Abstract
This article investigates an overlooked aspect of the life and work of the Viennese child psychologist Charlotte Bühler. Known for directing a department of child psychology at the Vienna Psychological Institute, Bühler intermittently lived in London from 1934 until her emigration to the United States in 1940. There she established a wide network of connections in the fields of child psychology and progressive education, provided training to several child psychologists, opened a child guidance centre, and dispensed advice in the parenting magazine The Nursery World. The growing interest in and exploration of the psychology of children in interwar and wartime Britain was marked by significant theoretical divergences and conflicts, but investigation of Charlotte Bühler’s time in London elucidates how the field also developed through the interplay and interrelationship of different approaches, including those of the Vienna School of Child Psychology.
In 1944, an editorial in the British Medical Journal commented that ‘Winnicott, Bühler, Isaacs, Bowley and others’ had noted the turbulent characteristics of children between the ages of two and five, and that Anna Freud viewed aggressive tendencies in nursery-aged children as normal (‘War in the Nursery’, 1944). The psychoanalysts Donald Winnicott, Susan Isaacs, and Anna Freud are well known for their pivotal roles in formulating influential new ideas on children and mother–child relations in Britain. 1 More surprising is the inclusion of Charlotte Bühler, a Viennese pioneer in the field of developmental psychology, on this list. In her seminal War in the Nursery, Denise Riley argued that the BMJ editorial embryonically reflected the monumental changes in theorising childhood and motherhood in post-war Britain (Riley, 1983). What, however, was the role of Charlotte Bühler, now largely forgotten in Britain, in these shifts? Bühler directed a large and well-known research centre in child psychology in interwar Vienna, but from 1934 to the outbreak of the Second World War, she divided her time between the Austrian capital and London, where she opened a child guidance centre and dispensed advice in the parenting magazine The Nursery World. This article disentangles how through this work, alongside the training of a new generation of psychologists and the publication of several of her books in English, aspects of Bühler’s theories and techniques became embedded in the field of child psychology in Britain.
The psychology of children was the subject of much theoretical enquiry and public interest in interwar Britain. The post-war period is commonly regarded as the time when psychoanalytic theories of the child and emphasis on the mother–child bond gained traction in social policies concerning children as well as in parenting advice. However, scholarship has pointed to the importance of developments in the interwar period that explain the post-war receptivity to such theories (Roper, 2016; Shapira, 2017; Urwin and Sharland, 1992). Yet ‘child psychology’ denoted a broad field in the interwar years. It encompassed theoretical developments in psychology, psychiatry, and psychoanalysis, and informed progressive educational and child guidance initiatives. Diverse understandings of children’s development, their minds, emotions, and inner worlds were formulated, leading to well-documented theoretical conflicts, as well as disagreements about therapeutic practices and the legitimacy of the popularisation of new theories (Shapira, 2013; Stewart, 2013; Thomson, 2006). However, while divergent and contested views of the nature of infancy and childhood were formulated, there were also cross-fertilisations, convergences, and theoretical debts among different ways of thinking about children and family relations. These intricacies of understanding children’s psychology created the conceptual space for Charlotte Bühler to introduce theories originating with the Viennese School of Child Psychology. An exploration of her time and work in London illuminates the interplay among different theories and practices in shaping child psychology in the interwar years. Moreover, an examination of Bühler’s introduction of the research of the Viennese School to Britain reveals a new influence on changing views regarding separations and the residential care of children, which shaped the development of theories of attachment in post-war Britain.
Scholars have detailed the importance of the child guidance movement and the development of child psychoanalysis in introducing new theories on children’s minds and emotions in interwar Britain (Shapira, 2013; Stewart, 2013). While historians have explored American influences on funding and organisational models of the child guidance movement in England (Stewart, 2011), a transnational context was even more significant in the development of child psychoanalysis. This was catalysed by the arrival in London of Melanie Klein in 1926 and Anna Freud in 1938, and the ensuing ‘Controversial Discussions’ had an enduring effect on psychoanalysis in Britain (King and Steiner, 1991; Shapira, 2013). This article draws attention to the influence of another child psychologist coming to London from Vienna. Charlotte Bühler, a pioneering developmental psychologist, had an ambivalent relationship with the developing field of child psychoanalysis, in Vienna as much as in London. However, while there existed profound theoretical differences, the diverse ways of conceptualising infancy and early childhood converged in proposing new ways of thinking about babies and children. This article, then, disentangles a further transnational connection between British and Austrian child psychology and explores how Charlotte Bühler’s theories played a role in the promulgation of new ideas on childhood and their application to parenting methods. In so doing, it elucidates an overlooked aspect of the changing landscape of thinking about the psychology of children in interwar Britain.
Child psychology and theories of childhood: Interwar Britain and Austria
When Charlotte Bühler began to spend regular time in London in 1934, child psychology was an eclectic and diverse field in both Britain and Austria. Interest in the psychology of children was not located in a single movement or discipline. It was formulated in multiple sites, emerging disciplines, and initiatives, including the child guidance movement and progressive educational endeavours, and could be encountered in new parenting advice (Gardner and Stevens, 1992; Stewart, 2013; Thomson, 2006). Historians of Britain have detailed how the interwar period saw welfare concern with the physical health of children supplemented by a growing emphasis on the mental life and emotions of childhood, initiating a shift ‘from bodies to minds’ that fully unfolded in the post-war period (Hendrick, 1994; Urwin and Sharland, 1992). The infant and child welfare movements of the early 20th century were concerned primarily with children’s bodies. This was reflected in the childcare advice literature of the time, often preoccupied with reducing infant mortality. In Britain, in the wake of the First World War, this advice came to be dominated by the ‘Truby King method’, named after the New Zealand physician Frederick Truby King. This confirmed infant care to be a matter of national and imperial importance, and advocated the observance of strict routines to promote infant health. While the importance of regular habits was to ensure infant survival and long-term health, a lack of a routine in early childhood was also associated with a behaviourist proposition of disorderly character development (Bryder, 2005; Rowold, 2019a).
