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MOTHERS AND FATHERS
837
undesirable in that it suggests the presence of
a
single
disease.
Similarly myocardial infarction may arise without thrombosis, or indeed without complete obstruction of a coronary artery. These distinctions are well known to doctors from their training in the postmortem room. But nowadays much of the research on degenerative heart-disease lies in the hands of chemists and statisticians, who cannot automatically be assumed to appreciate these differences. In endeavours involving cooperation between different scientific disciplines, care in ensuring the accurate use of technical terms is especially necessary.
working-class the dominant mother was far more likely disparage the father and call attention to his inadequacies. Working-class family relations, indeed, seemed more full of problems, though these did not necessarily later cause mental illness. Dr. Clausen hopes in the next stage of his investigation to arrange for an observer to join families temporarily to see what really goes on, and a start has been made with nursery-school children. Family attitudes and practices have yet to be correlated with psychopathology, but careful on-the-spot studies of this kind will offer child psychiatry and social psychiatry some of the objective standards and information which they still lack. In the
to
MOTHERS AND FATHERS
IN 1939 Faris and Dunham1 found that schizophrenia was commoner in the por- areas of Chicago, near the industrial and business centres, than in other districts of the city. Studies in other towns, especially large towns, and other countries have confirmed this observation. Most of the important questions which it raised have yet to be answered, but last week at the Maudsley Hospital, Dr. J. A. Clausen described a useful contribution. For some years Dr. Clausen and the National Institute of Mental Health at Bethesda have been inquiring into the social background and early life of psychiatric patients. Their first study was into the childhood and upbringing of all schizophrenics treated in Maryland hospitals over a twelve-year period. Compared with normal controls, more of the pre-schizophrenics were isolated in childhood, but close examination of the data showed that this could be the result rather than the cause of their condition. Another difference was that the patients, though not necessarily the other children in the family, recalled their mothers as the dominating figure and their father as a relative weakling. This finding was especially common in middle-class families, and was less usual in the larger group of poorer patients. Dr. Clausen and his associate, Dr. M. L. Kohn, are now examining the family pattern in 200 middle-class and 200 working-class homes. Interviews with different family members on such
subjects as parental dominance, peer relationships, restrictiveness, and discipline are still being analysed, but some interesting facts have already emerged. Thus the working-class try to instil in their children qualities, such as honesty and cleanliness, which the middle-class are apt to take for granted. The middle-class are more concerned that their child should show energy and initiative and develop his talsnts and personality. About 80% of mothers, fathers, and children agreed that the mother handled day-to-day decisions but that the parents usually decided big things together. For major family decisions if one parent took sole responsibility, it was more often father. This image of the authoritative father was clearer among the children (especially among sons) than the parents. The mothers saw themselves as mildly dominant in decisions about the children; the fathers thought they were overwhelmingly so, especially in decisions about daughters. Mothers who regarded themselves as the less dominant parent said that when angry they " held themselves in " and gave way in a dispute. Mothers who admitted that they lost their tempers easily often seen as highly dominant by their husbands -even those who did not see themselves as authoritative figures. Irrespective of maternal dominance, a warmer father/son relation was found in middle-class families.
were more
1.
Faris, R. E. L., Dunham, H. W. Chicago, 1939.
Mental Disorders
m
Urban Areas.
