CHILDREN'S HOSTELS IN WAR AND PEACE

A CONTRIBUTION TO THE SYMPOSlUM ON 'LESSONS FOR CHILD PSYCHIATRY'

GIVEN AT A MEETING OF THE MEDICAL SECTION OF THE BRITISH
PSYCHOLOGICAL SOCIETY ON 17 FEBRUARY 1946

BY D. W. WINNICOTT, London

Evacuation produced its own problems and
war-time its own solutions to problems. Can
we make use, in peace, of the results of what
was so painfully experienced in time of acute
stress and awareness of common danger?
Probably very little that was new in psycho-
logical theory came out of the evacuation
experience, but there islittledoubt that because
of it things became known to very large
numbers of people who would otherwise have
remained ignorant. Especially did the general
public become aware of the fact of anti-
social behaviour, from bed-wetting to train-
wrecking.
It has been truly said that the fact of anti-
social behaviour is in itself a stabilizing factor
in society, it is (in one way of speaking) a
return of the repressed, a reminder of indi-
vidual spontaneity or impulsiveness, and of
society's denial of the unconscious to which
instinct is relegated.
For my part, 1 was fortunate in being em-
ployed bya countycouncil (from 1939 to 1946)
in connexion with a group of five hostels for
children who were diAicult to billet. In the
course of this work,* which involved a visit
each week to the county, I had rather detailed
knowledge of 285 children, most of whom
were observed over a period of years. Our job
was to cope with the immediate problem, and
* A description of this work from different time clinics and we find they need just what
angles can be rcad in: ((1) Winnicott & Uritton.
'The Problems of Flonicless Children', N c w
Gliicotiori Fi~llow.~liipMuiiotqrupli. 1944, no. I , p. I :
( h ) Winnicott & Britton, ' Residcntial Management us say that what thcse children need is ell-
asTrcatmcnt for IXfficult C'hildrcn:The Evolution vilwiriicwtal stubility, parsortal management,
of a Wartinic Hostels Schemc', Hiirnari Rcltrtioiic, ilnd cwrttiriuity of management. We assunie an
1947, vol. I, no. I . p. 87.
we succeeded or failed in so far as we did or
did not relieve those in charge of the local
evacuation arrangements of difficulties which
threatened the success of their work. Now the
war is over, there is still some value to be got
out of the experience we went through,
especially out of this fact of the public's new
awareness of anti-social tendencies as psycho-
logical phenomena.
Of course, we must avoid seeming to suggest
that hostels (or boarding schools for mal-
adjusted children, a5 they are officially called
now) are a panacea for emotional disturbance
of children. We tend to t h i n k of hostel
management simply bccause the alternative is
merely to d o nothing at all through the short-
age of psychotherapists. But this tendency has
to be checked. With this proviso it can be said
that there are children who urgently need to
be cared for in some kind of home. I n my
clinic at the Paddington Green Children's
Hospital (a medical out-patient department)
there is a proportion of cases absolutely
needing hostel management.
There are two broad categories of such
children in peace time: children whose homes
do not exist or whose parents cannot form a
stable background in which a child can
develop, and children with an existing home
which, nevertheless, contains a mentally ill
parent. Such children appear in our pcace-
the children who were difficult to billet needed.
Their home environment has failed them. Let
ordinary standard of physical care.
176 D. W. W I N N I C O T T
To ensure personal management the staffing in his relation to the warden (or some member
of a hostel must be adequate, and the wardens of the staff), and the psychotherapist cannot
must be able to stand the emotional strain easily make up for this in spite of the fact that
that belongs to the proper care of any child, he can give deeper understanding. Wardens,
but especially to the care of children whose if they are good at this special type of job,
own homes have failed to bear such strain. must tend to dislike psychotherapy of the
Because of this the wardens need constant children in their care. In the same way good
support from Psychiatrist and Psychiatric parents hate their children to be undergoing
Social Worker.* The children (unselfcon- analysis, even when they seek it and co-operate
sciously) look to the hostel, or failing that to fully.
society in a wider sense, to provide the frame- The Psychiatric Social Worker and myself,
work for their lives that their own homes have in this scheme, kept in intimate contact with
failed to give them. Inadequate staffing not the wardens both in regard to their personal
only makes personal management impossible, problems, and to the children and the pro-
but also it leads to ill-health and breakdowns blems of their management as they arose. This
in the staff, and therefore interferes with contrasts with ordinary clinic work in which
continuity of personal relationship which is the psychiatrist can do best in a direct personal
essential in this work, relation to each child patient, and to the
A psychiatrist who is in charge of a clinic parents.