Alongside this approach, others, embedded in the contradictory context of Britain’s ‘morbid age’ (Overy, 2009) were transforming thinking about children’s psychology. Academic institutions, such as the Institute of Education in London, were important centres for the development and dissemination of new theories of the child. Meanwhile, the ‘new psychology’ (selectively influenced by Freudian ideas), psychoanalysis, and the child guidance movement played key roles in developing therapy-oriented theories on children’s psychology and re-imagining parent–child relations. In England, which saw the establishment of the Child Guidance Council in 1927, child guidance was crucially informed by psychiatric medicine. The underlying principle of the movement was that any child could experience ‘maladjustment’, reflecting disturbances in emotional development. Shifting the focus from hereditarian theories, the causes of maladjustment were located in the child’s environment, which was commonly interpreted as the child’s home environment, family relationships – increasingly mother–child relations – and parental behaviours. As John Stewart has noted, the child guidance movement hence instigated a shift from seeing ‘problem children’ to positioning parents as part of the problem (Hayes, 2007; Stewart, 2013: 10).
Austria also saw the emergence of a child guidance movement in the years following the First World War. The first clinic was opened in 1919 in ‘Red Vienna’, as one of several initiatives in child welfare of the Social Democratic city government. In Vienna, child guidance was largely influenced by the theories of Alfred Adler, who was at this point already disengaged from Freud’s circle and concepts. The expansion of clinics occurred under the auspices of the Viennese School reforms; most clinics were housed in schools, and consultations took place in the presence of parents and teachers (Danto, 2005; Datler, Gstach, and Wininger, 2009). Other independent clinics were also set up, forming part of the same growing interest in and preoccupation with children’s minds and emotional worlds. In 1923, Hermine Hugh-Hellmuth established Vienna’s first psychoanalytically oriented child guidance clinic in the Ambulatorium, Freud’s free clinic, and this soon turned into its busiest department (Danto, 2005). In London, the Tavistock Clinic opened in 1920 under Hugh Crichton-Miller, a psychiatrist and key proponent of the ‘new psychology’. From the start, the clinic treated children, as well as adults, and in 1926 it opened a children’s department. Also in London, Margaret Lowenfeld opened the Children’s Clinic for the Treatment and Study of Nervous and Difficult Children in 1928 (renamed the Institute of Child Psychology in 1931), where she pioneered a form of play therapy.
If the child guidance project exemplified the new concern with children’s mental life and emotions, psychoanalysis also played a role in the shift ‘from bodies to minds’. Melanie Klein, born in Vienna, settled in London in 1926 and was pivotal to the development of child psychoanalysis in Britain. Before the arrival of Anna Freud in 1938, it was Klein who catalysed child psychoanalysis, training many of the first generation of child psychoanalysts (Sugden, 2022). While there remained cultural ambivalence about psychoanalysis in interwar Britain, it was increasingly discussed, often favourably, and psychoanalytic ideas about the child in particular extended beyond the British Psycho-analytic Society (Shapira, 2013). Nonetheless, before 1938, Vienna was at the centre of developments that foregrounded infants’ and children’s internal worlds, making the city the ‘capital of child analysis’ (Appignanesi and Forrester, 1992). As early as 1913, Hermine Hug-Hellmuth published a psychoanalytically informed observational study of early child development (Hug-Hellmuth, 1913). Developing theories on the infant psyche that differed from Klein’s ideas, and eventually led to a series of heated discussions in wartime Britain, Anna Freud organised the Kinderseminar, a group that explored the emerging field of child psychoanalysis in 1920s Vienna (Geissmann and Geissmann, 1998). One of its members, August Aichorn, provided a psychoanalytic account of juvenile delinquents in residential care in 1925 (Aichhorn, 1925). The same year, another member of the Kinderseminar, Sigfried Bernfeld, published The Psychology of the Infant, which, once translated into English, was considered ‘one of the most important books on child psychology’ (Midgley, 2007: 940).
In Vienna, however, new understandings of infancy and childhood were also formulated at a research centre in developmental psychology at the Vienna Psychological Institute, under the directorship of Charlotte Bühler. Born in Berlin in 1893, Bühler began studying philosophy and psychology in 1913, not long after women were first admitted to universities in Germany, graduating with a doctorate in psychology from the University of Munich in 1919. Child psychology, broadly defined, was an important field in which women carved out new careers after the First World War, and Bühler, unusually for this generation, combined her professional career with raising children (in Germany, an influential branch of the women’s movement had campaigned for women’s entry to higher education on the understanding that professional careers were an alternative to motherhood). In 1922, the Viennese Social Democratic city government invited Bühler’s husband, Karl, to set up a psychological institute at the University of Vienna, where Charlotte was offered an ‘assistant professorship’. A Laura Spelman Rockefeller Memorial fellowship led to ten months in the United States from 1924 to 1925 and, upon her return, Bühler directed a team of researchers studying babies and children at the psychological institute. The Rockefeller Foundation supported the expansion and reach of this research, leading to a stream of doctoral students, many from abroad (Ash, 1987).
Bühler’s work in Vienna was firmly located in the emerging field of developmental psychology. She began to formulate her ideas on child development in the USA, where she conducted a pilot study on the social behaviour and affective expressions of babies, and started to elaborate a method for observing the child’s ‘entire behaviour’ and ‘total level of development’, rejecting the behaviourist focus on reflexes and conditioning (Bühler, 1972; Woodward, 2012). Upon her return to Vienna, the Social Democrats offered Bühler, and a team of assistants and doctoral students, use of the city’s Children’s Reception Centre for research, in return for making their findings available to the centre. 2 Opened in 1925, the Children’s Reception Centre housed predominantly working-class babies, children, and youths who had come under municipal care. After three weeks of quarantine and observation, children were transferred to foster places, children’s homes, reformatories, or, more rarely, back to their parents. At the Reception Centre, Bühler developed a system of round-the-clock infant observation. Treating the centre as a neutral space for experimental testing and empirical observation, Bühler and her team postulated that development followed a predictable course of internal maturation. The resulting ‘Viennese Tests’ established a ‘developmental profile’ expressed in a ‘developmental quotient’, quantitatively evaluating a child’s development of perception, body mastery, social behaviour, engagement with inanimate objects, learning and mental production, and overall development (Benetka, 1995; Bühler, 1930; Bühler and Hetzer, 1932; Bühler, Hetzer, and Tudor-Hart, 1927).
