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From degeneration to mental disorders: the development of child psychiatric theory and child psychiatric practices in Denmark, c. 1900-1950

De la dégénérescence aux troubles mentaux. Théories et pratiques de la psychiatrie infantile au Danemark, c. 1900-1950
Jennie Sejr Junghans
p. 155-169


Bien que la pédopsychiatrie n’ait pas été officiellement reconnue comme une spécialité médicale au Danemark avant 1953, la première moitié du xxe siècle a vu un développement important des théories et des pratiques pédopsychiatriques. Alors que la notion d’hérédité avait auparavant dominé les manuels médicaux et limité les efforts de traitement, la première clinique psychiatrique pour enfants souffrant de troubles mentaux a ouvert ses portes à l’hôpital universitaire de Copenhague en 1935, annonçant une nouvelle approche des troubles mentaux des enfants. Au début des années 1950, le rôle des conditions socio-économiques et des relations intrafamiliales pour la santé mentale des enfants est davantage pris en compte, tant dans les manuels que dans les pratiques.

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  • 1 Sheffer Edith, Asperger’s Children – The Origins of Autism in Nazi Vienna, New York, W. W. Norton (...)

1Even though the history of child psychiatry has attracted scholarly attention in recent years, our present knowledge of how the field of child psychiatry evolved and of how children were observed, diagnosed and treated in psychiatric practices is still fairly limited and obscure. One of the reasons for this concerns access: whereas the development of child psychiatric theories can be traced in medical literature, examining child psychiatric practices is more difficult, because access to 20th century clinical material is often restricted due to privacy concerns or downright impossible because the material has not been preserved. Recent contributions to the field therefore focus mainly on 19th century practices, theoretical developments, international collaboration, and the development of specific diagnoses1. The present article explores a few facets of the complex history of Danish child psychiatry in the first half of the 20th century by examining the first two Danish child psychiatric textbooks published in the period and by looking at medical records from two selected psychiatric hospitals.

  • 2 The Danish parliament decided in 1946 that a second national child psychiatric facility should be b (...)

2At the beginning of the 20th century, specific services for mentally ill children were non-existent and Danish psychiatrists were only beginning to think of children as potential patients. Despite official regulations barring children from admittance, cases deemed severe were admitted to ordinary mental hospitals for adults, where treatment efforts were rarely adjusted in any specific way to the age of the child. The first Danish textbook on children’s mental disorders was published in 1909 alongside a small number of articles, yet these focused primarily on hereditary factors and therefore left little room for psychiatric, pedagogical, or parental intervention. By 1935, change was under way as a small outpatient clinic specifically for mentally ill children was established at the Copenhagen University Hospital. The clinic was the very first of its kind in Denmark and would be the only one until 19462. Officially, child psychiatry was not recognized as a medical specialty before 1953.

3Thus, the relationship between child psychiatric theory and practices in the first half of the 20th century was complicated: children and adolescents admitted to ordinary mental hospitals or the clinic at the Copenhagen University Hospital were deemed ill or maladjusted enough to be in need of psychiatric evaluation, but actual ideas on treatment and aetiology were few, vague and contradictory. The understanding of mentally disturbed children presented in medical textbooks was heavily influenced by eugenics and as a consequence, treatment efforts were limited. Yet, in the years following the end of the Second World War, important theoretical changes were taking place and within the international child psychiatric community, the perceived importance of the field changed dramatically.

  • 3 Hallager Frederik Kristoffer, « Litteraturanmeldelse », Ugeskrift for Læger, vol. 72, no 3, 20 jan (...)
  • 4 The archival work with the medical records on children and adolescents at Middelfart State Hospital (...)

4This article will shed some light on this process in two aspects. First, developments in theoretical child psychiatry will be examined via the two first Danish child psychiatric textbooks, August Wimmer’s Degenerated Children (in Danish: Degenererede Børn), published in 1909, and Margrethe Lomholt’s Child Psychiatry (in Danish: Børnepsykiatri), published in 1948. Both textbooks were written by prominent Danish psychiatrists and represented influential attempts at conceptualising and categorising children’s mental disorders. Despite receiving good criticism3, Wimmer’s textbook was only ever published in the first edition, which suggests that it was only read within specialized, narrow circles. By contrast, Lomholt’s textbook was published in no less than seven editions from 1948 to 1979 – a testament to the professionalization of the field of child psychiatry in Denmark after the Second World War. Second, child psychiatric practices will be examined using medical records from two psychiatric institutions, Middelfart State Hospital and the child psychiatric clinic at the Copenhagen University Hospital. The selected medical records on children and adolescents admitted to Middelfart State Hospital cover the period from 1891 to 1940 and therefore reveal how child psychiatric practices were performed in an ordinary mental hospital in the countryside at the start of the 20th century4. By contrast, the medical records from the clinic at the Copenhagen University Hospital demonstrate new approaches at a specialist clinic in the city from 1935 until the late 1950s. Thus, the child psychiatric textbooks function as a point of entry for examining the nature of the theoretical changes and the medical records reveal to what extent the theoretical changes were translated into practice and how mentally disordered children and adolescents were handled in practice.

