardation, though not as final as death, was nevertheless a probable outcome to be reckoned with. Second, Spitz produced some visual evidence (films) that linked the institutional environment in his study to obvious deterioration.

It seems safe to say that Spitz's detailed evidence, followed a few years later by Bowlby's (1950) WHO monographs, became a major deterrent to group care in the Western world. So profound was the impression, so compatible with childrearing attitudes generally held, that his work has withstood a considerable amount of modifying evidence—namely, that group care need not be destructive to the infant and young child providing, of course, it meticulously avoids the debilitating conditions an institution may offer. Spitz's findings and their profound impact are thus an obstacle and a 134 warning. The obstacle proponents of group care must overcome by contrary evidence; the warning is of the profound impact poor group care has on the young child.

A careful, honest scientist, Spitz contributed to the subject of group care even more than he is usually credited. The major paper on hospitalism reproduced here also contains evidence to deny its inevitability in institutional settings. To be sure, Spitz showed that institutions for infants can be mercilessly destructive, but he also showed (Table 8.2) that they need not necessarily be so—a bit of evidence most of his readers found conveniently forgettable. Thus if Spitz is given the attention he deserves, he shows not only what negative effects institutional care can produce but also the essential differences between stultifying and growth-promoting group environments.