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Appalachia's Children

Appalachia's Children: The Challenge of Mental Health

David H. Looff
Copyright Date: 1971
Edition: 1
Pages: 206
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  • Book Info
    Appalachia's Children
    Book Description:

    This thoughtful, compassionate book makes a major contribution to our understanding of the Southern Appalachian child -- his mental disorders and his adaptive strengths. Drawing upon his extensive fieldwork as a clinical child psychiatrist in Eastern Kentucky, Dr. Looff suggests means by which these children can be helped to bridge the gap between their subculture and the mainstream of American life today.

    The children described in this book, the author points out, are in a real sense not "all children." Since no child grows up in a vacuum, the children of Eastern Kentucky cannot be understood apart from the historical, geographic, and socioeconomic characteristics of the area in which they grow. Knowledge of the children requires some knowledge of the lives of parent, teachers, and the many others upon whom they are dependent. That is to say, mental disorder -- or mental health -- is embedded in a social matrix. Dr. Looff therefore examines the milieu of these Southern Appalachian children, their future as adults, and how they can achieve their potential -- whether in their native or an urban setting. In viewing the children within their own cultural framework, Dr. Looff shows how they develop toward mental health or psychopathology, suggesting supportive techniques that build upon the strengths inherent in each child. These strengths, he suggests, rise out of the same culture that burdens the child with handicaps.

    Dr. Looff's position is one of guarded optimism, based on the successes of the techniques he has used and observed in seven years of work in Appalachian field clinics. Although he details instances of mental disorder in children, and instances of failure in family functioning, he notes at the same time family strengths and sees these strengths as sources of hope.

    Although this book is based on fieldwork techniques within a specific area and culture, it is paradigmatically suggestive of wider application. Dr. Looff demonstrates effectively and clearly the profound need for increased concern about what is happening to the rising generation -- the children of Eastern Kentucky, the children of the Southern Appalachian region, and the children of the rural south.

    eISBN: 978-0-8131-5042-0
    Subjects: Psychology, Sociology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Foreword
    (pp. ix-xii)
    Reginald S. Lourie

    There is always an excitement when one encounters a breakthrough. This is particularly true when it opens new solutions to an old, resistant and painful problem. That is the feeling with which I read Dr. Looff’s manuscript for this book. The problem is Appalachia.

    Appalachia has been a thorn in the side of the United States for more than a hundred years. While Negro slaves were being set free, another type of slavery was evolving in the rough Appalachian mountains, locked in by geography and bypassed by a rapidly developing country and economy, until, as Jack Weller describes it in...

  4. Preface
    (pp. xiii-xviii)
    D. H. L.

    • CHAPTER 1 Appalachian Themes
      (pp. 3-8)

      Eastern Kentucky first thrust itself on my awareness when, as a boy of twelve, I was given a copy ofNames on the Land.¹ The author of that book had drawn together a collection of unusual names of towns and places from across the United States. As a native Northwesterner—from Whidbey Island, in Puget Sound, in the western part of the state of Washington—I was fascinated by the author’s descriptions of the origins of such Eastern Kentucky places as Ida May, Paint Lick, Hell-for-Certain, Brightshade, and Asher’s Fork. I wondered then what the people were like who lived...

    • CHAPTER 2 The Manchester Project
      (pp. 9-17)

      The persons I describe and discuss in this book live in four Eastern Kentucky counties—Clay, Jackson, Lee, and Owsley. I came into contact with them through an unusual venture which we call the Manchester Project (Manchester is the county seat of Clay County).

      This came into being in 1964, largely as a result of the initiative of Mildred Gabbard, the regional health officer for the four counties, and her staff of eight senior public health nurses. In a mountain area such a public health team is of much greater relative importance than its urban counterpart. In the first place,...

    • CHAPTER 3 Power of the Family
      (pp. 18-23)

      One day the University of Kentucky Medical Center admitted Lonnie Thompson, a gaunt, fifty-two-year-old coal miner from Eastern Kentucky. Lonnie was sent to Lexington by his local physician for review of his chronic obstructive airway disease—a disorder that in recent years has become widely known as coal miners’ black lung.

      When he was placed on the specialty ward, Lonnie found himself separted from the family members and friends who had brought him to Lexington. After several days had passed, days in which he became increasingly anxious, he found himself trapped in an extremely unfamiliar situation: a number of physicians...

    • CHAPTER 4 In the Clinic: Dependency Themes
      (pp. 24-58)

      Eastern Kentucky families are markedly inner-directed. Certainly interdependent functioning characterized the great majority of our clinic families. Thomas Ford has pointed to an aspect of this functioning that has very important implications for mental health. He observes that the Southern Appalachian family system is held together by norms of obligation and not necessarily by bonds of affection. This of course does not mean that affection is generally lacking, but rather that a family member still has strict obligations to other family members even though he may no longer feel any affection toward them. And Ford comments that inner-directedness resulting from...

    • CHAPTER 5 In the Clinic: Psychosexual Themes
      (pp. 59-76)

      As has been abundantly indicated, marked inner-directedness characterized a great majority of the families that came to our clinics. Close, interdependent functioning was prominent as well in those families reviewed in our survey of Eastern Kentucky child development. The training climate for infants involved extremely close ties with older family members. As the children grew, closeness became a training end in itself. Children were taught in a myriad of verbal and nonverbal ways to maintain the close family system. Events and situations apparently viewed by parents as potentially threatening to the closeness of the family were coped with in a...