Degenerated children (1909)

  • 5 Wimmer August, Degenererede Børn, Copenhague, Gyldendalske Boghandel Nordisk Forlag, 1909, p. 2-3.

5The first Danish textbook on mentally disordered children was published in 1909, titled Degenerated Children and authored by psychiatrist August Wimmer, who at the time of its publication was employed at the Copenhagen Municipality Hospital (“Kommunehospitalet”). Wimmer never had any children of his own, so the textbook’s empirical foundation was the many children he had observed and treated in the clinical practice in Copenhagen. In the book’s introduction, Wimmer explained that only two main categories of mental disturbances could affect the child: “genuine insanity” or so-called “mental abnormal states”. Like many of his contemporaries, he believed that genuine insanity in children was very uncommon and he recalled only having seen a few cases in his entire career. By comparison, Wimmer believed that the mental abnormal states were much more common and therefore a more pressing concern. The mental abnormal states were defined as mental abnormities grounded in the nervous system, that could be either congenital or acquired at an early time in the child’s life. This mental abnormity could reveal itself in a vast array of deviant behaviours, for example, crookedness, laziness, mendacity, and more. However, Wimmer emphasized that the naughty or inappropriate behaviour of these children was caused by a sick nervous system, which meant that their crookedness and bad behaviour could not be cured by any means of normal upbringing. These children should be understood and treated as being sick, Wimmer argued5.

  • 6 Ibid., p. 59.

6Thus, Wimmer was the first Danish psychiatrist arguing that children’s behavioural patterns could be understood in terms of mental disorder. He divided children’s mental abnormities into three main groups. The first group consisted of conditions where the mental faculties of the child were believed to be essentially defective or lacking. This group contained children suffering from mental retardation and children deemed morally defective or paranoid. The second group contained children where the mental abnormities were only ‘functional’ in the sense that their abnormal behaviour could not be explained by defective mental faculties. Children belonging to this group suffered from mood disorders similar to the adult diagnoses of depression and mania. The third group covered children suffering from neuroses, which in Wimmer’s interpretation meant children who on top of the mental symptoms also suffered from various nervous symptoms (cramps, paralysis and more) – children suffering from hysteria, epilepsy and neurasthenia were included6.

  • 7 This concept of degeneration was heavily inspired by Darwin’s theory of evolution and by the Frenc (...)
  • 8 Wimmer, Degenererede…, p. 249-253.

7Even though Wimmer was progressive in arguing that children could suffer from mental problems and be in need of psychiatric evaluation, the title of his textbook clearly revealed the theoretical foundations of his child psychiatry: mentally disordered children were the unfortunate – and almost inevitable – outcome of degeneration, understood as a negative, physical heritage, which would deteriorate for every generation7. This theoretical frame also explains why Wimmer’s categories of degenerated children mimicked contemporary psychiatric diagnoses for adults. It follows from the idea of inevitable degeneration that actual treatment options were few and limited in scope. Wimmer noted that the only reliable way of preventing degenerated children was denying adult degenerates the right to marry and procreate. The damage had already been done if the child was born and the only treatment from then on consisted in so-called “medical pedagogical treatment” that needed to be initiated as soon as the child’s mental degeneration had been diagnosed. Generally, this treatment centred on carefully monitoring the child’s physical health and bodily functions, securing a simple diet and making sure that the degenerated child got enough sleep8. Hence, a degenerated child could never be cured, but a degenerative constitution could be kept adequately in check and thereby permit a fairly normal life.

  • 9 Ibid., p. 242.

