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The Physician as Educator and The Child's Need for Affection1
By Alfred Adler 
Chapters VI and XIII in The Collected Clinical Works of Alfred Adler: Volume 2
The problem of rearing as encountered by parents and teachers is easily underestimated. It would seem after centuries of civilization that the controversial questions surrounding the raising of children would have been resolved. It would also seem that everyone having learned this could pass it on to others and with a clear understanding of an individual’s potential and goals function effectively and fruitfully. What a fallacy that is! No other experience could impress upon us as clearly the subjectiveness of our views and our thinking and the extent to which the way we lead our lives is animated by our will. There is an almost insurmountable force that guides every step of those raising children to force them to follow their paths and make them like themselves not only in the way they act but also in their view of life and temperament. Bringing up a child according to a pattern, or educating the child toward a particular pattern, was often, and still is, the guiding star of parents. Unjustified, of course! However, everyone who does not consciously resist it follows that star.
A fleeting glance shows us the multifariousness of personal traits. No child is like any other and in each child there are traces of his traits that can be observed into old age. Yes, everything that we can see in a human being, admire, or hate is nothing but the sum of his characteristics and the manner in which he makes himself known to the outside world. With this view of the relationship of characteristics to personality it should be clear that there can be no discussion of a total eradication of original traits, whether or not they suit the educator. What is possible in the art of education can be stated concisely as our ability either to further traits or to stem their development, or, and this is more practicable, to guide specific traits toward social goals that cannot be attained without education or with the wrong methods.
From this can also be derived the precept that the role of educator is not for everyone. Disposition and development are significant for the educator when judged in terms of the impact he makes. He must be exemplary in making deliberate judgments. He must know the heights and depths of the human soul. He must be able to scrutinize his own qualities and their development as well as those of others. He must have the strength to overcome his own personal tendencies and to immerse himself into the personality of another and to scoop out of the shaft of another's soul whatever is lacking for growth. If among
1 Originally published as "Der Artz als Erzieher" in Heilen und Bilden. 2 New translation by Gerald L. Liebenau, 2002.
thousands there is one individual endowed with such natural resources, that person is an educator. Our verdict will be no different when we judge the characteristics and capabilities of a good physician. He also must be exceptionally endowed with the ability to make deliberate judgments. The human soul must become a familiar instrument and, like the educator, he must avoid wasting his strength on superficial manifestations. With an ever alert interest he must work on the roots and drives of every anomaly and must understand how to reach the path that leads from the symptom to the source of an illness. He must be free from being overwhelmed by self-delusion for he, like the educator, must know and be able to master himself and uncover with clear logic and intuition the healing forces in the patient, awaken them, and nurture them.
The educational power of physicians and of medical science is enormous. It leaves in all areas of prophylaxis imperishable traces and moves the best people to work actively in this field. We are the first line of defense in the struggle against alcoholism and infectious diseases. Physicians initiated the cry for help against the sexual diseases' crushing effect on the vitality of the individual. Until an effective cure is available, the assault of tuberculosis has been withstood only through constant education and warnings by physicians. The horror of infant death that for decades has been accepted as sacrosanct murder and barbarity has now been illuminated by science and become a focal point in the battle for eradication. School hygiene eagerly awaits the start of seeing fruition from its efforts and looking forward toward freeing itself from the brazen grip of miserly administrators. A wealth of generous and valuable advice inundates the people day after day and if not much of that comes to fruition it is because the educational services and welfare are not in the hands of physicians.
In the area of children's physical education the physician's dominant position is unquestioned. The amount and type of nourishment, the apportionment of work to recreation and play, training and physical development should, and, in cases of need, must be regulated by the physician. The overseeing of the child's physical development, the immediate relief in cases of sudden distress, is one of the physician's most important professional duties. Not the treating and healing of sick children, but the protection of children from illness is medical science's most consequent and loftiest objective.
