THE BEGINNINGS IN CHILD AND ADOLESCENT PSYCHIATRY AND NEUROLOGY AND OF ASSOCIATE PROFESSIONS: SOME HISTORICAL ASPECTS AROUND THE WORLD AND IN ROMANIA

ABSTRACT: 

The author considers that the anniversary of 20 years since the foundation of S.N.P.C.A.R., the Society of Neurology and Psychiatry of Children and Adolescents from Romania, is an opportunity that allows us to consider some important data in the genesis and evolution of these modern specialties. The following paper is devoted to certain aspects of the international history, followed by a presentation of evolution of our specialties in Romania. Many of the aspects presented here are extracted from existing materials, published and communicated during congresses and in journals, but there are still others that are original, and are meant to complete the existing records. We invite all our colleagues to contribute to our history with information, articles and new data, which should be included in the history of the development of neuro–paediatrics, child and adolescence psychiatry and of the associated professions.

INTERNATIONAL HISTORY OF CHILD AND ADOLESCENT NEUROLOGY AND PSYCHIATRY

In respect for the founders of our specialty, it is necessary and proper to recall key dates connected to the birth of child psychiatry by pointing to known landmarks of our own history. Knowledge of history aspects of our professions complete the much-needed information meant to help us enlarge our horizon in fi elds to which we have dedicated our professional life. In previous centuries, many psychologists, doctors, teachers, priests and philosophers have addressed issues of mentally ill children, of the deaf, the blind, the disabled or the orphan. However, the scientifi c concerns have become more focused and systematic starting with the eighteenth and nineteenth centuries.

Leo Kanner

Leo Kanner, in the Chapter „History of Child Psychiatry” (1972), states: “the concept of child psychiatry did not appear before the twentieth century.” Still he starts by quoting from works and scholars who had preceded our ancestors and prepared the way to the future assertion of child’s psychiatry. Among them, Kanner pointed out the contribution of Jean M. Itard (1774-1838), who dedicated himself to the study and rehabilitation of an abandoned child (wolf-child). He considered Itard an important initiator in the study of child’s abilities and of forms of psycho sensorial retardation. Then, Kanner mentions Emile Rousseau who, in 1762 published a scientifi c description of the stages of child development and Johann Heinrich Pestalozzi (1746-1827), the Swiss educational reformer and pedagogue who, in conformity with his humanistic outlook, has developed a theory on education considering the child as a physical, intellectual, and moral entity. In 1777, N. Brouzet published in Paris the work “Education mental de l’enfant et traitement de ses maladies”, where he referred to retarded children with mental illnesses. A world famous event took place in 1793, when Philip Pinel freed the insane from their chains at the Bicetre asylum in Paris.

The chronology of the discoveries, personalities, legislation, that is to say the enumeration of the conceptions on the sick child and of the interventions in his favour contains very many data, which are diffi – cult to select and systematize. But we know that every country has its own history in this fi eld.

From M. Durand – Fordel, we have the fi rst medical study from 1855: “Le suicid chez les enfants” Also from the nineteenth century we should mention Charcot’s 1872 lessons on the diseases of the nervous system and the 1873 systematizations by the Jackson, an Englishman who described scientifi cally the forms of epileptic seizures, including focal and uncinate ones. In 1887, J. Langdon Down described “Th e Pseudo-mongoloid Dystrophy with Mental Retardation”. Later on, in 1959, J. Lejeune, R. Turpin și M. Gautier identifi ed the Down syndrome as a chromosome 21 trisomy.

Philippe Pinel

The 20th century is modern; it begins for us in 1901, when the Swedish sociologist, Ellen Key, gives this period the name of “the Century of the Child”. Also in 1901, E. Bleuler, in collaboration with C.G.Jung and H.W.Mayer, defi ne the concept of schizophrenia. From then on, every year brought plenty of novelties in the psychiatry of adult and child. Goldfarb was the first to draw the attention on the concept of maternal deprivation.

In 1905, Alfred Binet and Th eodore Simon launched the Intelligence Scale bearing their names, while Sigmund Freud and Adolf Mayer off ered the dynamic vision according to which current mental disorders have their causes rooted in the past.

The first Child Psychopathology treatise was published by August Homburger in August 1926. This book is appreciated by Kanner as a cornerstone
of the future specialty that Anna Freud and Melanie Klein helped to develop by introducing the principles of child psychoanalysis in performing the diagnostic and therapeutic play. Let us not forget that, in 1925, G. Heuyer, founded the fi rst clinic of child neuropsychiatry diseases in Paris.