RESPIRATORY PARALYSIS AFTER URETEROSIGMOIDOSTOMY
MUCH interest has been aroused by the blood-electrolyte changes which may follow surgical diversion of urine into the bowel. Reabsorption of electrolytes from urine retained in the intestine, coupled with impaired renal function, may bring about a state of chemical imbalance usually characterised by a rise in the serum-chloride and a fall in the alkali reserve. - While " hyperchloraemic acidosis " has now become well recognised as an occasional sequel of ureterocolic anastomosis, an incidental loss of potassium-possibly influenced by other factors-has attracted somewhat less attention. Hypokalxmia has, however, been reported in about a third of all patients submitted to this operation,’ and serious symptoms have sometimes arisen. Among these, anorexia, vomiting, progressive weakness, and diarrhoea have been prominent-the diarrhoea probably aggravating the potassium loss. Similar symptoms havebeen noted in cases of vesicointestinal fistula, where potassium depletion has been associated with protracted urinary diarrhoea. Conversely the full hypokalasmic syndrome may be induced in susceptible patients already suffering from anorexia (but without diarrhoea) merely through reduction of potassium intake. In a study of seven cases Lowe, Stowers, and Walker2 draw attention to the variety of electrolytic disturbances which may follow ureterosigmoidostomy and emphasise the need for careful biochemical assessment and prophylaxis of ascending renal infection. Steinbeck and Tyrer3 comment on the occurence of hypokalaemic pareses and cite a case in which there were recurrent attacks of quadriplegia and respiratory embarrassment. In such cases the rapid and apparently unexplained onset of severe asthenia and malaise may give rise to difficulty in diagnosis. Straffon and Coppridge4 have reported two cases in which extensive muscular weakness progressing to respiratory paralysis invited a differential diagnosis of acute neurological disease. In one case a girl of 12, who had undergone ureterosigmoidostomy six years previously on account of vesical exstrophy, was admitted with a tentative diagnosis of poliomyelitis after three days of progressive muscular weakness of the legs and back. In the other-a man of 56 who had undergone ureterocolic anastomosis fourteen years previously-a rapidly spreading flaccid paralysis Both simulated Landry’s acute ascending myelitis. patients required temporary resuscitation in a mechanical
respirator pending detection of the electrolyte deficiency, and both later responded dramatically to potassium replacement therapy. 1. 2. 3. 4.
Jacobs, A., Stirling, W. B. Brit J. Urol. 1952, 24, 259. Lowe, K. G., Stowers, J. M., Walker, W. F. Scot. med. J. 1959, 4, Steinbeck, A. W., Tyrer, J. H. Brit. J. Urol. 1959, 31, 280. Straffon, R. A., Coppridge, A. J. J. Amer. med Ass. 1959, 171, 139.
473.
undesirable in that it suggests the presence of
a
single
disease.
Similarly myocardial infarction may arise without thrombosis, or indeed without complete obstruction of a coronary artery. These distinctions are well known to doctors from their training in the postmortem room. But nowadays much of the research on degenerative heart-disease lies in the hands of chemists and statisticians, who cannot automatically be assumed to appreciate these differences. In endeavours involving cooperation between different scientific disciplines, care in ensuring the accurate use of technical terms is especially necessary.
working-class the dominant mother was far more likely disparage the father and call attention to his inadequacies. Working-class family relations, indeed, seemed more full of problems, though these did not necessarily later cause mental illness. Dr. Clausen hopes in the next stage of his investigation to arrange for an observer to join families temporarily to see what really goes on, and a start has been made with nursery-school children. Family attitudes and practices have yet to be correlated with psychopathology, but careful on-the-spot studies of this kind will offer child psychiatry and social psychiatry some of the objective standards and information which they still lack. In the
to
MOTHERS AND FATHERS
IN 1939 Faris and Dunham1 found that schizophrenia was commoner in the por- areas of Chicago, near the industrial and business centres, than in other districts of the city. Studies in other towns, especially large towns, and other countries have confirmed this observation. Most of the important questions which it raised have yet to be answered, but last week at the Maudsley Hospital, Dr. J. A. Clausen described a useful contribution. For some years Dr. Clausen and the National Institute of Mental Health at Bethesda have been inquiring into the social background and early life of psychiatric patients. Their first study was into the childhood and upbringing of all schizophrenics treated in Maryland hospitals over a twelve-year period. Compared with normal controls, more of the pre-schizophrenics were isolated in childhood, but close examination of the data showed that this could be the result rather than the cause of their condition. Another difference was that the patients, though not necessarily the other children in the family, recalled their mothers as the dominating figure and their father as a relative weakling. This finding was especially common in middle-class families, and was less usual in the larger group of poorer patients. Dr. Clausen and his associate, Dr. M. L. Kohn, are now examining the family pattern in 200 middle-class and 200 working-class homes. Interviews with different family members on such
subjects as parental dominance, peer relationships, restrictiveness, and discipline are still being analysed, but some interesting facts have already emerged. Thus the working-class try to instil in their children qualities, such as honesty and cleanliness, which the middle-class are apt to take for granted. The middle-class are more concerned that their child should show energy and initiative and develop his talsnts and personality. About 80% of mothers, fathers, and children agreed that the mother handled day-to-day decisions but that the parents usually decided big things together. For major family decisions if one parent took sole responsibility, it was more often father. This image of the authoritative father was clearer among the children (especially among sons) than the parents. The mothers saw themselves as mildly dominant in decisions about the children; the fathers thought they were overwhelmingly so, especially in decisions about daughters. Mothers who regarded themselves as the less dominant parent said that when angry they " held themselves in " and gave way in a dispute. Mothers who admitted that they lost their tempers easily often seen as highly dominant by their husbands -even those who did not see themselves as authoritative figures. Irrespective of maternal dominance, a warmer father/son relation was found in middle-class families.