The development of the body cannot be separated from training the mind. Participation in the latter is not too frequently afforded the physician even though with his objectivity and thoroughness he is particularly well equipped to draw on valuable treasures from his rich lore of experience. Preyer's work on Die Seele des Kindes --
The Soul of the Child3
-- provides a mass of fundamental data that should be known to every educator. The work is far from having exhausted the subject but offers material for judging and examining one's own experiences. The same is true for Karl Grooss' book, Ueber das Seelenleben des Kindes
3 4th edition, Leipzig, Th. Griebens publisher4 Berlin, Reuther & Reichardt
Inner Life of the Child, which is of greater interest to the psychologist. Neither book strives to influence public education and for a number of reasons is unable to do so. Perhaps it took Freud's forceful em
phasis on children
5 and the description of the tragic conflicts that flow from anomalies in childhood experiences for us to understand clearly the importance of early childhood education.
In light of the total anarchy under which the development of children takes place in their parents' home, we might understand that many noteworthy people prefer the lack of any education over the forms of education available today. Yet, there are a number of problems which, without the knowledge of a child's psyche, cannot be resolved. Some of these constantly arising problems will be discussed in what follows since we believe that the physician above all is called upon to raise his voice.
As is well known, the education of the child is said to begin in the mother's womb. The physician is obligated to advise the parents that only healthy people are fit for propagation. His duty is to to point out that where there is alcoholism, venereal disease, psychoses, epilepsy, tuberculosis, etc. the marriage is endangered, and that there are harmful effects for posterity. The physical and psychological care of the pregnant woman cannot be neglected; the importance of nursing must be communicated.
Of greatest importance for the upbringing of the infant is diligence and cleanliness. Nothing is easier than to foster a selfish cry-baby by constantly catering to his need for nourishment. He will be unable to endure later not having his wishes satisfied without becoming very upset. Education toward cleanliness must above all serve as a powerful lever to further culture. A child who has become used to keeping his body clean will later not be comfortable with dirty things.
The neglect of physical education, as is commonly the practice in our time, is certain to have adverse effects on the physical and mental health of the individual. A good physical condition goes hand in hand with mental development. Weak and sickly children easily lose the best support for their mental progress: confidence in their own powers. The same can be found in pampered children and those who have been overly protected by fearful parents. They avoid all physical and mental demands and like to escape by simulating illness. For that reason physical exercise like gymnastics, jumping, swimming, and outside play must not be overlooked by the educator. Such activities give the child self-confidence and will later be manifested in personal courage and strength, which, nourished by surplus sources of strength, will protect the child from depravity.
Where the physician has to deal with children who are mentally retarded, deaf, blind, or afflicted by cretinism his task will be to ascertain the extent of the problem, estimate chances for curing or improving the condition and
S. Freud, Traumdeutung, (dream analysis), Deuticke, Vienna
recommending an appropriate, and at most times an individualized, treatment and educational program.
The most important aid in education is love. Education can occur only with love and affection for the child. We have observed time and again how children pay attention to those they love and how they try to imitate them in their movements, expression, and language. Such love cannot be overestimated since it is the best insurance for making education possible. This love should be divided equally between mother and father and everything must be done to avoid excluding one or the other. Conflicts between parents and any criticism of measures applied by one or the other should be kept secret from the child. Preferring one child over another should be concealed since it would immediately create bitter jealousy. As it is, it is difficult to dampen an older child's jealousy --exhibited in many ways -- of a newborn. On the other hand, excessive love and effusiveness should be avoided. As comforting to parents it may be, such excessiveness hampers the development of the child. Directing love and affection toward ethically worthy striving, work, and diligence would guarantee the right middle course.
When outsiders are in charge of the upbringing or educating of the child such as a nurse, private teacher, governess, or a retired person, the parents must be aware of the dangers inherent in transferring such a responsibility. Aside from catching infectious diseases or exposure to obvious vices, one must question the capability of a governess to replace a parent's love. Intimidated, bitter, and in demeaning situations their entire life, such unfortunate creatures often are not capable of seeing to a child's intellectual development.
