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Psychogenic factors in Sydenham's chorea among children : the social work aspects of a sample group of cases Staghall, Hattie Ransom

Abstract

During its first nine years of operation, the Eastern Washington Rheumatic Fever Program has served twenty-five children who had rheumatic chorea, and throughout this period members of the medical team have been puzzled concerning the etiology of choreic symptoms in this small but outstanding group. This study explores psychogenic aspects of this special group of cases, and views the implications of social casework responsibilities as related to total treatment plans for such children. The study is based mainly on a careful analysis of the twenty-five case histories, and in this regard a detailed schedule was used as guide. In "following up" cases where it was possible to do som direct contacts with patients or their families were made, as well as initiation of correspondence with some of the other social agencies particularly involved in certain case situations. Historical and statistical research material was included in the presentation of background factors of the illness in general, and In the outline of the rheumatic fever program. The primary objective of the study was to emphasize the importance of social and emotional factors in chorea as a sample illness, and to clarify the urgency of the need for social casework treatment concerning these factors. In growing children where such psychological problems exist, remedial therapy is particularly essential, and for this reason alone the study serves a useful purpose. Probably the most important specific findings of the survey were that these children seemed unusually conforming and submissive, so that their symptomatic behaviour appeared to indicate a need for permissable expression of pent-up, forbidden impulses. They seemed singularly deprived of adequate dependency upon parents or parent surrogates, and overly repressed, confirming, and masochistic, they found this abnormal means of ventilating instinctive aggressions and hostilities; this way of regressing to a more comfortable, dependent condition. Although the group studied was small, it nevertheless represented a complete survey of cases of rheumatic chorea appearing in the defined area during a nine year period. Therefore the conclusions presented are valuable in providing tentative bases for consideration in offering social casework assistance with the total treatment for the choreic child.

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