Viennese School researchers also observed babies and children in other contexts – long-term institutional and domestic environments – and Bühler increasingly focused on determining the social nature of child development, to establish the effects of different influences upon ‘individual variations from [the] normal schedule’ and understand how environmental factors affected individual development. 3 Consistent with this, Bühler and her co-workers conducted a project of observing parent–child and sibling relations in families, the results of which were published as Kind und Familie (The Child and His Family) in 1937. The early 20th-century undertaking of constructing norms of children’s development was underpinned by the assumption that such knowledge could provide the basis for intervention (Urwin and Hood-Williams, 2013), and Bühler always firmly maintained that the Viennese Tests had ‘practical value for parents, teachers, physicians, and social workers’ (Bühler, 1935: 12). A ‘good test’, she declared, ‘should have the same function as a good diagnosis’ and be followed by ‘proper treatment’ (Bühler and Hetzer, 1935: 19). In the mid 1930s, Bühler extended the application of developmental testing from working-class children in Viennese municipal care to small numbers of middle-class children in London, opening a child guidance clinic, which was later followed by similar clinics in Leiden and Oslo. 4 The Viennese School of Child Psychology hence contributed to the early 20th-century normalising vision of childhood, in which children became objects of psychological scrutiny, and development was mapped onto expected trajectories, bedding down ‘normative “standards” and wider narratives of (adult and child) perfectibility’ (King and Taylor, 2017: 720).
Charlotte Bühler and child psychology: Between Vienna and London
Years later still, Charlotte Bühler insisted that ‘what we observed in Vienna and the data we assembled, remained entirely in the realm of observable behaviour’ (Steiner, 2000: 154). Throughout her time in Vienna and London, Bühler was not sympathetic to the theories of Sigmund Freud, Anna Freud, or any of their co-workers. Indeed, Ilse Hellman, an assistant at the Vienna Psychological Institute, later recalled that ‘Charlotte Bühler was completely anti-psychoanalytic’ and that ‘she had nothing to do with fantasies or the idea of an unconscious, … and certainly not with sexuality’ (Hellman, 1990: 4). 5 Many of the early psychoanalysts were, in turn, disparaging of the work of the ‘baby watchers’ (Midgley, 2013). Hence the relationship between the Vienna Psychological Institute and the Vienna Psychoanalytic Institute was, in Bühler’s own words, ‘predominantly negative’ (Bühler, 1972: 29). Assistants and researchers at the Vienna Psychological Institute were ‘forbidden to go and listen to Anna Freud or to attend her seminars’. Nonetheless, as Ilse Hellman explained, ‘Quite a few people … went to them secretly’ (Hellman, 1990: 4).
While the two institutes maintained a strict separation, several students and researchers engaged with both, bridging the diverging ways of theorising about babies and young children. Riccardo Steiner has noted that many of the psychoanalysts in Vienna who took an interest in child development were influenced, more or less directly, by Bühler’s research methodology, while at the same time also being in analysis with Anna Freud or one of her colleagues (Steiner, 2000). The psychoanalytic interpretation of infant development in Bernfeld’s The Psychology of the Infant (1925) was underpinned by observational data of infant behaviour gathered by Bühler and others (Isaacs, 1930). The psychoanalyst René Spitz learned the methods of infant observation from Bühler at the Children’s Reception Centre while also attending Anna Freud’s Kinderseminar. Later, the Viennese Tests and collaboration with the Bühlerian psychologist Katherine Wolf played an important role in Spitz’s work of the 1940s (Rowold, 2019b). Esther Bick, who came to Britain as a refugee just before the outbreak of the Second World War, wrote her doctorate at the Vienna Psychological Institute, observing children who underwent the Viennese Tests, while also training in psychoanalysis (Geissmann and Geissmann, 1998). In Britain, Bick introduced infant observation with a psychoanalytic lens. When initiating a course on child observation at the Tavistock Clinic after the war, she is recorded as having said ‘I will do Bühler, but properly’ (Grosskurth, 1986: 426). Others started their careers at the Vienna Psychological Institute and only turned to psychoanalysis in London, as was the case with Ilse Hellman, who also belonged to the team conducting the observations of children in their family environment, which informed The Child and His Family. In interwar Vienna, an intense engagement existed with the psychology of infancy and early childhood, leading to very different conceptualisations of the early months and years of life. Steiner, however, makes an important point about the ‘Viennese psychoanalytic baby’ brought to London by Anna Freud in 1938: it came out of a complex blend of theories and observations, and the sociocultural context of Vienna where Anna Freud’s ideas on the psychic life of babies and children germinated, included Bühler’s observation techniques and research on the emotions and social interactions of early life (Steiner, 2000).
If there was interplay between different approaches and methodologies for exploring infancy and childhood in Vienna, some of which were brought to Britain, similar developments could also be observed in London. Starting in 1934, Bühler spent regular and increasing time in the British capital, seeking to set up an institute to ‘help to spread the work of the Viennese school’, but also in the hope that this might lead to further publishing opportunities for her in English, as such opportunities were now much reduced in German. 6 While discussed less than Jean Piaget’s developmental theories, Bühler’s research was not unknown before she started to spend part of the year in Britain. However, it became more widely disseminated with the appearance of British editions of some of her books, magazine articles, talks, and lectures. Bühler cultivated a wide range of personal and institutional connections in London, associating with disparate individuals and groups in the broad fields of child psychology and progressive education. For instance, she gave lectures under the auspices of the New Education Fellowship at the Froebel Institute and contributed to a course at the Tavistock Clinic (Bühler, 1935; Dicks, 1970). Also in London, Bühler mostly retained her distance from the British Psycho-analytic Society and its members, and there is no evidence that she met Melanie Klein or engaged with her ideas on children's internal worlds and their unconscious phantasies, which could evoke intense feelings of love, hate, aggression, and guilt. The notable exception, however, was Susan Isaacs, with whom Bühler’s path crossed personally and professionally. On one of Bühler’s first trips to London, Isaacs, then the head of the Child Development Department at the Institute of Education of the University of London, invited her to give a short course on the psychological development of preschool children. 7
Bühler’s relationship with Isaacs was complicated. More than anyone, Isaacs embodied the alliances of different fields of interwar British child psychology, cultivating extensive connections and wide interests. A full member of the British Psycho-analytic Society since 1923, she had initially moved from teacher training to philosophy for her first degree, followed by postgraduate study in psychology. While she developed a Kleinian understanding of children’s psychic life and played an important role in the interwar popularisation of psychoanalytic theories in her advice column in The Nursery World (under the pseudonym of ‘Ursula Wise’), her writings blended elements of psychology and psychoanalysis (Sugden, 2020, 2022). Not surprisingly, Isaacs had serious reservations about Bühler’s work and approach, finding her discussions of psychoanalytic theories ill-informed and viewing her refusal to consider unconscious motives as ‘throwing out the baby with the bath water’ (Isaacs, 1937; 1940: 494). Without underplaying theoretical differences and overstating synergies, however, the two women also owed each other intellectual debts. Isaacs integrated developmental outlines, including Bühler’s, into her work. For instance, in a publication of 1938 on the ‘recent advances in the psychology of young children’, she referred to the ideas of Bühler (and others) before discussing developments ‘by means of the technique of psycho-analysis’. Bühler’s claim that in babies under five months negative emotions predominated until slowly overtaken by positive ones was, for Isaacs, evidence that this age brought a crisis of development. The contention of ‘objective studies’ that tantrums occurred more at certain ages than others led Isaacs to outline a case study of what tantrums meant to a four-year-old child in her practice (Isaacs, 1948[1938]). Later, after the end of the Second World War, Isaacs gave evidence to the Curtis Committee, whose report constituted a significant moment in the history of child welfare in Britain. Forming the basis of the Children Act of 1948, the report favoured familial over residential care for children ‘deprived of a normal home life’. In her memorandum submitted to the Committee, Isaacs referenced the Vienna Psychological Institute's findings that institutions were ‘unfavourable’ to children’s development (Isaacs, 1948[1945]). If Isaacs found some aspects of Bühler and the Vienna Psychological Institute’s work relevant, the reverse was true as well. When Bühler took over the role of agony aunt from Isaacs in The Nursery World, she was happy to recommend Isaacs’ books The Nursery Years and Habit Training to readers of the magazine. Moreover, it is very likely that aspects of her own advice in the column were influenced by Isaacs’ responses when writing as ‘Ursula Wise’, not least the adoption of Isaacs’ sympathetic and respectful tone when responding to readers’ problems (Shapira, 2017).