8At first sight, it might seem odd why Wimmer wrote a textbook of over 250 pages on degenerated children, when he did not have much faith in the possibility of curing or even treating them efficiently. Wimmer warned his readers: “It is often said that the child is the father of man. This sentence is especially true of the degenerated children. Age only rarely softens their unfortunate, mental distinctiveness, more often it is drawn up with darker lines. Therefore, it will not be difficult to recognize the types of children, which I have described in the previous parts, when one at a later point encounters them as adults9.” Hence, Wimmer’s medical interest and advice on the need for attention to children’s mental disorders was grounded in socio-economic concerns: degenerated children were not only difficult to deal with when they were children. The abnormal mental constitution was also a sinister warning of the even more serious difficulties that society would have to endure when the child would become an adult. The individual degeneration was only a lesser problem in itself, but the prevalence of degeneration in general was a much more serious, societal problem: when the degenerated children became adults, and began to reproduce themselves, thereby passing on their pathological heritage to the next generation, society would get even more mentally ill patients, criminals, alcoholics, etc., to take care of.

Child psychiatry (1948) – the child psychiatrist becomes an analyst

  • 10 Junghans, Mellem…, p. 47-50.

9Even though debates on the nature, severity and incidence of children’s mental disorders ensued amongst Danish psychiatrists in the decades following the publication of Wimmer’s textbook in 190910, Degenerated Children was not challenged before 1948, when Child Psychiatry (in Danish: “Børnepsykiatri”) was published. The book was written by the Danish psychiatrist Margrete Lomholt, who worked at the child psychiatric department at Risskov psychiatric hospital in Aarhus, and was a mother of four children herself. In line with Wimmer, Lomholt argued that “actual mental diseases” were uncommon in children, but that many children suffered from non-psychotic mental disturbances. The first two chapters of Lomholt’s textbook covered the normal development of the child, aetiology and examination methodology and the last chapter covered treatment. The remaining chapters covered intellectual defects, organic mental diseases, psychoses, psychopathy, psychosomatic disorders, behavioural disorders, neuroses and mental disturbances in children with speech or reading impairments.

  • 11 Lomholt Margrete, Børnepsykiatri, Copenhague, Rosenkilde og Baggers Forlag, 1948, p. 74.
  • 12 Lomholt, Børnepsykiatri…, p. 102-111.
  • 13 Ibid., p. 149.

10According to Lomholt, the defining feature of children with intellectual defects was the inability to function normally among peers, not just because of the intellectual defects but also because of a primitive emotional life as well as poor imagination and perceptive skills. Although Lomholt did not use the term “degeneration”, she was leaning towards a similar line of thinking, when stating that the large number of mentally retarded children was a problem for society as a whole, because they – without the correct medical and pedagogical treatment – would turn into criminals, prostitutes, unemployed or other types of ‘antisocial’ individuals11. Although no treatment could help the most severely impaired, Lomholt was less pessimistic than Wimmer when it came to children with milder intellectual defects – she emphasized the crucial role of early identification and intervention in giving the child the chance of an independent and productive future. Whereas the chapter on organic mental diseases focused on epilepsy, encephalitis, congenital syphilis and other diseases with a known aetiology, the following chapters on psychoses and psychopathy were remarkably short and stated that psychoses and psychopathy were in essence diagnoses for adults and could only very rarely be used in relation to children12. The chapters on psychosomatic and behavioural disorders were markedly different from the previous ones, because Lomholt listed symptoms (for example vomiting, enuresis, tics, lack of concentration, stealing, lying and jealousy-reactions) without connecting them to or making them fit into a more specific diagnosis. She explained that all of the various symptoms exhibited were equally worthy of attention from the child psychiatrist and that it was essential to understand these symptoms as the child’s reaction to some sort of difficulties in his/her milieu13. Using several case-stories, Lomholt demonstrated to her readers that the proficient child psychiatrist was one who was able to gather reliable information, analyse it and thereby identify the underlying causes of the child’s behaviour and then finally, able to share this knowledge with the child’s parents in a way that made them able to deal with the situation and help their child overcome his/her difficulties.

  • 14 Ibid., p. 28-47.

11That Lomholt assigned the child psychiatrist a more analytic role was also clear in her novel description of how to approach the child and parents in the consultation room. She explained that it was of utmost importance to observe not only the child, but also the parents from the very beginning of the consultation, as this would provide the child psychiatrist with valuable clues about the relationship between child and parents. The child psychiatrist should not only perform a thorough physical examination of the child and conduct various tests, but also inquire the parents about the reason for their visit, the child’s medical history, socio-economic conditions of the home, schooling, relationships with family and friends, and much more14.

