Histories

Pioneering child guidance: A Miller's tale

12 March 2008

Had Emanuel Miller's introduction to the UK of the child guidance movement – the precursor of child and adolescent mental health services – been his only achievement, it would have been enough by itself to earn him his place among the pioneers of modern thinking and practice on behalf of children's health and development.

Born in 1893 in Whitechapel, London to emigre parents from Lithuania, Miller won a scholarship to Cambridge University where he studied natural and moral sciences. Throughout his life, he maintained a keen interest in both science, especially zoology, and theology. He was a gifted Hebrew scholar but returned to London and qualified in medicine in 1918 before returning to Cambridge to extend his studies in Psychological Medicine.

He devoted particular attention to child psychology, child psychotherapy and child guidance, and in 1926 – long before the formation of the National Health Service – he became Honorary Director of the East London Child Guidance Clinic, the first of its kind in Europe. He was instrumental in opening a similar clinic at the West End Hospital for Nervous Diseases.

Later, he was elected to the Royal Colleges of Physicians and took up a post at the Maudsley Hospital where he became an influential writer and teacher as well as a respected practitioner.

Miller's research was rigorously empirical, in contrast to contemporary Freudians who tended to be relentlessly theoretical. The approach is reflected in his publications, particularly Types of Mind and Body, Modern Psycho-therapy, Insomnia and Disturbances of Sleep. In 1968 he edited Foundations of Child Psychiatry, which, before Michael Rutter and Eric Taylor's Child and Adolescent Psychiatry, was the primary UK text on the subject.

In 1931, he helped set up the Institute for the Study and Treatment of Delinquency – a humanitarian initiative designed to promote better understanding and treatment of juvenile offending. This organization not only disseminated new ideas but also ran a treatment clinic and published its own journal, the British Journal of Criminology (originally the British Journal of Delinquency).

A quarter of century later, he founded what became the Association for Child and Adolescent Mental Health, the UK's leading organization in its field, publisher of the prestigious journal Child and Adolescent Psychology and Psychiatry – and sponsors of the annual lecture to be delivered this Friday by Michael Rutter.

It is tempting to explain Miller's drive and success in terms of his family background. His brother was a distinguished theologian and four adoring sisters nurtured his gentle approach. He was married to a novelist, Betty Spiro, and his doctor son, Jonathan, a polymath for different times, became a TV arts presenter and opera and theater director among much else, after early fame in Beyond the Fringe. Jonathan’s sister Sarah, who died in 2006, also worked in television but combined this with a notable standing as an expert in Rabbinical studies.

Miller is difficult to categorize. He dressed immaculately, as the epitome of a Harley Street consultant, deflecting attention from his private life as a polymath, painter, sculptor and specialist in Hebrew texts.

In his memorial tribute in the British Journal of Criminology, Edward Glover wrote “what is really fascinating about Emanuel’s spiritual and intellectual development is the conflict that lay between his almost occult religious aspirations and his compelling interest in natural science, magnified, as that doubtless was, by his powerful impulses of curiosity and his greed of knowledge. His painting and sculpture perhaps sought to capture those aspects of life that elude the descriptive power of the written word”.

Emanuel Miller died in 1970. To appreciate his legacy, we have to consider the context of thinking about children before the Second World War. At the turn of the twentieth century, the causes of stress and insanity were seen as mostly physical in origin, and so symptoms were thought likely to be short-lived.

The establishment of universal education might have challenged this orthodoxy but it became focused on physical conditions, such as ear, nose, throat and speech problems, epilepsy and orthopedics that undermined progress in schools.

Even in the emerging discipline of psychology, much practice focused on the measurement of intelligence and categorization of subnormality rather than disorder and personality development.

Miller helped to change all of that.

References

Edward Glover, “In Piam Memoriam Emanuel Milller, M.A., F.R.C.P., D.P.M. 1893–1970", British Journal of Criminology, 1971, Vol 11, pp 4-13

Jack Kahn, “Tribute to Emanuel Miller” Journal of Child Psychology and Psychiatry 19 (4) , pp 305–308, 1978

Hindley, C B, "Obituary Emanuel Miller 1893-1970". Journal of Child Psychology & Psychiatry & Allied Disciplines, 1970, Vol. 11 Issue 3, p157

-- Prevention Action [http://www.preventionaction.org/people/pioneering-child-guidance-millers-tale]