On May 19, 1933, at the Psychiatric Association Congress in Switzerland, Dr.Tramer described a new branch of medicine called “Kinderpsychiatrie”, and in 1934 he also founded the fi rst Journal of this specialty. In 1935 Kanner used an equivalent term “Child Psychiatry” in the fi rst book of our specialty written in English. In 1937, G. Heuyer organised in Paris the fi rst International Congress, where the term “psychiatrie infantile” was launched and entered current usage. On the proposal of Paul Schroder (Leipzig), the same congress established the International Committee of Child Psychiatry which later became “Th e International Association of Paediatric Psychiatry and Associate Professions” (IAPPAP). Also in Paris, in 1938, the first university department of child neuropsychiatry was established under the leadership of G. Heuyer, an initiative taken by other European countries immediately.

The three founders, doctors Tramer, Kanner and Heuyer, have stressed since then that child psychiatry is a science of the future, that it should be recognized as such, side by side with other medical specialties. Of course, many authors have contributed further to the progress of knowledge in the fi eld of Child Neuropsychiatry. Among them, one may mention Goldfarb and Bowlby who had studied the consequences of maternal deprivation for many years. In 1951, Bowlby published three laws of human life:

Love and mother’s embrace during childhood is as important for mental health as are the proteins for child’s physical development.

The consequences of failures or the perturbations of the child’s emotional and affective reactions lead to psychic diseases and disorders.

Maternal deprivation has immediate, long lasting negative consequences.

These theses were supported by R.Spitz who described the concept of hospitalism, by Ainsworth who studied multiple deprivations and by Langmayer who stressed the negative role of psycho sensory deprivation in childhood.

Only in 1972, M. Rutter reconsidered critically the concept of maternal deprivation, stressing the role of the family, of the social groups and the possibility of a maternal substitute. I must mention that Rutter’s proposal of a new type of educating the aff ective relationships seems now as extreme and it cannot substitute a mother in the life of a child.

Going back to our historical outline, we shall point out some important dates (without the ambition that we could cover all the discoveries in our field). Thus, after 1932, when Melanie Klein published “The Child’s Psychoanalysis” many materials and studies appeared, some of which remained in the practice of the specialty while others have been lost. Another important date to remember is the year 1935 when Frederick and Erna Gibbs applied electroencephalography to the study of epilepsy, a discovery that is still valid. In 1936, J.Piaget published “Th e Birth of Intelligence in Children”, in 1939, D. Wechsler developed his fi rst Intelligence Test, which he revised in 1974 to suit adults and children and in 1981 these tests underwent a new revision so as to take into account the technical and cultural innovations which appeared along the way.

According to L. Kanner’s description, the period 1936-1946 meant fundamental contributions to our specialty, particularly in the study of psychoses: Lutz (Switzerland), Creak (U. K.), Suhareva (Russia), Despert, Bender, Kanner (Autism), Margareth Mahler (Symbiotic Psychosis) etc.

In 1943, Leon Kanner described the early infantile autism, a disorder that bears his name. Also in 1943, Hans Asperger described and then gave his name to a “minor” type of autism. Rene Spitz studied and published the pathology of depression in childhood in 1946, which he called “anaclytic depression in hospitalism”. Th e same year, L.Moreno published in New York “Psychodrama”. Th e Canadian Hans Selye demonstrated in 1950 the implication of the hypothalamic– pituitary–adrenal axis in acute stress. In 1954, Lennox described his syndrome for the fi rst time in children, as a variant of the epilepsy “petit mal”. Between 1930 and 1950, the aetiology of many degenerative metabolic diseases in children was clarified. J. Piaget published his famous works “Psychology and Epistemology” and “The psychology of the Child” in 1969.

Hans Asperger

In 1970, B. Katz (U.K.), Von Euler (Sweden) and J. Axelrod (U.S.A.) received the Nobel Prize for discoveries concerning the neurotransmitters. We shall mention further Ajuriaguerra with his Manual of Infantile Psychiatry and R. L. Spitzer and collab. who published the Diagnostic and statistical manual of mental disorders in 1980: DSMIII. It is known that the DSMs have abolished the classical terminology in psychiatry (neurosis, psychopathy, etc.) and replaced it with new terms like “disorders” and “reactions”. Th is modernizing process is still going on at present.

The list of discoveries and outstanding personalities in child and adolescent neuropsychiatry from the last decades could continue with more details, which we propose to publish in future issues of our journal. Still, we bring to attention A. Walk who published “The pre – history of child psychiatry” in 1964 and W. Ll. Parry-Jones who, in 1989, published the result of serious historical research in our domain: “The History of Child and Adolescent Psychiatry: Its Present Day Relevance”.

As for the denomination of our specialty, in Romania, as in other countries, too, this issue has suff ered different changes such as “child psychiatry”, “infantile neuropsychiatry (NPI)”, “infant-juvenile neuropsychiatry”, “neuropsychiatry of child, adolescent and their families” health psychology, “youth psychiatry” “child and adolescent psychiatry”, “socio-paediatrics”, “socio-psychiatry” alongside with “child neurology, or “neuro-paediatrics”.