  • 15 The literature list in Wimmer’s textbook listed 50 works, of which 35 were written in German, 8 in (...)
  • 16 Kanner Leo, Child Psychiatry, London, Baillière, Tindall & Cox, 1935, p. 16.
  • 17 Kanner Child…., p. 15.

12Whereas Wimmer’s textbook was heavily influenced by German and French psychiatry, it is not only clear that Lomholt was more oriented towards American and British research, but also that the amount of available literature on the topic of mentally disordered children had blossomed since 190915. The literature list in Lomholt’s textbook is varied both in terms of topics and languages; however, the most progressive chapters in her book are clearly influenced by the internationally renowned textbook Child psychiatry, published in 1935, authored by the Austrian-American psychiatrist Leo Kanner. Kanner’s textbook represented a profound analytical shift in the theoretical and methodological foundations of child psychiatry, because it rejected popular notions about heredity as well as psychoanalytic theories. Instead, Kanner’s approach dictated that the professional child psychiatrist should ask two questions when a child was brought to an examination: What is the complaint? And who is the child who presents this complaint16? The complaint presented by the parents could be a bruise, temper tantrums, night terrors or enuresis, for example, and the task of the child psychiatrist was to inquire about the onset of the problem, its development and the previously used therapeutic efforts. After a thorough examination of the child, the psychiatrist would reformulate the complaint of the parents into a diagnosis enabling a clear recognition of the problem and plans for treatment17. In order to answer the second question, “Who is the child who presents this complaint?”, a brief personal history of the child should be obtained, followed by another thorough examination. Reliable information on intellectual capacity, emotional life, habits, aversions, predilections and milieu had to be at hand. Thus, Lomholt’s chapter on examination methodology was clearly influenced by Kanner’s approach, but also Lomholts. Her two chapters on psychosomatic and behavioural disorders also reveal the link: Kanner’s textbook was not divided into chapters with separate diagnoses, but divided into chapters with different ‘complaints’, ranging from bedwetting, hyperactivity and stealing to jealousy, temper tantrums and poor reading skills.

13Hence, some chapters of Lomholt’s textbook represents a novel and much more holistic approach to mentally disordered children. Whereas psychiatrists like Wimmer and his contemporaries (in Denmark as well as internationally) had thought of mental disorders as something within the child and mainly grounded in heredity, Lomholt’s approach (clearly influenced by Kanner) emphasized that many of the most common mental disorders of children should be interpreted in relation to the child’s environment. Despite arguing for the importance of the environment, Lomholt still leaned towards diffuse notions on heredity (especially in her chapter on children with intellectual defects), but she was much more hesitant when explaining the precise aetiology of children’s mental disorders in general.

Safekeeping “degenerated adolescents”? – child psychiatric practices at Middelfart State Hospital, 1891-1940

  • 18 Fransen Peter, “Den arkivalske virkelighed”, Rønn Edith & Hartby Inger (ed.), Det forrykte mennesk (...)
  • 19 Junghans, Mellem…; op. cit. Christiansen Karen Spillemose and Ssjelborg-pedersen Pedersen Signe, Si (...)
  • 20 Junghans, Mellem… p. 59.

14At the beginning of the 20th century, care for the mentally ill in Denmark was a matter for the state, but children and adolescents could not officially be admitted as patients at the state’s mental hospitals and were not mentioned according into the official regulations from 188818. Therefore, when children or adolescents exhibited symptoms of mental illness, little could – in theory – be done. Despite this, some Danish studies have shown that a small number of children and adolescents was in fact admitted to Danish mental hospitals in the second half of the 19th century and the early 20th century19. The most substantial of these studies is a study from 2012, examining 263 medical records on mentally ill children admitted to Middelfart State Hospital in the period from 1891 to 1940. Middelfart State hospital was a state-owned psychiatric hospital in picturesque surroundings in a rural province in Denmark and at the time of its opening in 1888, it was the most modern Danish psychiatric hospital. Children and adolescents aged 5-18 constituted around 5% of the admitted patients. The majority of these (80%) were adolescents aged 16 to 18, whereas the rest were younger, but no one below the age of 520.

  • 21 For a more detailed description of the admittance process at Middelfart State Hospital, see: Jungha (...)
  • 22 In the existing literature, the economic resources of the household, the public reputation of menta (...)

