A Two-Year-Old Goes to Hospital两岁小孩去医院
A Film Shown By JOHN BOWLBY, M.D., and JAMES ROBERTSON
[November 28, 1952]
Proceedings of the Royal Society of Medicine Vol. 46 Section of Paediatrics
Dr. John Bowlby:The theme of this film is a very commonplace one-simply the story of a child of 2 years who spends eight days in hospital for a minor operation and who frets a good deal of this time. It may be asked why bother to make and show a film of something so commonplace?
Dr. John Bowlby：这部电影的主题是一个很平常的简单故事，两岁的小孩一个在医院接受小手术，在这8天的大多数时间里都烦躁不安。人们可能要问，为什么拍摄并展示一部如此普通的电影？
The reason is that we believe that fretting should no longer be looked upon as an unavoidable inconvenience but as something of serious importance and worthy of scientific study. There is now evidence that prolonged periods of maternal deprivation in very young children can, in some cases, give rise to extremely serious psychiatric disturbances. There has been a succession of papers and monographs on this subject during the last fifteen years and two years ago WHO published a review of this evidence (Bowlby, 1951). Furthermore, it is becoming fairly well known that the majority of children under 4 years old who have spent only a brief period in hospital, or otherwise away from their mothers, show emotional upsets of shorter or longer duration.
原因是，我们认为，仍旧将烦躁不安视为是一个不可避免的麻烦，这是不应该，而应将其视为一件严肃的事情，值得科学的研究。现在有证据表明，在某些情况下，长期剥夺非常年幼孩子的 母爱，会引起非常严重的精神障碍。关于这个问题，在过去的十五年间，以及两年前WHO出版的关于这一证据的回顾之中，已经有了一系列的论文和专著。此外，众所周知，大多数4岁以下的儿童在医院度过一个短暂的时光、或以其他的方式远离他们母亲， 会或长或短的表现出情绪的不安。
Since the existence of the problem is no longer in doubt, the Research Team investigating it at the Tavistock Clinic is concentrating its attention on the psychological processes which lead to these adverse effects. We are giving special attention to the emotional responses of very young children during the first days and weeks following separation from their mothers. After a number of semisystematic studies we decided eighteen months ago to attempt as full a coverage as possible of one child throughout her stay in hospital. It was during this pilot study that this film was made.
It is because we believe it permits of an objective examination of what actually happens when a young child has this experience that we think it may be of value in furthering our understanding of fretting and the emotional disturbances to which it can lead. We believe that it is only on the basis of this knowledge that improved methods of care can be developed.
BOWLBY, E. J. M. (1951) Maternal Care and Mental Health. WHO Mono. Ser. No. 2. Geneva.
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Mr. James Robertson:There are special difficulties in the way of getting objective data on the meaning of separation to children under 4. They can tell little in words, so that understanding has to be sought largely through interpreting their behaviour. As fieldworker I discovered that there were often limits to the agreement to be had in discussion with nurses and paediatricians not only about the meaning of behaviour in certain young patients but also about the actual facts of that behaviour.
Mr. James Robertson:对于获取4岁以下儿童分离意义的客观的资料而言，是非常困难的。他们只能说很少的词，因此，在很大程度上，必须通过他们行为的解释来理解之。作为实地考察工作者，我发现在与护士的讨论的一致性经常是有限的，而且儿科医生对于某些小患者的行为的意义，以及这些行为的真实事实也是有限制的。
There was a gap in observation and interpretation which could not be bridged. It seemed that emotional factors in the pediatricians, nurses, and myself were suspect. I was thought at times to be diminished in my objectivity by becoming over-identified with the children; I in turn considered that a contrary phenomenon tended to occur in hospital staffs, namely that defences had built up in them against the painful recognition of the extent to which young patients are unhappy-not only in the initial phase of overt fretting but in later, stages of being "settled in".
In the film I have tried to provide a record which will be accepted as objective, and which has the merit that the behaviour can be viewed as often as desired in discussion between interested groups. Thus I hope our mutual interest in discovering what is true will be advanced. Objectivity was sought by several devices. A schedule of filming was agreed beforehand with the ward staff; it consists of documentary record of main events such as admission, anesthetic, parents' visits-and a daily "time sample" covering the same period and at intervals determined by a clock which is seen in the film.
