Hospital Treatment for Infants at
High Psychiatric Risk
Philippe Mazet, M.D.
Françoise Gerstle, M.D.
Yannick Buffet, M.D.
Didier Rabain, M.D.
Didier-Jacques Duche, M.D.
As practitioners of child psychiatry in a large Parisian general hospital, we have sometimes been called upon to intervene in situations where there is an acute incompatibility between mother and child. Confronted with the deep distress of a very young child whose somatic symptoms are life-endangering, faced with the suffering of a mother and her child where the relationship has become very unfavorable to both, or faced with the exhaustion of a mother who rejects her child, the child psychiatrist may be led to introduce an ongoing solution, to open up a space between the protagonists, to opt for a pause in order to protect them from an interaction that has become destructive and sometimes even deadly.
It was thus that we elected, in the framework of the Child and Adolescent Psychiatry Center of La Salpêtrière, to hospitalize a small number (twenty-five) of under-three-year-olds as a result of an initial experiment in 1975, when a tiny eight-month-old girl who was severely anorectic and was "letting herself die," was admitted. The outcome was very beneficial to both the child and her family. This case marked a turning point in our understanding of how to cope with certain aspects of infant psychopathology, and it prompted us to deepen the interest and the specifity of this type of therapy, which, ever since, has never ceased to give us an opportunity for self-questioning, reflection, and the working out of new procedures and attitudes in respect to severely disturbed infant-mother (parent) interaction. Of course, such hospitalization only occupies a very restricted place among the different sorts of possible therapy for this age group. Interventions within the pediatric or maternity units, ongoing contact with the doctors, nursery nurses, and others in direct contact with the child constitute the greatest part of our care for infants.
Three main types of situation that have called for treatment in our psychiatric unit stand out. The first type is not the most common, but it is the most serious on a short-term basis; it involves infants suffering from severe somatic disorders which can endanger their lives. The life of the child suffering from physical marasmus, severe malnutrition, serious failure to thrive, massive anorexia, or severe merycism is in danger. It is obviously necessary to make an initial therapeutic intervention which takes this dimension into account, as well as to understand the family dynamics and the mother-child interactions implicit in the situation.
The case of Karim illustrates the kinds of