IN PSYCHIATRY, as in any other branch of medicine, diagnosis and as full as possible an understanding of etiology and pathology are prerequisites to the prescribing of a treatment program. Unfortunately, in problems of delinquency, often the factors at play are more complex than in most diseases and, therefore, treatment needs are also more complex amid less clearly defined. Delinquency, of course, is not a diagnosis but a symptom. The delinquent act is like fever or a swelling; the factors underlying it are multiple and varied.
I shall try, somewhat in summary form, to describe treatment needs in terms of basic causes of delinquency. Our material is drawn from experience in a large public clinic in a medical school that serves the State of Michigan, and provides opportunity for intensive inpatient as well as outpatient study.
First, however, a note of caution: That juvenile delinquency has increased in recent years, especially acts of violence or destruction, is indicated by the statistics at hand. Reading many popular accounts today, one might well get the impression that all teen-agers have "gone to the dogs," that, as a group, they are marauding vandals without capacity for feeling or responsibility. This is, of course, far from the truth. Delinquency is a major social problem but our understanding of it is not helped if in our concern for the more dramatic we exaggerate and lose perspective. The tendency in recent years has been to describe the teen-ager in terms of only negatives. Some writers have gone so far as to stretch absurdity to the point of representing the most vicious, sadistic crime of the year as typical adolescent behavior.