The closest relationship Bühler developed in London, however, was with Margaret Lowenfeld, the director of the Institute of Child Psychology. Lowenfeld, who originated an early form of play therapy, had an eclectic approach to child psychology (Urwin and Hood-Williams, 2013). She found that the studies of Charlotte Bühler and the American psychologist Arnold Gesell, as much as the findings of psychoanalysis, had delineated the importance of the first years of life and led to a greater understanding of these years (Lowenfeld, 1935). Making use of Bühler’s findings in her teaching at her institute, Lowenfeld’s book Play in Childhood (1935) also extensively cited her work. 8 Bühler, on the other hand, worked on adapting Lowenfeld’s’ ‘World Technique’, an apparatus Lowenfeld had created and used for therapeutic interpretation of the ‘worlds’ children created. Bühler sought to standardise it to assess development by distilling the ‘use made by normal children in relation to age’, which, in Lowenfeld’s view, could provide a useful benchmark to compare the material selected by ‘normal and emotionally disturbed children’ (Lowenfeld, 2013[1939]: 269). 9 While influenced in aspects of her work by the people and approaches she encountered in London, Bühler equally found a place for the work of the Vienna School in the landscape of child psychology in Britain.
The Parents’ Association Institute
Charlotte Bühler and Margaret Lowenfeld, in collaboration with the progressive educationalist Belle Rennie, worked together on a further endeavour. Lowenfeld and Rennie knew each other through involvement with the Parents’ Association, an organisation formed in 1925 for parents and progressive educators. 10 In 1935, the three women put forward a funding proposal to the Rockefeller Foundation for a new Institute of Child Psychology in London. The proposed institute was to merge Lowenfeld’s existing Institute of Child Psychology with a department overseen by Bühler. It would have Lowenfeld work with ‘neurotic and problem children’, and Bühler engage in ‘preventative’ work with ‘normal children’ to fend off the development of ‘neurosis and other problems’. 11 Bühler envisioned an institute which would combine research, training, and consultations. 12 In the event, however, the Rockefeller Foundation rejected the proposal, and Bühler set up a much more modest endeavour under the auspices of the Parents’ Association with financial backing from Belle Rennie. 13 While a merger with Lowenfeld’s institute did not take place, Bühler continued to observe children at this institute, and Lowenfeld encouraged her students to attend Bühler’s to train in child observation (Mitchell and Friedman, 1994).
The Parents’ Association Institute opened in South Kensington in 1935, and henceforth Bühler travelled twice annually to London, spending several months in the city. The new institute operated in effect as a small child guidance clinic, to which middle-class children were referred by parents or teachers (The Nursery World, 21 December 1938). It also trained several ‘English girls’ in child observation and administering the Viennese Tests. 14 As in Vienna, a newly emerging generation of child psychologists found more common ground between Charlotte Bühler and Anna Freud’s approaches than the two women themselves. The Parents’ Association Institute constituted the beginning and sometimes a bridge for several women entering the fields of child psychology, psychoanalysis, and psychotherapy. Doris Wills, for instance, was one of the ‘English girls’ Bühler referred to. After the Parents’ Association Institute, she went on to train and then had a long career at Anna Freud’s Hampstead Child Therapy Clinic, which was set up after the war. When looking back on her career, Wills recalled fondly that despite her denial of the existence of the unconscious, Bühler was one of the ‘most interesting and careful observers of child development’ with whom she had trained (Wills, 1978: 97). Ilse Hellman also progressed from first training with Bühler to training as an analyst (Timms, 2003). When Bühler was not in London to oversee the Parents’ Association Institute, she was replaced by another psychologist. At first, her assistant in Vienna, Lotte Schenk-Danzinger, came with her to Britain. When Schenk-Danzinger returned to Austria in 1937, Ilse Hellman replaced her, only too glad to be able to leave Austria (Hellman, 1990). Introduced by Bühler to Susan Isaacs, Hellman was soon asked by Isaacs to assist with her advice column in Home and School by writing responses to parents whose letters were not printed in the magazine. 15 After the Parents’ Association Institute closed at the time of the first London evacuation, Hellman was invited in 1941 by Anna Freud to work in the Hampstead War Nursery, and she started training in psychoanalysis the following year. 16 With a doctorate from the Vienna Psychological Institute and the experience of having worked at Bühler’s London Institute, Hellman brought training in empirical psychology to the Hampstead Nursery. There, she contributed to looking after the nursery children, but also provided teaching on children’s mental development and the Viennese Tests (Young-Bruehl, 2008). Like Doris Wills, Hellman felt that Bühler had helped to set her on her path, recalling that she ‘learnt a lot from her, you know the basics of child development, intellectual and physical’. 17 Another doctoral student at the Vienna Psychological Institute, Liselotte Frankl (one of the students who simultaneously went to Anna Freud’s seminar in Vienna), did not work again with Bühler in London. However, she became a training analyst, supervisor, and medical director at the Hampstead Child Therapy Clinic, and claimed that clinical and research efforts there combined the work of Anna Freud and Charlotte Bühler (Gardner and Stevens, 1992).