15Mentally disordered children were kept at home, unless their illness was severe enough for them to pose a threat to themselves or the members of their household. In order for a child to be admitted, the local general practitioner would have to fill out a form stating the nature of the mental symptoms and how they had evolved as well as testifying to what symptoms he/she had personally observed. The request would be sent to the chief psychiatrist at Middelfart State Hospital, who would then decide whether or not to admit the child. Thus, an admittance to a mental hospital necessitated a positive evaluation by the local practitioner and the head of the psychiatric institution21. Before being admitted to Middelfart, many children and adolescents had been admitted to local hospitals or other institutions, which suggests that sending a child to a mental hospital was the last resort22.

16That safekeeping was more important than actual treatment is suggested by the fact that the treatment offered at Middelfart was not adjusted in relation to the age of the patient: the most common treatment was rest (preferably in bed) and in some cases, sedatives (for example, potassium bromide, chloral hydrate or opium). Thus, the treatment of children and adolescents did not differ significantly from the treatment of adults, or the treatment offered at a normal hospital or what could be administered in the child’s home with the assistance of the local general practitioner.

  • 23 Junghans, Mellem…, p. 73-75.

17The majority of child and adolescent admittances to Middelfart State Hospital were marked by two distinct features: the child’s behaviour had become so obstructive that the child posed a threat to himself/herself or his/her surroundings and the child was no longer able to be sufficiently productive (in school, at home or in employment). Reversely, these features were also the two parameters that determined when and if a child or adolescent could be discharged. First, the child should be able to and want to work (exhibit diligence). Occupational therapy was an integral part of everyday life at an institution like Middelfart State Hospital and patients had to participate in various kinds of practical work (handwork, cooking, laundering, gardening, etc.). This ensured that the costs of running the institution were kept in check, but also functioned as a way of preparing patients for returning to life outside the hospital. Children and adolescents were no exception in this regard. Second, the ability to socialize appropriately with staff and fellow patients and in accordance with age, gender and social class was also essential. This meant behaving with respect towards authorities, being able to converse appropriately, being kind and trusting towards others23.

18Even though the vague diagnostic categories Wimmer had presented in Degenerated Children were not explicitly found in the medical records at Middelfart, the theoretical underpinnings of his work were visible: when children and adolescents were admitted, long and detailed descriptions of their family backgrounds were necessary for the psychiatrist to assess the weight of hereditary taint. These descriptions focused not only on mental and neurological diseases but also on character traits and behaviour deemed deviant (criminality, prostitution, unemployment). On the other hand, the socio-economic conditions of the home and familial relationships caused little to no concern and were accepted as something that did not play any significant role in causing mental disturbances in children and adolescents. All in all, specific child psychiatric practices at Middelfart State Hospital seems to have been the result of a small number of urgent cases and therefore resting on a theoretically wanting foundation.

Exploring the mind of the child – child psychiatric practices at the Copenhagen University Hospital, c. 1935-1960

  • 24 Danish National Archives, Copenhagen, Rigshospitalet, Børnepsykiatrisk Afdeling OB: Patientjournal (...)

19The patients and practices at the child psychiatric clinic at the Copenhagen University Hospital were markedly different from the ones at Middelfart. The first noticeable difference was that the patients accepted at the clinic were younger, i.e. the majority (61%) were between 6-13 of age (corresponding roughly to the age of formal schooling), 23% were between 1-5 years of age and the remaining were 14 years of age or older24. This is not surprising as the clinic was the first of its kind in Denmark and therefore focused exclusively on an age group that officially could be examined nowhere else. One of the more interesting differences between the two facilities was that the children who were admitted to Middelfart ended up there as a last resort – everything else had failed or proven insufficient, so a stay at Middelfart in order to receive a diagnosis and for the child’s caretakers and immediate surroundings to receive some much-needed rest was the goal. The child psychiatric clinic at the Copenhagen University Hospital was not a last resort, but a place where staff with (child) psychiatric expertise would observe and assess a mentally disordered child with the purpose of stating a diagnosis and making provisions for the child’s future. Neither treatment nor safekeeping was offered at the clinic. In order to conduct more thorough examinations and observations of the most puzzling and severe cases, the clinic was expanded with a bed-ward in 1944, but treatment was still not the purpose when admitting a child. Thus, the only thing offered at the clinic was the child psychiatric expertise needed to diagnose the child and identify the best available treatment.