    • CHAPTER 6 In the Clinic: Communication Patterns
      (pp. 77-92)

      The use of language in Eastern Kentucky presents some striking contrasts. On the one hand, there are clear indications that many people in the region find verbal communication very difficult. Theirs is an economy of language amounting to sparseness. The stereotype of the Southern Appalachian mountaineer as a silent, taciturn individual is based on this difficulty. Neighbors of these people characterize them graphically as “quiet-turned.” In our field clinics, we have followed a number of the silent members of these relatively silent families. The striking phenomenon is that the silent families exist side by side with others who are quite...

    • CHAPTER 7 Family Portrait
      (pp. 93-106)

      A gauntlet was thrown down before us in the fall of 1964, early in the course of our work in the field clinics. At that time we were new in the region—a comparatively untried mental health resource team for children. Although our clinics in the local health departments had been established at the invitation of the regional health officer and her nursing staff, others in local leadership positions knew little about us. It was natural, then, that the challenge was a family that had baffled those who had tried to work with it. The psychiatric social worker for the...

    • CHAPTER 8 Some Findings and Comparisons
      (pp. 107-114)

      At this point we need to turn to some figures that give an explicit picture of the kinds and scale of problems dealt with by the Manchester Project. Table 1 summarizes the data on the psychopathology of the 287 emotionally troubled children diagnosed and treated in our field clinics during the initial six years of operation of the project—August 1964 through July 1970.

      The diagnostic terms used in this summary call for some discussion. First, the children referred to our field clinics had been designated as having emotional or learning problems by other persons in their cultural setting. These...

    • CHAPTER 9 Some Development Conclusions
      (pp. 115-124)

      When we launched the Manchester Project in 1964, we spent a good deal of time in reviewing the sociology of Eastern Kentucky and in making a field survey of child development in the region. Both the review and the survey were undertaken for purely pragmatic reasons. As a clinical team, we needed to understand how families in the region raise normal children, children able to cope relatively successfully with various developmental tasks. Such an understanding would give us a clinical yardstick for measuring (not in a precise sense, of course) the successes and failures in life adjustment of the children...


    • CHAPTER 10 New Health Programs
      (pp. 127-139)

      Ultimately, in Eastern Kentucky as anywhere else, it is people that make the area important. It is the people of the southern mountains, in their region or in the places to which they migrate, who are the makers and carriers of their society and culture. They are the ones, primarily, who train the rising generation of their children and live their lives in either satisfyingly productive or bleakly nonproductive ways. Thus, although many agencies, bureaus, and departments of the federal government and the various state governments are rightfully concerned with naturalresource development in Appalachia and with ways of fostering regional...

    • CHAPTER 11 New Community Programs
      (pp. 140-150)

      In the course of our clinical study of Eastern Kentucky families we talked with many different people—teachers, ministers, physicians, public-assistance and child welfare workers, and others. At first, these conferences were designed to round out our understanding of the problems or progress of particular children we were reviewing at the moment in our field clinics. Later, a regular program of case consultation to the schools and agencies in the counties served by our project afforded us the opportunity of exploring together the effects these community institutions had on the developing lives of children. We came to understand something about...


    • CHAPTER 12 The Region and Its People
      (pp. 153-163)

      The Southern Appalachian region, running from West Virginia and part of southeastern Ohio in the north to sections of northern Georgia and Alabama in the south, is a diverse land of mountains, broad river valleys, and eroded highland plateaus. The thirty-two counties that make up Eastern Kentucky are included in the western division of the region, called the Cumberland Plateau. Little of Eastern Kentucky is truly mountainous. The worn, stream-dissected highlands of the Cumberland Plateau present today a remarkably even appearance to one who flies over the region and views it in broad perspective. An aerial view shows how thinly...

    • CHAPTER 13 Operation of the Field Clinics
      (pp. 164-167)

      During the initial six years of operation of the Manchester Project, 287 emotionally troubled children and their families were referred to our field mental health clinics for diagnostic evaluation and treatment. An additional group of 650 children were discussed in case consultations at local schools. The majority of clinic referrals were made by the senior public health nurses from their district case loads. School personnel and local physicians also referred families, but always through the nursing staffs at the health departments. In this way, referrals took advantage of the nurses’ intimate knowledge of and proximity to the community, its families,...

    • CHAPTER 14 Mental Health of the Very Poor
      (pp. 168-174)

      The termvery poor, as used here and as used by others,¹ refers to those families in Eastern Kentucky who live at the bottom of the socioeconomic ladder, as distinguished from those poor who are one rung up this ladder—the generally self-sufficient and at least moderately successful working-class families. The very poor include individuals who have extremely limited employment skills. They are usually unskilled, casual laborers who remain chronically unemployed or severely underemployed. They are apt to have less than a fourth-grade education; many are illiterate or only barely able to read and write. For the most part, they...

  8. Notes
    (pp. 175-182)
  9. Index
    (pp. 183-186)