While training was only a small component of its activities, the Parents’ Association Institute also contributed to one of the prominent projects of interwar child psychology: child guidance and parent education. The institute, headed by a developmental psychologist, differed from many of the child guidance clinics in England, which typically had an organisational model where a psychiatrist headed a team consisting of a psychologist and psychiatric social workers (Stewart, 2013). It was common practice in child guidance clinics, as well as in Lowenfeld’s Institute of Child Psychology, to administer intelligence tests in children’s initial assessment. 18 At Bühler’s Parents’ Institute, however, the Viennese developmental tests and profiles not only constituted the instrument of initial assessment but also functioned as a diagnostic tool. 19 In From Birth to Maturity, her first book published by a British publisher, Bühler explained that the Viennese Tests allowed to determine whether ‘the environment is having a favourable effect on the child, thus enabling us to advise parents and educators’ (Bühler, 1935: xiii).
To Bühler, environmental influences and parental behaviours and practices shaped children’s development as early as the first year of life (Bühler, 1937b). This approach was exemplified by the case of a four-month-old baby who had undergone the Viennese Tests. Bühler found that ‘the physical and mental condition of the child was well above the average, while the social reactions were well below normal’. She learned that the baby’s mother worked and that the baby was dependent on frequently changing domestic help ‘for attention and care’. Bühler advised that ‘unless the child was to become shy and unwilling and unable to make contacts with people’, the mother needed to employ someone to whom ‘the child could grow accustomed and respond to’. 20 Bühler was hence an early advocate for the necessity of consistent and affectionate care of young children, as shall be discussed further below. However, as shown by this case, in distinction to some of her contemporaries and many post-war theorists, Bühler did not advocate the need for full-time maternal care in infancy.
As was the case with other child guidance clinics, the Parent’s Association Institute’s engagement with children and their parents was conceived primarily as a preventative intervention rather than working with ‘delinquent’ children or youth, or those who suffered from ‘neurosis’, for whom psychotherapy was deemed more appropriate (Bühler, 1935). In the main, the institute sought to facilitate the ‘application of psychology to the upbringing of the normal child by the normal parent’. 21 Interventions in the (domestic) environment and parental behaviours, particularly during ‘critical periods’, could optimise conditions for children’s development, and psychologists, according to Bühler, had a role in testing children to make sure that ‘nothing is creeping into the environment which can cramp or deform the full, all-round development of the child’. 22 The expectation for children to develop in particular ways made raising children a delicate and challenging task, easily undertaken wrongly. As all children were at risk of certain influences ‘deforming’ their development, Bühler proposed that children ought to be monitored regularly by psychologists. Parenting needed professional, expert involvement, and raising children was to be a joint endeavour between parents and psychologists.
The Nursery World: Charlotte Bühler’s parenting advice
The Parents’ Association Institute continued to operate until 1939, but it always remained a very modest operation. Charlotte Bühler reached a wider audience of middle-class mothers and their nannies (as well as some fathers and grandmothers) in Britain through an advice column in The Nursery World. Historians have pointed to psychoanalysis as playing an important role in formulating new approaches to parenting, which refuted traditional child-rearing methods that stressed discipline and obedience, as well as proposing the careful management of the display of affection (Shapira, 2017; Urwin and Sharland, 1992). Bühler, drawing on different theoretical underpinnings, also played a role in this. Moreover, her column in The Nursery World gave her a platform to introduce the magazine readership to an early theory of attachment, based largely on observations of children in residential institutions carried out by researchers associated with the Vienna Psychological Institute.
The Nursery World first appeared in 1925, with the intention of addressing the interests of both middle-class mothers and nursery nurses, or nannies. 23 While mainly targeted at a middle-class readership, the magazine’s correspondence columns printed letters from middle-class mothers who employed trained or untrained nannies, as well as those without paid help. The nursery nurses who wrote to the columns came from a wider social spectrum, reflecting the increasingly diverse backgrounds of nannies in this period (Holden, 2017). There were several correspondence columns in the magazine. ‘Over the Teacups’ offered readers the opportunity to exchange views and tips, and debate contemporary ideas on child-rearing. Other columns were written by childcare experts of different kinds. A nurse qualified by the Truby King Mothercraft Training Society provided advice to readers writing to ‘Questions About Baby’. In this column, mothers (and nannies) were consistently told to follow the Truby King method, adhere to strict routines, particularly when it came to feeding, and avoid spoiling the baby (Rowold, 2019a). However, another column, on ‘Childhood Problems’, introduced new approaches to raising (older) children. Historians have highlighted that from 1929 to 1937 the column was written by the psychoanalyst Susan Isaacs, under the pseudonym ‘Ursula Wise’ (Shapira, 2017). Less known is that in March 1937 Charlotte Bühler took over this column from Isaacs. With an interruption in 1938, Bühler continued writing the column until at least the outbreak of war in September 1939. At the time of the Anschluss of Austria in March 1938, Bühler was in London. From there she travelled to Oslo, where she sought to secure her husband’s release from custody and help her children leave Austria. 24 During these months, the column was written by Bühler’s assistant, Lotte Schenk-Danzinger, then back living in Vienna. When war was declared in September 1939, The Nursery World no longer published the name of the German-Austrian columnist, but it is likely that Bühler continued writing her column until she emigrated to the USA in the spring of 1940, just before the Nazi invasion of Norway. While the column continued to be published without a byline, it is probable that Ilse Hellman, Bühler’s former assistant in Vienna and co-director at the Parents’ Association Institute, then took over the column. 25
When she replaced Susan Isaacs (or ‘Ursula Wise’) as the columnist in March 1937, Bühler’s introduction to the readership of The Nursery World stressed her scientific credentials as a childcare expert, explaining that she held a doctorate and had a ‘distinguished career as a child psychologist’. It was also suggested that her qualification to dispense childcare advice derived not only from her scientific background but from the fact that she was a mother herself (The Nursery World, 24 March 1937: 631, 641). Bühler’s advice differed from that of Isaacs. Michal Shapira has detailed how in her role as agony aunt, Isaacs interwove Kleinian psychoanalytic ideas into her responses so that her column became an important vector of the interwar popularisation of psychoanalytically informed parenting advice. In columns dedicated to fears, phobias, and phantasies, Isaacs laid out some of Klein’s theories, and in this manner, parents were taught to ‘speak Kleinian’. In keeping with her understanding, Isaacs saw certain behaviours, such as thumb-sucking, bed-wetting, and temper tantrums, as expressing children’s internal conflicts (Shapira, 2017). The psychoanalyst Nina Searl explained this approach to parenting thus: ‘If parents can realize the amount of reason which exists behind their children’s most unreasonable conduct, and the hidden difficulties with which they struggle, they may themselves be the better able to remain patient, loving and understanding’ (Searl, 1936: 130). Isaacs indeed encouraged raising children by considering their emotions and emotional difficulties, and in this way played an important role in providing an alternative approach to prevailing child-rearing methods (Shapira, 2017).