20Compared to Middelfart State Hospital, it also seems fair to suggest that the child psychiatric clinic was led and run by idealistic and creative staff who dared to use more unconventional and experimental therapies and methods in their work with the children and their families. Even though Middelfart State Hospital had been a prestigious and modern project, when it was built in 1888, it was quickly overcrowded and out of synchronization with modern needs. By contrast, the methodologies and techniques used by the staff at the clinic at the Copenhagen University Hospital were many and diverse: the medical records reveal that apart from IQ-tests and small tests on specific cognitive or emotional abilities (for example language comprehension, morality or creativity) various forms of psychotherapy, photographs, drawings, play-therapy and various brain scans were also tools accessible to the psychiatric staff. Hence, even though treatment was not a goal, the toolbox for the psychiatrists at the Copenhagen University Hospital was far more refined. Drawings and play-therapy could be used as tools to access the inner life of the child, thereby revealing conflicts and emotions in a child too young to speak or whose mental disorder prevented it from using language in a comprehensible manner. Despite the diversity of these tools, it is evident both in the medical records from Middelfart State Hospital and from the clinic at the Copenhagen University Hospital that rehabilitation was an elusive concept, because available medical treatment options were very limited in scope. Like a few children and adolescents admitted to Middelfart, a few of the children admitted to the clinic at the Copenhagen University Hospital also received psychopharmacological medications during their stay, but it does not seem to have been widely used.

21In contrast with the children and adolescents at Middelfart, expectations regarding productivity were markedly different: the children received some schooling, but social and creative activities were equally important (i.e. different kinds of crafting, drawing, playing theatre, playing with toys, social interaction with the other admitted children and staff, playing outside, supervised excursions outside the hospital, and more.). Hence, expectations regarding what a normal child should take an interest in and could benefit from mentally was quite different at the clinic at the Copenhagen University Hospital. This indicates that ideas about the foundations of healthy child development and the “good childhood” had in essence changed.

  • 25 Ibid.

22An essential feature of the child psychiatric consultation-room was its role as a place of conflict – this goes for Middelfart State Hospital as well as the clinic at the Copenhagen University Hospital, but in slightly different ways. Children and adolescents were brought to Middelfart State Hospital, when all other options were exhausted and as a last resort. The children who were brought to the clinic at the Copenhagen University Hospital were taken there because they were in conflict with their surroundings, either their parents, siblings or other family members, children in school or their local neighbourhood, school- teachers or other authorities, but rarely as a last resort. A few children were brought to the clinic because their parents had a conflict and needed a psychiatric evaluation in relation to a legal trial over custody. Whereas the admittance of a child or adolescent to Middelfart State Hospital was something out of the ordinary, something that parents had to actively seek out despite the stigma connected to mental hospitals at the time, access to the clinic at the Copenhagen University Hospital was much easier: most children had been referred through the local general practitioner, but it was also possible for parents to contact the clinic directly. Thus, using the language of Kanner and Lomholt, the ‘complaints’ found in the medical records from the clinic at the Copenhagen University Hospital were much more diverse and most children did not have as lengthy and complicated medical histories behind them. A testament to the influence of Lomholt’s textbook, almost half of the children seen at the clinic at the Copenhagen University Hospital had notes in their medical records stating that their mental disorders were connected to their milieu25.

  • 26 Junghans, Mellem…, p. 71-72.

23Because the patients admitted to Middelfart were quite different from the patients seen at the Copenhagen University Hospital in terms of age as well as the length and severity of their medical histories, the experiences of the children and their parents were also likely to be different. Because the majority of the minors admitted to Middelfart were adolescents between 16 and 18, it is clear from the medical records that some of them were able to rebel against diagnoses and treatment by attempting to run away, physically resisting medication or simply refusing to cooperate and conform to the rules and norms of the institution26. This suggests that power relations between psychiatric staff and adolescent patients could be challenging and uneven. By comparison, the admitted children at the Copenhagen University Hospital presents a different imagery: neither children nor parents seem to have resisted the given diagnoses or suggested treatments. On the contrary and only with a few exceptions, the medical records, usually exhibit a good relationship between children and staff. It seems plausible that the psychiatric staff at the Copenhagen University Hospital were more sophistically trained in establishing good contact with children and parents – which, as Lomholt had stated in her textbook, was of the utmost importance. By contrast, the staff at Middelfart State Hospital does not seem to have been trained in or aware of these new techniques and methodologies, probably because they did not have the need as they rarely admitted child psychiatric patients.