from which cases are referred to hostels should Provision of hostels. We must not be sur-
be responsible for a hostel himself, so that he prised to find ministriesissuing edicts in favour
may keep in touch with the special problems of hostels, and also meet the children in need
involved in such work. The same is true of of hostels, and yet to find nothing happening,
magistrates at juvenilc courts, who would do even to find hostels everywhere closing down.
well to sit on hostel committees. The contact between the supply and the need
Psychorherupy. In dealing with anti-social is only to be provided by men and women
children in clinics it is useless just to recom- who are able and willing to live an experience
mend psychotherapy. The first essential is to with the children, willing to let a group steal
get each child properly placed, and proper a few years of their lives. Those of us who are
placing in itself works as a therapy in a fair clinically involved with these children must
proportion of cases, given time. Psychotherapy all the time play a part in bringing together
can be added. It is essential to get the therapy the three things-official policy, wardens and
arranged tactfully. If a psychotherapist is children-and must not expect anything good
available, and if the hostel wardens actually really to happen apart from our own personal
want to help in regard to a child, then indi- voluntary deliberate efforts. Even in State
vidual psychotherapy can be added. But there Medicine the ideas and the clinical contacts
is a complication which cannot be ignored; belong to the clinician, without whom the best
in the good care of a child of this type the scheme is void.
child has to become almost a part of the Placing. The obvious method to be adopted
warden, and if someone else is giving treat- by a large body (such as the London County
ment the child is apt to lose something vital Council, or a ministry) is to work the distribu-
tion of cases from a central bureau which
* It would seem to be the psychiatrist’sjob to keeps in touch with the various groups of
be to some extent responsible for the staffing
because the mental and physical state of the staff hostels. If I have a child in my clinic needing
is the main thing in the therapy. A hostel whose a hostel (and it is always urgent), I am to send
staff is appointed and managed by one authority a report including I.Q. and school report to the
and whose children are under the care of another central bureau, from which each case is to be
is unlikely to be successful. distributed according to routine. But I do not
 C H I L D R E N ’ S HOSTELS I N WAR A N D PEACE
play the game, nor do the parents, except
when the child is so awful that the only need
is to be rid of him immediately. In this mass-
production arrangement something personal
is lacking. The fact is that if a child comes
under my care I cannot just put his or her
name on a list somewhere. Doctors and
parents must be allowed to maintain interest
in the placing of their children; they must
actually find out that what is provided is
good.
There must be some personal link between
clinic and hostel, someone must know some-
one. If no one knows anyone then suspicion
develops, because in the imagination there are
bad parents, bad doctors, bad wardens, bad
hostels, even bad ministries. And by bad
I mean malicious. If a doctor or a hostel
warden is not known as good, he is easily felt
to be malevolent.
It will be apparent that our convalescent
homes are unsuitable for these children, usually
physically healthy, who need long-term
management by specially chosen wardens
supported by the Psychiatric Social Worker
and Psychiatrist. Moreover, hospital-trained
nurses seem to be rendered unsuitable for this
work by their professional training; and many
pediatricians turn a blind-eye to psychology.
Prevention of delinquency. This work is
prophylactic work for the Home Office, whose
main job it is to implement the law. For some
reason or other I have met opposition to this
idea from doctors who work for the Home
Office. But hostels for evacuees all over the
country succeeded in preventingmany children
from reaching the courts, thereby saving im-
mense sums of money as well as producing
citizens instead of habitual offenders; and
from our point of view as doctors, the impor-
tant thing is that the children have been under
the Ministry of Health, that is, they have been
recognized as ill. One can only hope that the
Ministry of Education, which is now taking
over (written in 1945) will do as well during
peace-time as the Ministry of Health did
during the war, in this prophylactic work for
the Home Office.
177
Main thesis. It happened that by my two
appointments I was in touch with the London
need for hostels at the same time as I was
involved in the provision of hostels in an
evacuation area. As physician to a London
children’s hospital, I was struck by the way in
which this war-time provision solved the
peace-time problem of management of the
early anti-social case. It is this aspect of the
whole problem that I wish to describe.
