Kindermisbruik. De blinde vlek op het netvlies van de vroege kinderpsychiatrie. Een onderzoek naar de manier waarop de vroege kinderpsychiatrie in Nederland in de eerste decennia van de twintigste eeuw omging met seksueel misbruik.
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In this thesis, I investigated how the emerging field of child psychiatry in the Netherlands approached sexual abuse of children during the first half of the twentieth century. Increasingly, child abuse had become unacceptable in the second half of the nineteenth century, due to a changing and more positive child concept. This was reflected by more numerous court cases related to abuse. Furthermore, the physical and serious psychological implications of rape and sexual assault of children were described in French forensic medicine literature. Thus, it seemed that child abuse was a timely issue for research on treatment and prevention by Dutch child psychiatrists. Surprisingly, early Dutch child psychiatry ignored child abuse during the first forty years of its existence. No publications were dedicated to the implications of sexual assault of children. In this thesis, I explore how the development, organisation, and the predominant paradigm of early child psychiatry underpinned this initial lack of interest. The early years of Dutch child psychiatry were heavily influenced by two factors that were closely intertwined: (1) the MOB (Medisch Opvoedkundig Bureau); and (2) psychoanalysis, the dominant psychiatric paradigm. The MOB was the forerunner of child psychiatric care in the Netherlands, as this institution offered parents educational support regarding behavioural issues with their children. The first child psychiatrists originated in the MOB and were deeply immersed in psychoanalysis. According to Freud’s psychoanalytic paradigm, behavioural problems of a child were largely the result of suppressed impulses fuelled by Oedipal incestuous desires. According to this view these desires were part of the child’s constitution and were therefore considered normal. I submit that because of the influential psychoanalytic paradigm, child psychiatrists minimized or ignored external sources of abuse. It was not until the 1970s when psychoanalysis had sufficiently lost ground, that the innocence of the child was restored, and sexual abuse was ascribed to environmental factors. This provided new insights in sources of sexual aggression towards children, such as parental abuse. The postmodern philosopher Michel Foucault, who wrote a history on sexuality, stated that this neglect by and silence of the medical profession could be considered a kind of discourse. By denying sexual abuse of children, other statements were made, like the importance of family life and the innate constitution of a child that includes its desire for incest. This supports Foucault’s idea that the history and development of medical science, in particular psychiatry, is not linear and is not entirely driven by new, empirical knowledge, but to a large extent, depends on social and cultural factors.