Concluding remarks: child psychiatry after the Second World War

24This article provides small pieces of the puzzle on the development of Danish child psychiatry. Only in recent years have historians directed their attention at children in psychiatric care, and no doubt much more research still lies ahead. Obvious fields for future enquiry include the role and use of psychotherapy, IQ-testing and other tools, notions of gender and its influence on child psychiatric practices, international relations in child psychiatry and the role of interdisciplinary teamwork.

  • 27 Flugel John Carl (ed.), Proceedings of the international conference on Child Psychiatry 11th-14th (...)

25It is thought-provoking that it took almost five decades and two world wars before child psychiatry became a weightier part of both medical and public conscience. Situating child psychiatric practices and the general development of child psychiatry in a wider, international context, it could be suggested that two developments in particular, closely associated with the Second World War, played a significant role. First, the turn away from German science after the Second World War, pushed the theoretical foundations of Danish child psychiatry towards Anglo-Saxon approaches that did not emphasize heredity and eugenics in quite the same way. Second, in the aftermath of the Second World War, it seemed more urgent than ever to stop and contain aggression aggressiveness even on the smallest scale at the earliest possible time to prevent another devastating world war – child psychiatry was believed to be the perfect tool for this. At the second international conference on child psychiatry held in London in 1948, the President of the congress, John Rawling Rees, eloquently stated in his opening speech: “We can, and we must, see to it that children are more wisely handled, so that with better understanding they may grow up as people free to make positive and useful contacts with their fellows, rather than suffer from all those disorders that come from insecurity, misdirected aggression and all the negative qualities that lead to individual unhappiness and just as certainly to tensions and stresses in the larger groups of society27.” Thus, whereas Wimmer had argued in 1909 that civil society was threatened by the costs of degenerated children who – if left untreated – would turn into mentally ill, criminal or asocial adults, the concern voiced by Rees in 1948 pointed towards the costs of war and the need to produce mentally healthy and stable citizens.

26The comparison between the medical textbooks of Wimmer and Lomholt demonstrates a significant shift in notions about aetiology, treatment options and the role of the child psychiatrist and importance of child psychiatry. While Wimmer focused narrowly on heredity and the potential threat of degeneration to all of society, Lomholt was clearly inspired by Kanner’s holistic approach, even though she only incorporated parts of his textbook in her own. Thus, child psychiatric theory in Denmark underwent significant changes in the first half of the 20th century. The changes are significant, but less conspicuous, when comparing the psychiatric practices at Middelfart State Hospital with the child psychiatric clinic the Copenhagen University Hospital. Whereas the idea of a psychiatric clinic specialized in the care and treatment of children would have been almost unthinkable at the start of the 20th century, the clinic at the Copenhagen University Hospital had to be expanded only nine years after its establishment – a testament to its success. Furthermore, the practices at the clinic differed markedly from psychiatric practices at normal mental hospitals for adults, demonstrating how new ideas on child development were taking hold.

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1 Sheffer Edith, Asperger’s Children – The Origins of Autism in Nazi Vienna, New York, W. W. Norton & Company, 2018. Taylor Steven J., Child insanity in England 1845-1907, London, Palgrave McMillan, 2017. Evans Bonnie, The metamorphosis of autism – A history of child development in Britain, Manchester University Press, 2017. Boussion Samuel & Coffin Jean-Christophe (dir.), Le psychiatre, l’enfant et L’État – Enjeux d’une spécialité en construction, 1900-1950, Revue d’histoire l’enfance « irrégulière », no 18, Rennes, PUR, 2016. Smith Matthew, Hyperactive – the controversial history of ADHD, London, Reaktion Books 2012. Shuttleworth Sally, The Mind of the Child – Child development in Literature, Science and Medicine, 1840-1900, Oxford University Press, 2010.

2 The Danish parliament decided in 1946 that a second national child psychiatric facility should be built in relation to Risskov Psychiatric Hospital in Aarhus. Mentally ill children were treated as outpatients from the same year, but the new child psychiatric ward was not opened before 1958.

