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
Tavistock Clinic
[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?
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?
Dr. John Bowlby:这部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.
由于这个问题的存在是不容质疑的,塔维斯托克诊所的这个研究团队的调查所关注的是导致这些不良反应的心理过程。在一年半之前,我们决定尽可能的涵盖一个孩子在她院期间的整个过程。正 是在此期间拍摄了这部电影。
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.
情感不安的事情而言,这可能是有价值的。我们相信,基于这一知识基础,这是唯一可以扩展改进护理的方法。
这是因为我们相信当一个小孩子有这样的经历的时候,是允许客观检查到底真的发生了什么,对于孩子的这一经历,我们认为,在促进我们理解导致其烦躁和REFERENCE 参考文献
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".
在观察和解释之间有一个不能弥合的差距。似乎儿科医生、护士以及我自己都怀疑这些情感因素。我认为,有时过度的认同于孩子们,会减少了我的客观性。相反,我认为一个相反的现象往往发生在医院的员工之中,也就是说,他们已经树立了防御,以便在某种程度上抵御对于小患者不开心的认识——不仅在最初的明显烦躁阶段,而且 也出现在随后被“安置好”的阶段。
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.