In sixteen instances I was able to draft
London out-patient children to the hostels
which I was visiting as psychiatrist. It came
about by the chance that I held the two
appointments, and it seemed to me to be
a good arrangement, one that could be
adapted to peace conditions. Because of my
position I could be the link between the child,
the parents or relatives, and the hostel
wardens, and also between the child’s past,
present and future. I now give an outline of
each of the cases that were under my care
both at the London end and in the country.
CLINICAL DETAILS OF THE SIXTEEN HOSPITAL
CASES THAT WERE PLACED IN THE HOSTELS,
194246 (REVISED UP TO FEB.1948)
Case 1. Brian (born 1935), was the only child
of parents who could provide a good physical
home. As a child attending medical out-patients,
Brian’s was a case of severe feeding inhibition,
brought about by simultaneous circumcision and
weaning at 8 months, and he was in consequence
a frail child. Many secondary symptoms were
organizing, but investigation showed that in this
case there was an external factor of primary
importance. The mother, who was otherwise an
entirely satisfactory person, was extremely anxious
in her relation to her son, and particularly so in
respect of his feeding. It was found to be unwise
to try to provide psychotherapy for the boy
unless he could first be placed away from home.
Brian spent 18 months in one hostel where he
needed very special minute-to-minute manage-
ment. The warden, a woman with considerable
experience of children, had to spend much time
dealing with the mother who kept in close touch
with the hostel, and who also paid periodic visits
to me at hospital. The arrangement might have
178 D. W. WINNICOTT
broken down a score of tinics but for the cxcep-
tional integration of nianagciiicnt. Each visit of
the mother to her child produccd a scrious set-back
in the boy's mental statc, but it could not have
bcm good (nor indeed legal) to hitvc taken the
boy over from his parents altogcthcr. Eventually
tlie boy produced in this wardcii a state rather like
that of his mother, so that she too bccame bent on
making him eat, and cvcry incnl bccame a struggle.
At this point Brian HUS movcd to one of the
other hostels. The wardcns were wcll instructed in
the details of his particular problem, and in a little
while this boy was catitig all he could get, and
with this the gcnclal mcntal statc improvcd. He
is highly intelligcnt, and hc now niadc great
advances at school, though rcniaiiiing cxtrcmcly
scnsitive to cxcitciiicnt or persecution.
Eventually his mothcr came round to the vicw
that the hostel was succccding whcrc she must fail,
and she now bccame co-opcrntivc, and could be
allowed to have him hoiiic for holidays. She often
acted vcry unwiscly, but thc ill-cffccts could bc
undonc after the b y ' s rctiirii. Iic bcgiln to see his
mother objcctivcly and could talk to the wardens
about her good points and her abnormal tendcn-
cies in relation to his c;irc. Al'tcr about 3 years he
showed for the first time in his lifc sonic spon-
taneous alTection for his mother, and this new
type of relation improved lrcr rclation to him.
Nevertheless, he still needs to be in the hostel,
going homc for holidays (1947).
Hc now shows his scnsitivc n;iturc by bccoming
physically ill at timcs of school cxiiiiiiiiations and
all special excitcmcnts, aiid a doctor not knowing
him, easily thinks he is a rheumatic or tuberculous
or allergic subject.
The mother continues to IISC niyself at tlie
hospital clinic as the intcgrating factor in the
child's lifc. In my experience this is the type of
case that can dcfcat skilled psycho-analysis if
applied to the child alone and while living in his
own home.
Case 2. Mary (born 1934), is the illegitiniate
only child of an insane but uncertitiable mother.
The child was becoming increasingly neurotic and
it was no use giving her psychotherapy while at
home. Twenty-scven months' rcsidcncc in one of
the hostels gave thc child a chance to be a normal
child in favourablc surroundings, and she
flourishcd. In the end she had t o go home, and
the mother continucd to keep in touch with the
hosnital clinic (1947). The child gained insight
into her mother's mental state and seems to be
maintaining her own personal mental health. The
mother uses her in efforts to blackmail a man
whom she claims is the father and threatens to sue
for maintenance.
Case3. Myrla(born 1936), had ahealthymother
who happened to be temporarily depressed because
her husband was away at the war. Her synlptonis
included a compulsion to make Myrla cat, and
the child's defence was to develop a really severe
feeding inhibition. This child was a normal
healthy child and in the hostel atc and behavcd
normally. She was 6 months in the hostel, by
which time thc mother had recovered com-
plctcly from her abnormal mcntal state, and had
lost her compulsion always to be forcing food on
the child. Follow-up from the hospital was edSy
becausc the mother brought her for other minor
complaints, and relations attending from time to
timc gave us reports.
