Hospitalism

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HOSPITALISM

René Spitz introduced the term hospitalism in his work defining disorders in infants who were institutionalized for long periods and deprived of substitute maternal care. The notion was later expanded to refer more generally to severe and lasting maternal deprivation.

Linked to Sigmund Freud's concept of maternal care according to, hospitalism refers to the most radical effects of deficiencies in this area. Spitz's defining study of the phenomenon concerned abandoned children who had been separated from their mothers at around three months and had lived for five to six months in a nursery that was said to be beyond reproach in terms of nursing care but that was isolated and devoid of human bonding relations for the babies. The pathology analyzed showed the following: overall developmental deterioration; stagnation in height-weight growth; a shift in development ratios; relational or affective expression reduced to silence; motor and behavioral deviancies; and increased morbidity/mortality rates. Many of these forms of damage were deemed to be irreversible. Spitz categorized hospitalism as "total affective deficiency" and distinguished it from anaclitic depression, categorized as "partial deficiency," which followed at least six months of satisfactory relations with the mother and which could improve once the child was reunited with the mother.

Spitz described these two pathological forms in a pair of publications (hospitalism in 1945, anaclitic depression in 1946) jointly subtitled "An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood." His work emphasizes the vital importance of object relations and the serious consequences of its failure. Additionally, it underscores the relevance of direct infant observation. The baby in reality and the reconstructed baby, placed in a relation of reciprocal reassessment, make possible a wealth of discoveries that validate the research method promoted by Spitz. His concept thus brings us back to the very origins of infant psychiatry, and the first World Congress on Infant Psychiatry, in 1980, was dedicated to his memory.

As a model of deprivation in institutional settings, hospitalism holds a historical place in the design of children's shelters and child-care facilities. The notion received international exposure through a World Health Organization monograph (No. 2, 1951) entitled "Maternal Care and Mental Health"; it was coordinated by John Bowlby, already an established presence in this field ten years prior to his shift in focus to attachment theory.

Spitz's concept of hospitalism drew a number of critical analyses, some on specific points (the inaccuracy of the term itself, lack of precision in pediatric terms, the omission of frequent repeated separation, failure to consider the father's role, etc.), others more general in their scope. These criticisms resulted in some major reassessments in a new World Health Organization monograph published in 1962, whose principal authors included Serge Lebovici and Mary D. Ainsworth.

Study of the short- and long-term consequences of a young infant being separated from its mother remained one of the foremost focuses of childhood psychiatry (Michel Soulé), constantly revised in the light of new discoveries and approaches: the competencies of infants, relational pathologies, advances in knowledge about the infant's mental functioning, psychosomatic repercussions as the top-ranking psychopathological expressions of frustration in early infancy (Léon Kreisler). With a few major exceptions, forms of hospitalism at the turn of the millennium are less connected to stays in institutions and more often concern the complexity of social and intrafamilial deprivation that children face in contemporary society.

LÉon Kreisler

See also: Abandonment; Anaclisis/anaclitic; Deprivation; Spitz, René Arpad.

Bibliography

Ainsworth, Mary D. Salter. (1962). The effects of maternal deprivation: a review of findings and controversy in the context of research strategy. In Mary D. Ainsworth and R. G. Andry Deprivation of maternal care. Geneva: World Health Organization.

Lebovici, Serge. (1962). Sur la notion de carence maternelle. In La carence de soins maternels, réévaluation de ses effets. Geneva: Organisation Mondiale de la Santé.

Soulé, Michel; Lauzanne, Kathlen; and Leblanc, Nelly. (1995). La carence de soins maternels. In Serge Lebovici, René Diatkine, and Michel Soulé (Eds.) Nouveau traité de psychiatrie de l'enfant et de l'adolescent (Vol. 4, pp. 2529-2545). Paris: Presses Universitaires de France.

Spitz, René A. (1945). Hospitalism: An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child, 1, 53-74.

Spitz, René A. (1946). Anaclitic depression. Psychoanalytic Study of the Child, 2, 313-342.