Punishment cannot be avoided in upbringing. In such instances, however, the only consideration must be improvement. Since beating a child no longer is legal it must appear barbaric for children to be spanked. Whoever believes that a child cannot be brought up without spanking admits to his or her incompetence and should not become involved in bringing up a child. When punishment cannot be avoided it should only be to demonstrate to the child the wrong done, to show and teach the limits of the child's powers, and by depriving the child of things that will not harm and will help him concentrate on what is better. Not allowing the child to sit at the table with the parents, a short, serious warning, a sharp glance should be sufficient. Denying the child food, which at the most should only be fruits and candies, should only be done in extreme cases, such as when the child stubbornly refuses to eat, and then only for short periods of time, and to serve as severe punishment. We regard locking up a child to be just as barbaric as beatings. We suspect that this kind of punishment has the same adverse impact on the child's character as would the first jail sentence for a youthful criminal. However, even light punishment, if applied too frequently, can easily lead to repetition and harm the individual's self-respect. Swearing and unusually harsh censure impedes chances for a successful upbringing. As with all educational measures applied to the extreme it is easy for the child to become used to them and then readily endure them later in life. Praise and reward, on the other hand, can be accepted by the child in surprisingly large measure. Here also, however, it is possible to do harm by exaggeration; the child then begins to believe that all his actions are praiseworthy and starts looking for immediate rewards. The upbringing of a child must be guided by far-seeing educators. Education is not for the next day, but for the distant future. Above all, consideration should be given that the child grows up with a clear knowledge that the parents always are fair judges and, at the same time, loving protectors.
Among the normally punishable misdeeds of children, childish obstinacy and lying are particularly noteworthy. Obstinacy in early childhood should be carefully censured with friendly warnings. In the early years it means nothing but a desire for independence. It is thus a positive symptom, that can turn bad only when constantly praised. When older or in adulthood, however, constant obstinacy is almost an impairment of the person's further development and can then actually be deterred only by pointing to the harmful consequences and calmly noting when they occur. In following this course, all references to a supernatural intercession, such as God's punishment, must be avoided since that would hide from the child the connection between cause and punishment. From that aspect, even where children are obstinate the development of their independence is threatened. Next to "yes" sayers there are an equal number of "no" sayers, neither differs from the other in attitude and weakness in character.
The greatest confusion exists in cases of children lying. Since our whole life is permeated by lies it should not be surprising to find that young children lie. In fact, the very young lie in the most harmless ways. It begins with words that lack any bad intent. Later, fantasies entail lies. These also should not be taken seriously. They often are fed by too many fantastic tales and books and are the result of an increasingly prevalent craving for status and dominance. Pointing out the reality of things, substituting for fantasies true stories, nature stories, and travel stories, and instituting physical activity makes a quick end to lying. In later years the motives become much clearer. The most important reasons are lying out of vanity, selfishness, and from fear. If the motives can be countered effectively the lying also will stop. When fear or embarrassment are the cause of lying, the blame falls on education. Under no condition should the child fear the upbringer or educator. One would be ill advised letting a child participate in lying or distorting of others and one should avoid in particular such expressions as "Wait, I'll tell your father!" to make a child apologize. This increases the tendency to lie and to say nothing. Confessions can become a natural crutch when carelessly employed by parents and can lead to a tendency to keep secrets and to avoid the truth. Good examples are a sure guarantee that lying will not become rooted in the individual and bode well for the entire educational process. On the other hand every sort of confrontation and inquisition will have a harmful effect. The same applies to forcing apologies which should always come only voluntarily. A highly effective means against lying is building a courageous character that would reject lying as an intolerable disparagement.
Obedience by a child should not be forced but should be a natural result of upbringing. The child must be allowed a freedom of choice. Nothing is more egregious than continuous warnings, as so often is practiced. Since in some instances it becomes unavoidable that the child obey, obedience should be gained through understanding. Thus every directive should be understandable and every unjust demand avoided since it shakes confidence in the parents. Similarly, all useless, unfeasible, and constant threats should be avoided. Unfairness toward the child by siblings or friends can be useful when applied to demonstrate the value of fairness toward everyone.