The child was selected at random by a hospital clerk from the list of those awaiting operation for umbilical hemia. Filming was done by myself with a hand camera in natural lighting. There was no other apparatus to disturb the ward and the child was not segregated. The only departure from routine was that a nurse was detailed to play with the child during the daily time sample.
SYNOPSIS OF FILM 影片概要
Laura is 2 years 5 months old, a first child and so far an only one. She is intelligent, mature, and has unusual control over the expression of feeling. She rarely cries. She is about to go into hospital for eight days to have a minor operation for umbilical hernia.
Although her parents had tried to prepare her for going into hospital, when she meets the admitting nurse she is cheerful and friendly and clearly does not realize that her mother will leave her. Going through the ward she seems less confident, and when she is undressed to be bathed she screams for her 'Mummy. Within ten minutes, however, her unusual control over feeling asserts itself and she is apparently calm.
She is put in a cot and breaks down again when nurse takes her temperature "Don't like it. I want my Mummy". A few minutes later her mother comes to say good-bye, and leaves for her consolation a piece of blanket she has had since infancy and which she calls her "baby". Throughout her stay this "blanket baby" and her Teddy make a link with home and are clung to when she is sad or frightened.
When alone she appears calm, but if a kindly person stops to talk with her her feelings appear. Sister comes to greet the new patient and Laura's face crumples "I want my Mummy". This occurred throughout her stay: and the camera shows that what may easily be taken for calmness is often a facade which contact with a friendly person breaks down.
When the surgeon comes she clutches her Teddy and blanket "baby" for comfort, and despite his tact she is apprehensive and resistive. Occasionally during the day she asks quietly for her Mummy, but without insistence.
On the second day she looks strained and sad, and has difficulty in responding to the nurse who comes to play with her. Then her feelings appear and she cries a little for her Mummy. But though she cries little throughout her stay she takes great interest in the children who cry-as if they cry for her who is too controlled to cry. The rectal anesthetic is kindly administered, but the strange experience frightens her. Thirty minutes after recovery from the anesthetic her parents visit. She is very distressed-"I want to go homes'-tries to get to her mother but has to be restrained because of the stitches, and rolls about on her pillow crying. As her parents leave she is subdued and seems perplexed. She waves slightly in response to their cheerful going.
第二天，她看起来紧张而又悲伤，而且对于和她来玩的护士有反应上的困难。然后她的情绪出现了，她为了她的妈妈哭了一会儿。然而，然而，尽管她在护士逗留中哭得很少，但她对那些哭泣的孩子们非常感兴趣，就好象 ，她们为了过度控制哭泣的她而哭泣。她无伤痛的做了直肠麻醉，但是奇怪的感受吓到了她。从麻醉中恢复三十分钟后，她的父母来了。她非常的痛苦——“我要回家”——试图抓住他的妈妈，但是因为身上有针，不得不控制住， 同时卷在她的枕头里哭着。当她的父母离开她时，她节制、并显得不知所措。她轻轻的挥手以回应他们愉快的离开。
On the third day she is seen quietly clutching her Teddy and blanket baby, not crying or demanding attention and likely to seem "settled" to busy ward staff. But when a nurse comes to play with her she is at first withdrawn, then in contact with the friendly person her feelings break through again and she cries bitterly for her Mummy. When the nurse leaves her control gradually reasserts itself. This cycle of withdrawal, breakdown, and resumed control is repeated shortly afterwards when the nurse again plays with her. In the afternoon her mother visits, but although Laura has been sitting up all morning and has wanted her mother she makes no attempt to get to her. Mother would like to take her in her arms but is deterred from doing so by what she believes to be hospital regulations. Ten minutes later a nurse sits her up, but it is fifteen minutes before Laura thaws out towards her mother. Then she becomes increasingly animated and friendly, and is transformed by a radiant smile seen for the first time in three days. When her mother says she has to leave Laura is immediately anxious, and as her mother leaves she turns her head away. She does not cry, but shows her feeling clearly by the change in her face and the restless movement of her hands. Although it is the middle of the afternoon she asks to be tucked down with all her personal possessions tucked around her and forbids the nurse to remove the chair on which her mother had been sitting.
