The article reviewed here is ‘Symptom Tolerance in Paediatrics. A Case History’ by Donald Winnicott. Winnicott begins with an observation about changes in medical practice and emphasises that ‘it is…the living tissues that ultimately bring about a restoration of health, not the antibiotic’. He then examines how the doctor makes use of the body’s own tendency to be healthy in combination with a search for the physical or psychological causes of disease. He then suggests that when the psychodynamic elements are not taken into consideration the physician may become ‘symptom allergic’ and will become a symptom curer. Symptoms however are an important feature of diagnostic criteria as well as a marker of remission and so Winnicott’s remarks offers a commentary on contemporary practice. Winnicott then examines a case of enuresis. The case is an interesting one in which a young boy develops hallucinations shortly after the birth of his sister, his school reports that he has started stealing, was later expelled from school and became withdrawn remaining in bed through the day – a picture which could produce many differentials. Winnicott expands upon his earlier point by exploring the complex psychopathology and we are able to see that there is much more than the single symptom of enuresis that the boy presented with and which Winnicott chose as a representative symptom to illustrate his previous argument. Then just as suddenly as all of these symptoms had developed they spontaneously resolve and we hear that the boy is doing well at school, is academically ahead of his peers and playing the usual sports although we have limited follow-up data. Winnicott’s paper is as much an insight into historical practice as it is into his own insights into psychoanalysis and as with previous papers he writes clearly but also allows the reader a chance for reflection on many issues.
Donald Winnicott. Symptom Tolerance in Paediatrics. A Case History [Presidential address to the Section of Paediatrics, Royal Society of Medicine, February 27, 1953. Proceedings of the Royal Society of Medicine. Vol 46. No 8. August 1953. Chapter 14. pp 101-117. In D.W.Winnicott. Through Paediatrics to Psycho-Analysis. The International Psycho-Analytical Library. The Hogarth Press and The Institute of Psycho-Analysis.
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