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(p. 29) Educational Diagnosis 

(p. 29) Educational Diagnosis
Chapter:
(p. 29) Educational Diagnosis
Author(s):

Donald W. Winnicott

DOI:
10.1093/med:psych/9780190271350.003.0002
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Subscriber: null; date: 16 January 2019

Originally published in the National Froebel Foundation Bulletin, 1946, 41, 3. Also published in The child and the outside world: Studies in developing relationships (pp. 29–34). London: Tavistock, 1957; and The child, the family, and the outside world (pp. 205–210). Harmondsworth, UK: Penguin, 1964.

What is there that a doctor can usefully say to a teacher? Obviously he cannot teach him how to teach, and no one wants a teacher to take up a therapeutic attitude towards pupils. Pupils are not patients. At least, they are not patients in relation to the teacher while they are being taught.

When a doctor surveys the field of education, he soon finds himself asking a question: the whole of a doctor’s work is based on diagnosis; what in teaching corresponds to this in medical practice?

Diagnosis is so important to a doctor that there was once a tendency in medical schools to ignore the subject of therapy, or to relegate it to a corner where it can easily be forgotten. At the height of this phase of medical education, which was reached perhaps three or four decades ago, people spoke with enthusiasm about a new phase in medical education in which therapy would be the main thing taught. We are now presented with remarkable methods of therapy: penicillin, safe surgery, immunization against diphtheria, and so on, and the public is deluded into thinking that the practice of medicine is thereby improved, little knowing that these very improvements threaten the foundation of good medicine, which is accurate diagnosis. If an individual is ill and feverish, and is given an anti-biotic, and gets well, he thinks he is well served, but sociologically the case is a tragedy, because the doctor is relieved of the necessity of making a diagnosis by the fact of the patient’s response to the drug, blindly administered. Diagnosis on a scientific basis is the most precious part of our medical heritage, and distinguishes the medical profession from the faith healers, and the osteopaths, and all the other people we consult when we want a quick cure.

(p. 30) The question is, what do we see when we look at the teaching profession that corresponds with this business of diagnosis? It is quite possible that I am wrong, but I feel bound to say that I can see but little in teaching that is truly equivalent to the deliberate diagnosis of doctors. In my dealings with the teaching profession I am frequently disturbed in mind by the way in which the general mass of children are educated without first being diagnosed. Obvious exceptions spring to the mind, but I think the general statement is true. At any rate, it may be useful for a doctor to show what in his opinion could be gained from something equivalent to diagnosis, if it were seriously undertaken in the teaching world.

First of all, what is already being done in this direction? There is one way in which diagnosis comes in in every school; if a child is objectionable the tendency is for that child to be got rid of, either expelled, or removed by indirect pressure. This may be good for the school, but bad for the child, and most teachers would agree that the best thing is for such children to be eliminated at the beginning, when the Committee or the Headmaster or Headmistress ‘finds it unfortunately impossible to take another child at the moment’. However, it is extremely difficult for a Head to be certain that in refusing to admit doubtful cases he at the same time is not keeping out specially interesting children. If there were a scientific method available for selection of pupils, it would doubtless be used.

Scientific method is at hand for measuring available intelligence, the Intelligence Quotient (I.Q.). The various tests are well known and are employed on an increasing scale, though sometimes they are used as if they meant more than they can ever do. An I.Q. can be valuable at both ends of the scale. It is helpful to know by these carefully prepared tests that a child who is not doing well is able to reach an average attainment, thus showing that it is his emotional difficulties that are holding him up, if not actually a fault in the method of teaching; and it is also helpful to know that a child is so far below the average intellectually that he almost certainly has a poor brain which cannot benefit from education designed for children with good brains. In the case of mental defectives the diagnosis is usually fairly obvious before the test is made. There is general recognition that the provision of special schools for the backward, and of occupation centres for the very backward, is an essential part of any education scheme.

So far so good. Diagnosis is being made in so far as scientific method is available. However, most teachers feel that it is natural for their classes to contain both clever and less clever children, and they naturally adapt themselves to the varying needs of their pupils in so far as the classes are not too big for them to be able to do individual work. What troubles teachers is not so much the varying intellectual capacity of their children, as their varying emotional needs. Even with regard to teaching, some children thrive on having things rammed down their throats, whereas others only learn at their own pace, and (p. 31) in their own way, almost in secret. With regard to discipline, groups vary greatly, and no hard and fast rule works. If kindness works in one school, it fails in another: freedom, kindness, and tolerance can produce casualties, just as an atmosphere of strictness can. And then there is the question of the emotional needs of various sorts of children the amount of reliance on the personality of the teacher, and the mature and primitive feelings that develop in the children towards the person of the teacher. All these things vary, and although the ordinary good teacher manages to sort them out, there is often a feeling that a few children have to be denied what they obviously need for the sake of the many others, who would be disturbed if the school were to be adapted to the special needs of one or two. These are very big problems that are occupying the minds of teachers day in, day out, and a doctor’s suggestion is that more could be done than is being done at present along the lines of diagnosis. Perhaps the trouble is that classification is not yet properly worked out. The following suggestions might help.