In general, the educator is obligated to play the important role of being an advocate for the orienting conscience of the child. He is responsible for leading the child toward an understanding of how the forces and expressions of the child's inner life relate, so as to prevent the child from going astray or being misled by others. An all too frequently encountered type is the child who is exceedingly fearful, overly shy and highly sensitive. These characteristics are not useful for either work or play. Every loud noise scares such "scatter-brained" children out of their dream world and when looking at them, they turn their eyes away. Their humiliation in social settings, in school, and with physicians (fear of doctors), always puts them to flight into loneliness. Serious admonitions disappear without a trace, the humiliation remains, becomes more severe, and in time the child becomes incapable of further development. There is no greater anti-social element than withdrawal or cowardliness, particularly when it seems to have been forced on the person. If necessary, I would feel confident making a useful butcher, hunter, insect collector, or even surgeon, out of the most horrible boy. The coward will always be culturally inferior. If one succeeds in uncovering the roots of shyness, we can save that child from ruin and self-righteousness. Usually such a child had gone through a period of the most bitter feeling of inferiority. In their ignorance of the world and because of an upbringing that lacked in understanding, such children constantly expect their incompetence to be unmasked.
A cause of such manifestations is an inferiority of organs, which often already found ways of compensating, or, just as serious, the consequences of a strict or pampered upbringing. It deludes the child into seeing life's problems as fearful, to regard others as hostile, and to think first and foremost of oneself.
At this point we cannot suppress several important comments. First of all, under no circumstances, even where there have been sexual offenses, should a child be made to be scared. This will never help attain one's goal. It takes self-confidence away from the child and brings him into horrible confusion. Children who have been filled with fear regularly flee from life's problems and will follow the same course when in adulthood confronted by distress from any direction. Second, a child's self-confidence, his personal courage, is his greatest asset. Later in life courageous children will not expect their fate to be effected by outside forces but will effect a change in their fortunes from inner strength. Third, the child's natural drive for knowledge should not be thwarted. Most children will pass through a stage where they will always ask questions. One should never see this merely as bothersome. With these questions the child reveals being puzzled by matters concerning his own existence and that all this questioning really comes down to this: From where did I come? and where am I going? As many of these questions should be answered as possible, and when the child asks silly or foolish question, he should be told so. When it finally comes to the one important question of conception it should be answered relative to the child's development, beginning with plants or lower animals as an explanation. This will lay the groundwork for the germ of an understanding of the cosmic relativity and the unity of organic life.
On the other hand early sexual awakening should be delayed as long as possible. What we know now is that sexuality exists in the earliest childhood years. It can easily be heightened by careless or malicious treatment, unseemliness, changes resulting from illness, by permitting coarseness, games, also by common children’s games. The child likes to observe and is inquisitive. The parents' bedroom should always be separate from that of the child. We can speak of co-education, but must warn of carelessness and surprises that would upset the child. Becoming aware of marital relations has a particularly devastating effect on children. Jealousy of the mother or father should be detected early and corrective measures should be taken.
A peculiar falling out with one's parents occurs mostly during puberty, and not only with parents but with everything surrounding the child. Skepticism and misgivings arise and boys in particular become prone to questioning any authority. There is hardly any doubt that these manifestations appear with the full recognition of sexual problems, with the awakening of the sexual drives, with self-assertion and masculinity, and that often these developments become excessive. This also is the time for sexual enlightenment which is carried out best by the father, mother, older friend, or physician. The counselor, turned educator, has the important task of using this time of doubt to nurture resistance against incompetent authority and to augment negative feelings with unvarnished information.
The child must be educated toward becoming a member of the community. The family and school automatically turn in that direction, even if resisted. Any diversion from that line threatens the child later with problems in adjusting for work, love, and society. Therefore, only those are suitable as teachers and educators who themselves have developed a social sense. Those who are obdurate, individualistic, egotistic, or fatalistic, especially if they believe in inherited qualities that cannot be changed, only cause harm. The same applies to single-minded dogmatists who only want to educate according to a scheme of their own and not in accordance with what society needs for its benefit.