Bühler’s less than sympathetic relationship to psychoanalysis and her refusal to consider the unconscious have been discussed. But Bühler was familiar with Isaacs’ childcare advice and was influenced by it in some of her own responses in The Nursery World. She was also happy to recommend Isaacs’ pamphlet on ‘habit training’, as well as her childcare advice manual, The Nursery Years, to readers, along with her own book, From Birth to Maturity (The Nursery World, 14 June 1939). However, if Isaacs viewed particular ways of acting in children as stemming from unconscious phantasies, Bühler commonly positioned children’s behaviour in her developmental framework. Nonetheless, despite the significant differences in the theoretical underpinnings of their advice, there also existed important similarities: in Bühler’s approach, knowledge of child development was to replace harsh parenting and its insistence on obedience and warnings of the dire consequences of spoiling children.
The synergies and divergences between the advice of Bühler and Isaacs could be seen in a recurrent problem area for mothers and nannies: toilet training. When Bühler started writing the column, an editorial attempted to redirect readers’ interests, explaining firmly that there were problems of child development on which expert advice was useful ‘besides that of the ever-recurring “pot”’ (The Nursery World, 24 March 1937: 640). Potty training, or ‘habit training’, had indeed figured prominently in the column Isaacs penned as ‘Ursula Wise’. Despite the editorial suggestion, however, questions about potty training continued to be brought frequently to the advice column, and it also remained a common point of discussion in the correspondence column, with mothers and nannies discussing, sometimes heatedly, their experiences and opinions on the issue.
Toilet training was controversial for several reasons. The washing associated with babies and toddlers was a labour-intensive aspect of early childcare, and the prospect of children being dry at an early age was no doubt appealing. However, toilet training by holding out babies over a potty with rigid regularity was one of the cornerstones of the dominant interwar behaviourist childcare advice associated with Truby King (Truby King, 1913). It became a key aspect of childcare which saw refutation of behaviourist methods. Susan Isaacs thus delivered robust critiques of this method in books, pamphlets, and often published responses to questions about ‘the pot’ in The Nursery World (Isaacs, 1936a, 1936b). To Isaacs, toilet training was ‘obviously one of the most important tasks’ in raising young children, as these bodily processes were of deep psychical importance, carrying with them ‘profound unconscious fantasies, concerned with the child’s relation to his mother and his mother’s to him’ (Isaacs, 1936a: 5; 1936b: 141). This was not Bühler’s understanding. But where she coincided with Isaacs was in the view that babies were not able yet to control their bowels and bladders (Isaacs, 1936a: 11). Bühler agreed that holding babies out from birth with regularity, and the expectation that they would become dry, was wrong-headed. Young babies were simply developmentally and physiologically not ready for early potty training. In 1937, she explained to a mother, In habit training, as in everything else, we are helped by the child’s natural development, but we must be patient and wait until the child is old enough to learn what we want to teach him. (The Nursery World, 7 April 1937: 744)
Bühler’s responses to other enquiries from readers of the magazine also commonly consisted of outlining that a child was going through a particular stage of development. For instance, for Bühler, the age between two and four was characterised by obstinacy. Readers looking for advice on their children or charges’ behaviour in this age group were commonly reassured that it was ‘normal’ and that the child would outgrow it: ‘Your little girl’s temper tantrums and screaming are typical for her age’, she explained to one mother (The Nursery World, 12 July 1939: 212). In May 1937, a father was told, You must realise that the stage your girl is going through is a very common one, and time is really the best help for parents, as most children grow out of the period when they are obstinate and inclined to require more attention than usual. (The Nursery World, 26 May 1937: 1000)
Shyness was equally to be expected in young children, and another mother was reassured that ‘your girl’s shyness is quite usual at her age’ (The Nursery World, 19 May 1937: 967). Another was similarly told that ‘at this age, it is quite normal for a child to mind grown-ups rushing at them and wanting them to get on intimate terms at once’ (The Nursery World, 19 April 1939: 761). Behaviours such as temper tantrums, shyness, thumb-sucking, asking for attention, or night-waking belonged to particular developmental phases, and as long as these behaviours fell within the expected time frame, parents were reassured that children would outgrow them (The Nursery World, 16 June 1937: 95).
As such, obedience was not expected, discipline had to be tempered, and corporal punishment was discouraged. The insistence on obedience, reinforced by corporal punishment, of traditional parenting methods was slowly questioned by the new parenting literature of the 1930s (Shapira, 2017; Thom, 2009). Bühler concurred. ‘Smacking the child is a most serious mistake in dealing with the problem’, she wrote in April 1937 (The Nursery World, 7 April 1937: 744). Bühler explained that corporal punishment could seriously upset the emotional balance of children and that people who had been spanked as children felt that this had deeply troubled their childhoods (The Nursery World, 21 July 1937). It also negatively affected the relationship between the child and the punishing adult in the long term, and meant that children who were thus chastised later had ‘great difficulties in finding the right line in bringing up their children’ (The Nursery World, 7 June 1939: 21).