In any group of children there are those whose homes are satisfactory and those whose homes are unsatisfactory. The former naturally use their homes for their emotional development. In their case the most important testing out and acting out is done at home, the parents of such children being able and willing to take responsibility. The children come to school for something to be added to their lives; they want to learn lessons. Even if learning is irksome, they want so many hours a day of hard work which will enable them to get through examinations, which can lead to their eventually working in a job like their parents. They expect organization of games, because this cannot be done at home, but playing in the ordinary sense of the word is something which belongs to home, and the fringe of home life. By contrast, the other children come to school for another purpose. They come with the idea that school might possibly provide what their home has failed to provide. They do not come to school to learn, but to find a home from home. This means that they seek a stable emotional situation in which they can exercise their own emotional lability, a group of which they can gradually become a part, a group that can be tested out as to its ability to withstand aggression and to tolerate aggressive ideas. How strange that these two kinds of children find themselves in the same classroom! It should surely be possible to have different types of schools, not by chance, but by planning, adapted to these extreme diagnostic groupings.

Teachers find themselves by temperament more suitable for one or other type of management. The first group of children cries out for teaching proper, with the emphasis on scholastic instruction, and it is with children living in their own satisfactory homes (or with good homes to go back to in the case of boarding-school children) that the most satisfactory teaching is done. On the other hand, with the other group of children without satisfactory homes, the need is for organized school life with suitable staffing arrangements, regular (p. 32) meals, supervision of clothing, management of children’s moods and of their extremes of compliance and non-cooperation. The emphasis here is on management. In this type of work teachers should be chosen for stability of character, or because of their own satisfactory private lives, rather than because of their ability to put across arithmetic. This cannot be done except in small groups; if there are too many children in the care of one teacher, how can each child be known personally, how can provision be made for day to day changes, and how can a teacher sort out such things as maniacal outbursts, unconsciously determined, from the more conscious testing of authority? In extreme cases the step has to be taken of providing these children with an alternative to home life in the shape of a hostel, this alone giving the school a chance to do some actual teaching. In small hostels there is immense gain from the fact that, because of the smallness of the group, each child can be totally managed over a long period of time in a personal way by a small constant staff. The relation of the staff to what remains of each child’s home life is in itself a tricky and time-absorbing business, which further proves the need for the avoidance of large groups in the management of these children.

A sorting out along these lines occurs naturally in private school selection, because there are all types of schools, and all types of masters and mistresses, and gradually through agencies and hearsay parents more or less sort out themselves, and the children find themselves in suitable schools. However, where day schools have to be provided by the State, the matter is quite different. The State has to act in a relatively blind way. Children have to be provided with schooling near the neighbourhood in which they live, and it is difficult to see how there can ever be enough schools in each neighbourhood for these extremes to be catered for. The State can grasp the difference between a mental defective and an intelligent child, and can take note of anti-social behaviour, but the application of anything so subtle as a sorting out of the children who have good homes from those who have not is extremely difficult. If the State attempts to sort out good from bad homes some gross errors will be made, and these errors will necessarily interfere with the especially good parents who are unconventional and who do not plan for appearances.

In spite of these difficulties, it seems to be worth while to draw attention to this sort of fact. Extremes sometimes usefully illustrate ideas. It is easy to say that a child who is anti-social and whose home has failed for one reason or another needs special management, and this can help us to see that so-called ‘normal’ children can already be divided into those whose homes are coping, and for whom education is a welcome addition, and those who expect from their school the essential qualities lacking in their own home.

The subject is even more complex because of the fact that some of the children who could be classified with those who lack a good home actually have a good home of which they are not able to make use, because of their own personal difficulties. Many families of several children have one who is (p. 33) unmanageable at home. It is a justifiable simplification, however, to make a division between those children whose homes can cope with them and those whose homes cannot cope with them, for the sake of illustrating a point. It would be necessary in a further development of this theme to make a further distinction between those children whose homes have failed them after making a good start, and those children who have had no satisfactory consistent personal introduction to the world at all, not even in early infancy. Along with these latter children will be those whose parents could have given these necessary things had not something interrupted the process, such as an operation, a long stay in hospital, a mother having suddenly to leave the child because of illness, and so on.

In a few words I have tried to show that teaching could very well base itself, as good medical practice does, on diagnosis. I have chosen only one kind of classification in order to make my meaning clear. This does not mean that there are not other and perhaps more important ways of sorting children. Sorting according to age and according to sex has certainly been much discussed among teachers. Further sorting could usefully be done according to psychiatric types. How strange to teach withdrawn and preoccupied children along with the extroverted and those whose goods are in the shop window! How strange to give the same teaching to a child in a depressive phase as is given to that child when the phase has given way to a more care-free mood! How strange to have one technique for the harnessing of true excitement and for the management of the ephemeral and unstable contra-depressive swing, or elated mood!

Of course, teachers do intuitively adapt themselves and their methods of teaching to the various and varying conditions that they meet with. In a sense this idea of classification and diagnosis is already even stale. Yet the suggestion is made here that teaching should be officially based on diagnosis, just as good medical practice is, and that intuitive understanding on the part of the specially talented teachers is not good enough for the profession as a whole. This is particularly important in view of the spread of State planning, which tends always to interfere with the talents of individuals, and to produce quantitative increase of accepted theory and practice. (p. 34)