Psychotherapy was inadvisable in this case
as it was not the child who was ill, and the
mother madespontaneous recovery, as is usual
in depression.
Cwsc 4. Snlvador (born 1933), was a Gibraltar
refugee. He had developed a severe schizoid
illness following bcing thrashed at school, and
although such an illness could ordinarily bc
managed best at home, in this case the honie could
not be used. The large family was housed in a few
rooms in a block of flats set aside for these
refugees, and there was already considerable
discontent among the refugees because of the
conditions under which they lived.
The boy was accepted in a hostcl because there
was n o othcr place at all where he could be sent.
He stayed 3 months, and his bizarre behaviour
was well tolerated because the wardens were kept
informed and were warned of approaching
dangers. He made a fair recovery. but was
removed before he got well because of the transfer
of the refugces to a camp in Ireland, where they
were kept for an indefinite period waiting for
return to Gibraltar. I t has bccn impossible to
follow up the case.
CUSP5. Rosemary (born 1935), was referred
because of sulking and tcmpers. and bccause, both
p r c n t s being at work, she could not be managed
in hcr otherwise good honie. After 12 months in
one hostel. whcrc she was givcn psychothcrapy
(by Miss M. Gurney), shc was billetod out. There,
 C H I L D R E N ' S H O S T E L S I N W A R A N D PEACE
however, she wet the bed and was rebilleted, 'his
time successfully. Hospital follow-up shows that
after returning home she settled well and is
developing satisfactorily.
Cusc 6. Ronald (born 19361, is the only and
illegitimate child of an odd woman who was
lo Illanage him after he had had a
mastoid operation* He bccanle deaf and
increasingly mentally retarded after the operation.
He Spellt 38 months in O n e Of the hostels where he
had to bC treated with the Utmost patience. His
mental retardation increased notably with any
emotional upset, and the deafness got interwoven
with the lack of rapport.
Following an ear examination at a clinic at
which the SLIrgeOtl said Out loud, 'that boy iS Very
deaf and nothing can be done 'Or him'* he
both in hearing and in general
intelligence and in his contacts.
In the course of another year of very sensitive
management he became quite an interesting child,
and eventually returned to his mother, and later
was placed with a pcrmancnt foster-n1other.
Hospital f O l h ' - U p Shows him to be fairly well
stabilized.
caw 7* Alan (born 1936)' maniacal
following repeated mastoid operations with pain-
dressings. In the ward he was the
and his and mood made it
inipossibie for him to remain, but there was
nowhere for go* His home failed lo
manage him and he was soon getting into irouble
in the streets. He went to one of the hostels but
ran away a week* At home his mother
had othcr children to look after and her husband
was away at the war' With continuoushelp
myself and the Psychiatric Worker
the boy's mother adapted her whole life to
neglecting everything in order to prevent minor
frustrations and consequent maniacal outbursts.
This produced phase Of considerable improve-
rnent, although the boy could not go to school.
Eventually the mother appealed to the court for
protection and boy was sent an approved
school, an exceptionally good one. Here he was
managed by a man who combined strength and
understanding anti who in addition had legal
backing for hecping him against his will, and he
soon bccame almost a normal child, able to enjoy
play and work and to make friends.
I n this case the hostel failed where the
a p p r o w d school succeeded because the fornier
179
,,ad no power t o keep the boy. The important
point is that there was nowhere for the boy t o
get proper management until he was sent to
an approved school.
Cuse 8. James (born 1937), was illegitimate and
his mother rather irresponsible. He was taken in
at one ofthe hostels and kept for 36 months-from
the time he was 6 years until he was gAafter
which tinle his mother had matured considerably
and was able to have him home. s h e was kept in
touch with the boy all the time he was way, and
this with the warden had a considerable
effect on her own development.
9. Yvonne (born 1937), was illegitimate
and her mother was at hi^ girl had a
distortion of emotional development which made
her do really dangerous things, such as mixing
inedible substanccs secretly into food that was
being prepared. She had to be some-
where and yet, being years old, was not an
obvious for an school. She was in
one hostel 2 months and in another 2 years, but
she continued to bc a and a disturber of
others, although very nice from the point of view
of the casual visitor. This child had same personal
treatment, but no made in her con-
dition. She ~ \ , e n t ~ ~ n went
l l y home, after her
mother had married again and had set up a good
holllc in which she wanted to have her child, but
the girl soon started to bchavc in a mad way again.