第三天，她安静地抓着泰迪和毯子宝宝，不哭也不要求关注，而且似乎被繁忙的病房工作人员“安置好了”。但是，当一个护士来和她玩，她起初是退缩，然后在与友善的人接触之时，她的情绪再次爆发，并为为她妈妈而哭泣。当护士离开，她的控制逐渐恢复了。当护士再次和她玩耍，立刻又重复了退缩、崩溃并回复控制的循环。妈妈想把她抱在怀里，却不敢这样做，她认为医院规章制度是不允许这样的。十分钟后，一名护士扶她起来坐着，但是十五分钟前，劳拉从她妈妈哪儿复苏了。然后，她变得越来越活泼和 友善，并且，在这第三天里，第一次变得看到了灿烂的微笑。当她妈妈说她必须离开，劳拉马上就焦虑不安，而且，她妈妈离开时，她把头转了过去。她没有哭，不过，她的脸上的变化 以及双手焦躁不安的举动清楚地表明了她的感觉。虽然这是下午，她却要求被把她的所有东西藏起来堆在她的身边，并禁止护士移动她母亲曾经坐着的椅子。
On the fourth dav the record is brief and featureless. She is not visited.
On the fifth day her mother visits in the afternoon, and again there is a period of withdrawal before she warms up to her mother. She asks to go on mother's lap, but when mother says she cannot she does not ask again. When her mother has to go Laura is pained, cries a little, then quietly recovers and sits with pursed lips.
On the sixth day a new child is admitted who cries a lot, Laura, very controlled herself, watches him with a tense face. (When she got up she went to him and said "You're crying because you want your Mummy. Don't cry. She'll come to-morrow.")
On the sevenith day both parents visit and Laura is up for the occasion. Although she knows chairs are being set out for them she shows no excitement, and when her mother comes she makes no attempt to go to her. She remains subdued. When Daddy comes from the office ten minutes later he gets a warmer welcome. Daddy leaves first and his going is apparently almost ignored. She asked to go with him but does not insist. When her mother leaves, Laura apparently ignores her going.
On the eighth morning she is shaken by sobs. Her mother had told her the previous evening that she would be going home to-day and her control has given way. When her mother comes Laura remains cautious, however, and not until her outdoor shoes are produced does she accept that she is going home. She insists on taking all her possessions home with her, even a tattered old book she refused to leave behind. When she dropped that book on the way out and a nurse picked it up, she screamed in temper and snatched it away-the fiercest feeling shown during her whole stay. On the way out she is seen walking apart from her mother.
Dr. D. W. Winnicott(President of the Section) welcomed the film as a highly successful first effort. Here, as he saw it, was a normal child. She came into hospital and gradually became affected as a normal child must. She was fortunately spared that phase of false recovery to which the child reaches if the break from the home lasts too long, and which may make the child cling to the nurse in fear when at last the mother or father comes to take the child home.
Dr. D. W. Winnicott（期刊儿科学主席） 欢迎这部非常成功的出世电影之作。在此，正如其所见，是一个正常的孩子。她住进了医院，并且就像一个正常孩子所不可避免的，逐渐变得做作。在此期间，她幸免于错误的康复，如果这个孩子所触及的与家人分离的这个阶段太过长久的话，这可能会让这个孩子在父亲或母亲最终带孩子回家时，在担惊受怕中依附于护士。
The main comment Dr. Winnicott wished to make was that from long experience he could say that this film was definitely about a real problem. The effect of separation of small children from their mothers was so often serious, even producing irreversible changes, that every time when a child is to be taken into hospital there ought to be a careful weighing up of the value on the physical side against the danger on the psychiatric side. This principle is not vitiated by the undoubted fact that in certain circumstances certain children (not young ones) derive benefit and even enrichment from a stay in hospital-perhaps because of the relief that this affords on account of a parent's anxiety state or depression mood.
It is interesting that the child who feels ill seems to be less harassed by being taken into hospital than the child who feels well, but who is considered to need something done. A verbal explanation given to a young child, whatever is said, is of no value as compared with the child's own feeling that help is needed. On feeling better, however, the child begins to have an urgent need to go home.