Children's Mental Health in the United States: The Development of Child Psychiatry at Johns Hopkins, 1890--1945

This dissertation tracks the development of child psychiatry as a medical specialty as it emerged at Johns Hopkins University from 1890 to 1945. This was a fitful process that often defied the logic of specialization. Previous histories locate the beginnings of child psychiatry to the Commonwealth Fund child guidance clinics of the 1920s. Yet, by defining the emergence of child psychiatry within this specific setting, such histories emphasize the process of medical professionalization as prerogatives of elite philanthropists who sought to develop rational bureaucratic solutions to social problems. Thus, child psychiatry emerges out of a drive towards further specialization and results in the "medicalization" of social problems. Instead, this dissertation begins in the Progressive era with child welfare reformers and Adolf Meyer whose psychiatry resonated with progressive concerns of social cohesion and efficiency. Although progressive reformers lost traction in the 1920s, Meyer continued to espouse progressive ideals through his teachings and practice of psychiatry until the 1940s. Thus, psychiatry at Johns Hopkins was never fully reduced to problems within the individual, as was the tendency of psychoanalysis.;Child psychiatry developed at Johns Hopkins out of efforts to avoid further specialization in medicine. Pediatrician Edwards Park sought to train doctors who could treat the "whole child," including behavioral problems, which were becoming the purview of psychiatrists, psychologists and social workers. At the same time, Meyer sought to secure psychiatry's place within the medical community as a means to bridge the mind-body divide. Thus, Meyer and Park appointed Leo Kanner to a psychiatric clinic within the Harriet Lane Home, the pediatric hospital at Johns Hopkins, in order to teach pediatricians and medical students to manage common behavioral problems. In practice, pediatricians referred the large majority of behavioral cases to Kanner, setting the groundwork for a specialized field. With the publication of the influential textbook Child Psychiatry in 1935, Kanner gave a name and domain to the field.