Bühler’s advice was based on the concept of a predictable course of development that could be influenced by circumstances and the family environment. For instance, in a June 1939 issue of The Nursery World, she explained to a mother that the phase of obstinacy her son was going through had been accentuated by the child’s separation from her and finding a new baby at home upon his return (The Nursery World, 28 June 1939). This was especially the case when behaviours continued beyond the expected time frame. ‘Temper tantrums as you describe them are very frequent under the age of four’, Bühler explained in 1939, ‘but whenever they occur over the age of six one must try to find the underlying cause’ (The Nursery World, 28 June 1939: 123). Underlying causes of particular behaviours could vary widely, including ‘nervous strain’ following an illness, jealousy after the birth of a sibling, death in the family, a departed nanny, new surroundings, and more; but Bühler was clear that she attributed behaviours neither to unconscious phantasies nor to Adler’s feelings of inferiority. Parents in such cases were mostly counselled to have a ‘great deal of patience’ and ‘understanding’ and give the child ‘plenty of affection and as much attention as you can’ (The Nursery World, 28 June 1939; 2 June 1937; 16 June 1937: 96). When Bühler felt the cause of behaviours could not be determined from the information provided, or emotional difficulties seemed severe, readers were advised to turn to a child guidance clinic for further help, or, if close enough, the Parents’ Association Institute (The Nursery World, 2 June 1937).
While external influences affected developmental trajectories and could be modified to promote perceived ‘normal’ development, children were not endlessly malleable. When a mother wrote to her in April 1937, concerned that her husband found their son too sensitive and was trying to ‘harden’ him, Bühler responded that it would be wrong to expect a sensitive nature to be hardened. She continued, ‘You will have to explain to your husband that he is really very cruel’ (The Nursery World, 14 April 1937: 773).
Attachment before attachment theory
In her advice, Charlotte Bühler hinted at an early theory of attachment. A body of research at the Vienna Psychological Institute in the late 1920s and early 1930s consisted of observing infants and children in institutions, concluding that long-term institutional care adversely affected children’s development (Bühler, 1931; Rowold, 2019b). Ilse Hellman later reflected that this research implied an early conceptualisation of the attachment needs of children, an understanding which also, as she pointed out, informed the system of ‘substitute mothers’ in Anna Freud and Dorothy Burlingham’s Hampstead War Nurseries, opened in 1940. 26 Lotte Schenk-Danziger, on the other hand, pointed out that the research of the Vienna School did not generate noticeable reforms in the institutional care of children and hence did not have the policy impact of John Bowlby’s theory of maternal deprivation, formulated in the immediate post-war period (Schenk-Danzinger, 1984; Thomson, 2013). However, the views of Bühler and the Vienna Psychological Institute on the ‘unfavourable’ effects of institutional care on children were known to Susan Isaacs, and fed into the evidence she provided after the Second World War to the Curtis Committee on the care of ‘homeless’ children (Isaacs, (1948[1945]). John Bowlby was also familiar with the work of some of the researchers associated with the Vienna Psychological Institute, referencing it in his WHO Report on Maternal Care and Mental Health of 1951 (Rowold, 2019b). Earlier, however, Bühler’s column in The Nursery World gave her a platform to introduce the magazine’s readership to some of these ideas and interweave them into advice on how to raise children in middle-class families.
Bühler explained in From Birth to Maturity that ‘in order to effect normal psychic and physical maturity, individual care and devotion are indispensable in the upbringing of small children’ (Bühler, 1935: 65). Young children have a ‘special need for love’ which could express itself in ‘clinging’ to their mothers or nurses (The Nursery World, 16 November 1938). This meant that children pass through a stage when they will not allow anybody except mother or nurse to do things for him, when he will not let her leave him, and when he calls out at night and is difficult about going to sleep. (The Nursery World, 31 March 1937: 677)
Counter to the common behaviourist advice found in the Truby King-inspired Mothercraft Manual and other similar advice, which proposed that children ought to be trained to fall asleep by themselves and sleep through the night from early babyhood, Bühler advised that the needs of babies or young children who wanted company when falling asleep or called out in the night should be heeded.
Informing these views was an understanding that young children had a need for security, which could easily be shaken. The risk of experiencing a ‘loss of security’ was particularly pronounced in children between the ages of two and four. According to Bühler, at this age children’s imagination and thinking were sufficiently developed to imagine, as much as perceive, dangers and ‘unpleasant things’ in the world (Bühler, 1937b). In this newly bewildering world, children turned to ‘the only constant element and the only source of security’ (The Nursery World, 16 June 1937). The realisation that the mother or nanny was not always available, however, easily led to a ‘shaken sense of security’ (The Nursery World, 31 March 1937). A loss of security could also be induced by circumstances such as a changed environment or a newly impatient caregiver. According to Bühler, the best measure to help children through this period of ‘thousand-fold’ insecurities was to give them the feeling of security they asked for (Bühler, 1937b).
Separations could also induce a feeling of insecurity. In her advice, Bühler suggested that young children were likely to suffer from lengthy separations. For instance, in 1937, a mother was told that it was ‘quite evident’ that her son’s difficult behaviour was a reaction to separation due to illness (The Nursery World, 21 July 1937). She later explained to a reader that ‘the problem of the separation of parents and children is a serious one’, and that it had to be ‘considered carefully according to the child's age and character’ (The Nursery World, 1 February 1939: 319). Separations put an emotional strain on young children and generated feelings of insecurity (The Nursery World, 28 July 1937). This was not just about separations from mothers; separation from nannies could equally cause problems (The Nursery World, 16 August 1939). In Bühler’s understanding, young children were commonly particularly attached to one person, and in practice, this was often their mother; however, to Bühler, others could equally fulfil these needs (The Nursery World, 21 June 1939). Consistency in affection and presence was important, not that it should come from the mother. Unlike the gradual centralisation of the mother–child bond in theories of child development, the full extent of which was to unfold in post-war Britain, Bühler noticeably never elevated these bonds over other caregiving relationships.