3 Hallager Frederik Kristoffer, « Litteraturanmeldelse », Ugeskrift for Læger, vol. 72, no 3, 20 janvier 1910, p. 66-67.

4 The archival work with the medical records on children and adolescents at Middelfart State Hospital was conducted in relation to the completion of my Master’s Thesis in 2011-2012. Admittance records of 263 children and adolescents were selected. For further details, see: Junghans Jennie Sejr, Mellem arv og miljø – Dansk børnepsykiatri 1891-1940 [unpublished master’s thesis, University of Copenhagen], 2012, p. 24-27.

5 Wimmer August, Degenererede Børn, Copenhague, Gyldendalske Boghandel Nordisk Forlag, 1909, p. 2-3.

6 Ibid., p. 59.

7 This concept of degeneration was heavily inspired by Darwin’s theory of evolution and by the French physician Benedict A. Morel’s theory on heritable degeneration.

8 Wimmer, Degenererede…, p. 249-253.

9 Ibid., p. 242.

10 Junghans, Mellem…, p. 47-50.

11 Lomholt Margrete, Børnepsykiatri, Copenhague, Rosenkilde og Baggers Forlag, 1948, p. 74.

12 Lomholt, Børnepsykiatri…, p. 102-111.

13 Ibid., p. 149.

14 Ibid., p. 28-47.

15 The literature list in Wimmer’s textbook listed 50 works, of which 35 were written in German, 8 in French and only three in Danish or Norwegian. The literature list in Lomholt’s textbook listed 42 works, of which 22 were written in Danish (or translated into Danish) and only four written in German. However, Lomholt did explicitly note that she had chosen and preferred easily accessible, Danish and Swedish works for the literature list, whereas Wimmers did not reveal similar considerations. See: Wimmer, Degenererede…, p. 263-264; Lomholt, Børnepsykiatri…, p. 261-263.

16 Kanner Leo, Child Psychiatry, London, Baillière, Tindall & Cox, 1935, p. 16.

17 Kanner Child…., p. 15.

18 Fransen Peter, “Den arkivalske virkelighed”, Rønn Edith & Hartby Inger (ed.), Det forrykte menneske – Den psykisk syge i historien ca. 1830-1980, Ebeltoft, Skippershoved, 2006, p. 96. Nørup Maiken Rude, “Sindssygehospitalet ved Middelfart”, Rønn & Hartby (ed.), Det forrykte…, p. 146.

19 Junghans, Mellem…; op. cit. Christiansen Karen Spillemose and Ssjelborg-pedersen Pedersen Signe, Sindslidende børn – deres indlæggelser på Jydske Asyl, Museet Psykiatrisk Hospital Risskov, 2009 [online]: (accessed online 2021/03/15).

20 Junghans, Mellem… p. 59.

21 For a more detailed description of the admittance process at Middelfart State Hospital, see: Junghans, Mellem…, p. 59-62. For a similar description on the admittance procedure for ‘idiot’ children in 19th century England, see Wright David, « Family Strategies and the institutional confinement of “idiot” children in Victorian England », Journal of Family History, 23-no 2, 1998, p. 193-194.

22 In the existing literature, the economic resources of the household, the public reputation of mental hospitals, migration in relation to urbanization have all been identified as crucial factors in families’ decisions to have children or adolescents admitted to mental hospitals. See Taylor, Child…, p. 67-97; Wright Family…, p. 195-204.

23 Junghans, Mellem…, p. 73-75.

24 Danish National Archives, Copenhagen, Rigshospitalet, Børnepsykiatrisk Afdeling OB: Patientjournaler (1935-1976). Box 4, 10, 16, 25, 35-36, 43, 52-53, 60, 68-69, 76-77.

25 Ibid.

26 Junghans, Mellem…, p. 71-72.

27 Flugel John Carl (ed.), Proceedings of the international conference on Child Psychiatry 11th-14th August, Londres, H. K. Lewis & Co. Ltd., 1948, p. 2.

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Jennie Sejr Junghans, « From degeneration to mental disorders: the development of child psychiatric theory and child psychiatric practices in Denmark, c. 1900-1950 »Revue d’histoire de l’enfance « irrégulière », 23 | 2021, 155-169.

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Jennie Sejr Junghans, « From degeneration to mental disorders: the development of child psychiatric theory and child psychiatric practices in Denmark, c. 1900-1950 »Revue d’histoire de l’enfance « irrégulière » [En ligne], 23 | 2021, mis en ligne le 09 septembre 2023, consulté le 02 décembre 2023. URL : ; DOI :

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Jennie Sejr Junghans

Doctorante en histoire de la médecine à l'Institut universitaire européen de Florence

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