Cmcn 10. Pctcr (born 19331, was out of control
(not reliable and stealing) because his father was
away in the itrmy and his mother was not able to
AfLer he had mon,hs in one
manage
of the hostels his father returned and the boy went
home and his progress was satisfactory. This was ;I
rather simple case o f a boy who needetl his father
at home, and who only became difficult when his
mother had him alone. The mother
was somewhat strange, and tended to make hinl
case ,,
girlishand dependent.
. Brian.s (born 1935. home became
broken, and a series of unfortunate coincidences
during evacuation led to his starting to steal. He
spent 15 months in one hostel and 10 months in
another and n short stay in a third, and eventually
went home after his mother had married again.
Although thc new home was very satisfactory he
HPS unable Lo believe in it all the time and
periodically became dcluded about his parents.
At such tinics he ran away and was liable :o steal.
180 D. W. W I N N I C O T T
He has been in the courts. It has been found now
that if the boy can come straight to hospital and
make personal contact with myself or the hospital
Psychiatric Social Worker, whenever he feels
uncertain about his home, he can manage. For
a long period he has been attending hospital on
his own (1948). In this way he has just avoided
being sent to an approved school. His work was
unsatisfactory in a secondary school and trouble
started, but his I.Q. being 110 he was transferred
to a modern technical school where he has at last
made a good contact.
Case 12. Graham (born 1933), with a home
disturbed by his father’smental illness,was getting
into trouble on account of a strong masochistic
tendency. In a hostel for 20 months he had to be
watched carefully all the time because of his
tendency to bring persecution on himself and to
sexualize being bullied. Eventually he was trans-
ferred to a hostel for adolescents (Q. Camp).
Case 13 . George (born 1938). In this case the
home was broken and the father mentally ill, and
addicted to drinking. The boy was in a hostel for
6 months and then went home. Follow-up has
proved impossible in this case.
Case 14. Kenneth (born 1930), was sent
originally by the school which found it difficult to
tolerate him and impossibleto tolerate his mother,
a bizarrecharacter,exceptionallydomineering.The
father, who was an old man, died when Kenneth
was a baby. At home with this mother the boy
could not develop satisfactorily, and he was sent
to one of the hostels where he stayed 24 months.
The mother had to be dealt with all the time and
the case presented very great difficulties, needing
constant psychiatric supervision. Subsequently a
great deal of work had to be done to protect this
boy from his mother, at the same time to enable
him gradually to get an objective view of her. He
was billeted with a good family while working for
matriculation, after passing which he returned
home. He is now managing a job satisfactorily
(1948). He still has to be helped in regard to his
relation to his mother.
Case 15. Joseph’s (born 1934) home had dis-
integrated, and in any case there had been a
bigamous marriage. His anti-social tendency was
developing when he was taken to a hostel where
he stayed 28 months. During his stay the warden
needed frequent psychiatric advice, chiefly on
account of his outbursts of rage. Eventually he
was sent to live with an uncle.
Case 16. Ian (born 1932), was the child of a
mother who was an uncertifiable psychiatric
problem. He was in a hostel 5 months but @roved
to have too distorted a mind to be favourably
affected by this specialized environment, and he
was eventually returned home. He was soon in
the courts and for a long period in a remand home.
The atmosphere of the remand home suited him
admirably and he began to do well in the school
there, and said he was happy for the first time
in his life. This boy had also been to an
exceptionally good hostel in another county, and
here again it had been proved impossible to affect
him favourably.
CONCLUSION
IN RESPECT OF THE
SIXTEEN CASES
This work depended for its value on the fact
that a London Children’s Hospital physician
happened to be the psychiatrist to a group of
hostels. The value of this work is not to be
assessed only by the degree of relief of the
psychiatric illness of each child. The value lay
also in the provision of a place where the
physician could care for these children
who, without such provision, must de-
generate a t hospital or at home, causing great
distress to adults, and badly affecting other
children.
It is a sad reflexion that many of the war-
time hostels have closed down, and now (1948)
there is no serious attempt to provide the
hostel accommodation urgently needed for the
early anti-social case. As for mad children,
for them there is practically no provision.
Officially, they do not exist.