While mothers, nannies, or other caregivers were commonly counselled to reassure children and help them regain their sense of security after separations with much patience and understanding, they were also counselled against sending young children to spend long periods away from home in the first place (The Nursery World, 2 February 1938; 22 March, 1939). Bühler knew that much of this advice went against received methods, and explained in one of her first columns in 1937, The only way of getting a child over this period is to give him the security he demands. It is not spoiling, if during this critical phase, one stays with the child until he falls asleep, and if one gets up at night to soothe him if he calls for mummy. If mother or nurse has to go out, and the child must be handled by another person, the situation must be accepted, even if he is difficult about it, but this should not be enforced unless it is necessary. Children grow out of this period quite naturally, and parents who give them the extra attention during this period of insecurity, find that it can gradually be withdrawn, the time varying, of course, with different children. (The Nursery World, 31 March 1937: 677)
Parents and modern parenting advice in The Nursery World
What about Nursery World readers? How did they react to ‘Dr. Charlotte Bühler’s’ advice? Among the letters written to the magazine, there were instances of mothers or nannies disagreeing with the counsel dispensed, commonly by foregrounding personal experiences. In one letter, ‘A. C. W.’, a mother of five, refuted Bühler’s developmental view that babies reached a peak of crying between the ages of seven and eight weeks. The mother argued instead that all crying at all ages could and should always be soothed. Taking a further (implicit) sideswipe at Truby King’s claim that ‘spoiling’ babies would ruin the character of the future child and adult, the mother reflected on the long-term consequences of her approach and maintained that her children, now older, were much better behaved around bedtime than her neighbours who had experienced sharper discipline (The Nursery World, 9 August 1939). If the question of potty training came up more frequently than Bühler would have liked, it was also the issue where both mothers and nannies most rejected new advice. Readers frequently wrote to the magazine defending the practice of regular holding out from birth. ‘It is [a] point on which I am completely at variance with Dr. Bühler’, one reader wrote, adding that it was a method that had worked very well for her children (The Nursery World, 12 July 1939: 215). Others simply took the matter to ‘Over the Teacups’, a different column in the magazine, where readers wrote to and commented on each other’s questions and opinions.
However, a continuous stream of readers’ letters seeking advice points to at least a section of magazine readers favourable to the psychologist’s ideas. Some readers explicitly appealed to Bühler’s knowledge of child psychology. ‘Could you tell me the reason for this sleeplessness and whether you consider the trouble physiological or psychological?’, one mother asked (The Nursery World, 7 June 1939: 29). Another, who was debating whether to send her four-year-old son to boarding school, wrote, ‘As I know practically nothing of child psychology, I shall be very glad if you will help me’ (The Nursery World, 12 July 1939: 218). It was not only mothers; there were also nannies who spoke in the new language, such as when looking for confirmation that their charge would benefit from seeing a child psychologist or suggesting to their employers to seek the columnist’s advice (The Nursery World, 19 July 1939). While nannies trained in Truby King methods often advertised their services as such, some parents, such as ‘Worried B.’, now enquired whether Bühler could recommend ‘any nursery governesses trained in your methods’ (The Nursery World, 12 July 1939: 220). 27
More than one reader asked her for recommendations of books in the field to help them with the task of bringing up their children. Bühler, in these cases, recommended her From Birth to Maturity and Susan Isaacs’ The Nursery Years (The Nursery World, 14 June 1939). Other readers understood that contemporary theories of child-rearing, including Bühler’s, put the fate of their children’s long-term well-being in their hands. ‘I am so afraid of doing the wrong thing and, as one is told, possibly affecting the children for life’, an unnerved mother wrote in June 1939 (The Nursery World, 14 June 1939: 61–2). Some readers also explicitly referred to concepts used by Bühler, including ‘security’ and ‘loss of security’ (The Nursery World, 22 March 1939; 28 June 1939). This was the case for a mother, for instance, who wrote to enquire whether it was a bad idea to let her young child regularly stay for lengthy periods with his grandmother. ‘The change does not seem to upset him in any way’, she said, ‘however, I have read so much in The Nursery World about upsetting small children’s sense of security by too many changes, that I am rather worried about it. Do you think it will have any latent bad effects?’ Bühler, unsurprisingly and in keeping with her views, counselled against this arrangement (The Nursery World, 14 June 1939: 55).
Conclusion
In 1959, psychologist Cyril Burt wrote a reader’s report on the proposed translation of one of Bühler’s books previously available only in German. He explained that in the 1930s, ‘Dr. Bühler’s work attracted wide attention, particularly among those working in the field of child psychology and education’. He continued, ‘But by now most of what seemed sound and new in her work has been incorporated into most psychological and educational textbooks.’ The proposed translation was therefore, he concluded, ‘primarily of historical interest’. 28 Bühler’s theories on the psychology of children were indeed no longer new. A few years earlier, in 1956, John Bowlby had invited her to give a talk in the Children’s Department of the Tavistock Clinic when she was on a visit to Europe from the USA. Bühler responded that while she would be delighted to give a talk at the Tavistock, she had not worked in the field of child psychology for some years and did not care to talk about it. Instead, her focus had turned to humanistic psychology. 29
This article has explored how Bühler’s intermittent presence in London from 1934 to 1939 contributed to the dissemination of her work and, more broadly, that of the Vienna School of Child Psychology. The 1944 editorial of the British Medical Journal that referred to Bühler, with which this article started, reflected the incorporation of some of her ideas into the landscape of child psychology in Britain. The exploration of the influence of a further child psychologist coming to London from Vienna, albeit one not working in the psychoanalytic tradition, redirects the focus from well-known important divergences and theoretical disagreements between Kleinians and Anna Freudians to the existence of personal, theoretical, and methodological interconnections between very different ways of conceptualising the psychology of children. Theories on the minds and emotions of children which gained increasing traction in post-war Britain grew out of these interwar developments.
The trajectory of the advice column on ‘childhood problems’ in The Nursery World was emblematic of the complex, interrelated, and transnational history of child psychology. First written by Susan Isaacs, a Kleinian psychoanalyst and psychologist, the column was subsequently composed by Charlotte Bühler, a Viennese developmental psychologist intermittently living in London. The Viennese Lotte Schenk-Danzinger briefly contributed, and Ilse Hellman later followed suit. Hellman, who had already collaborated with the Kleinian Isaacs on a different magazine column, was at the time a Bühlerian psychologist, working with Anna Freud at the Hampstead War Nursery and in analytic training with Dorothy Burlingham. Readers of the magazine, it should be noted, corresponded with the changing columnists without distinction, confirming and showing interest in ways of raising children that were underpinned by different theoretical frameworks but aligned in delineating the importance of the first years of life, paid attention to the minds and emotions of children, departed from disciplinarian child-rearing methods, and firmly assigned the fate of children’s well-being to parents. If, as Riccardo Steiner has argued, one needs to consider the sociocultural context of interwar Vienna, of which Charlotte Bühler was also a part, to locate the emergence of the Anna Freudian psychoanalytic child, Bühler’s theories, observation techniques, training, and advice to parents also had a place in the development of ideas on the psychology of babies and young children in interwar Britain.
Footnotes
Declaration of conflicting interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