were more
1.
Faris, R. E. L., Dunham, H. W. Chicago, 1939.
Mental Disorders
m
Urban Areas.
RESPIRATORY PARALYSIS AFTER URETEROSIGMOIDOSTOMY
MUCH interest has been aroused by the blood-electrolyte changes which may follow surgical diversion of urine into the bowel. Reabsorption of electrolytes from urine retained in the intestine, coupled with impaired renal function, may bring about a state of chemical imbalance usually characterised by a rise in the serum-chloride and a fall in the alkali reserve. - While " hyperchloraemic acidosis " has now become well recognised as an occasional sequel of ureterocolic anastomosis, an incidental loss of potassium-possibly influenced by other factors-has attracted somewhat less attention. Hypokalxmia has, however, been reported in about a third of all patients submitted to this operation,’ and serious symptoms have sometimes arisen. Among these, anorexia, vomiting, progressive weakness, and diarrhoea have been prominent-the diarrhoea probably aggravating the potassium loss. Similar symptoms havebeen noted in cases of vesicointestinal fistula, where potassium depletion has been associated with protracted urinary diarrhoea. Conversely the full hypokalasmic syndrome may be induced in susceptible patients already suffering from anorexia (but without diarrhoea) merely through reduction of potassium intake. In a study of seven cases Lowe, Stowers, and Walker2 draw attention to the variety of electrolytic disturbances which may follow ureterosigmoidostomy and emphasise the need for careful biochemical assessment and prophylaxis of ascending renal infection. Steinbeck and Tyrer3 comment on the occurence of hypokalaemic pareses and cite a case in which there were recurrent attacks of quadriplegia and respiratory embarrassment. In such cases the rapid and apparently unexplained onset of severe asthenia and malaise may give rise to difficulty in diagnosis. Straffon and Coppridge4 have reported two cases in which extensive muscular weakness progressing to respiratory paralysis invited a differential diagnosis of acute neurological disease. In one case a girl of 12, who had undergone ureterosigmoidostomy six years previously on account of vesical exstrophy, was admitted with a tentative diagnosis of poliomyelitis after three days of progressive muscular weakness of the legs and back. In the other-a man of 56 who had undergone ureterocolic anastomosis fourteen years previously-a rapidly spreading flaccid paralysis Both simulated Landry’s acute ascending myelitis. patients required temporary resuscitation in a mechanical
respirator pending detection of the electrolyte deficiency, and both later responded dramatically to potassium replacement therapy. 1. 2. 3. 4.
Jacobs, A., Stirling, W. B. Brit J. Urol. 1952, 24, 259. Lowe, K. G., Stowers, J. M., Walker, W. F. Scot. med. J. 1959, 4, Steinbeck, A. W., Tyrer, J. H. Brit. J. Urol. 1959, 31, 280. Straffon, R. A., Coppridge, A. J. J. Amer. med Ass. 1959, 171, 139.
473.