Child neurology, a specialty of great sensitiveness and precision (which today has a tendency towards being named “paediatric neurology”), has its own history, which developed intensely after World War II, together with adult neurology. Although certain neurologists prefer it to be a single entity, meaning that it should encompass both adults and children, I cannot believe that a neurologist specialised in adults will know how to handle a newborn baby, an infant or a toddler.

HISTORY OF CHILD AND ADOLESCENT NEUROLOGY AND PSYCHIATRY IN ROMANIA

In our country, in the years 1929-1930, Florica Bagdazar (1901-1978), who was practicing at Jimbolia Hospital (Timis-Torontal County) together with her husband, Dumitru Bagdasar, won a Rockfeller scholarship and went to study at New-York Harvard Public Health School, in the fi eld of child care and neuro-psychic diseases.

Florica Bagdasar

 In 1946, in Bucharest, she founded the „Centre for Children’s Mental Hygiene” which became „Centre for Child Neuropsychiatry” (in Galati Street). Th ere, together with other pioneers in the fi eld – E. Pamfi l, N. Toncescu, speech therapist Calavrezo, Măescu and others – she founded the fi rst academic clinical institution specialised in children. Th us, in our country, child psychiatry has its roots in the U.S.A., and it further developed its trunk and branches under the umbrella of European inspiration and relationships. Florica Bagdasar was the fi rst woman to be take part in a Romanian government, being Minister of Health between 1946 and 1948. Th en, the Communist regime fired, denigrated and persecuted her by during 1948-1956. When she was eventually “rehabilitated”, she became vice-president of the Romanian Red Cross. During the same period of beginnings Dr. Popescu – Silviu was also practicing, being the fi rst specialist in child and adolescent psychoanalysis in our country. Of course, we may approach the history in our country from a larger perspective, and mention many other forerunners who had a contribution to the foundation of the future specialty. Th e beginnings of childcare have been recorded in our country since 16th -17th centuries, when, around certain monasteries from Transylvania (in Medias), Moldavia and Muntenia, there were establishments for bringing up and educating orphan children. In an ample article, entitled “Milestones in the History of Child and Adolescent Neuropsychiatry” (2009), Șt. Milea has named these beginnings “the pre-scientifi c stage” to be followed by “the scientifi c stage”. In this article, published in RSCANP Journal, as well as in the volume of Th e First National Conference of the History of Romanian Psychiatry, Oradea, September 2009, St. Milea gave details of the shaping of concepts and administrative entities, which were conceived for the protection of the child with disabilities. Th e author included the contributions in the fi eld of the Psychology Schools from Cluj and Bucharest.

The documented materials published by Ștefan Milea, V. Ghiran, Sanda Măgureanu, N. Toncescu, C.Romanescu, Șt. Kecskemeti, C. Lupu and others refer, in majority, to the periods before 1990, especially after the end of World War II. In the next paragraphs, weshall point out some more signifi cant aspects, in majority conforming to the articles of the authors cited above. Th ere are some new elements, selected on the way, and an eff ort to update our approach with details from the period after 1990.

We must point out that, in 1900, in Ineu, Arad County, a school for retarded children was founded. In 1914, Gr. Odobescu and C.I. Parhon introduced the concept of psycho-endocrinology, and in 1928, in Iasi, The Society for Neurology, Psychiatry and Endocrinology was constituted under the leadership of C.I.Parhon. In 1933, S.Preda and I. Popescu Sibiu, established the fi rst offi ce of Psychiatry for Adults and Children in Sibiu. The year 1937, brings the description “Characters of Aff ectivity” by V. Pavelescu, and in 1938, Al. Obregia, the founder of the “Central” Hospital from Bucharest was the first at world level to practice sub-occipital puncture and he published the work “Consonantist Psychology”.

In spite of the organizational diffi culties and dangers of politization under the totalitarian regime, we may remember the events from those periods that have a well-defined place in the history of our specialty. Professional meetings were organised which took place at existing npi clinics and within the frame of the Society of Medical Sciences (SSM), that later became Th e Union of Societies of Medical Sciences (USSM). Articles could be published in the Journal of Neurology Psychiatry and Neurosurgery, communicationmeetings, symposia, congresses and conferences,etc. were organised in the name of this society, including the foundation, in Bucharest, of the “Infantile Neuropsychiatry Circle”, where the fi rst communication meetings and case presentations took place.

The first university disciplines in the fi eld of infantile neuropsychiatry were founded starting with 1948, being conceived by Conf. Dr. Florica Bagdasar in Bucharest and followed by Conf. S. Blumenfeld, by Conf. Constantin Romanescu in Iași, Psih. Creiniceanu and Conf. M. Muller followed by V. Ilea jr.,

Margareta Ștefan and Conf. V. Ghiran in Cluj, by Conf. E. Pamfi l in Timișoara. Th ese disciplines were taught at the Faculties of Paediatrics.

The Medical Publishing House in Bucharest had and it still has great importance, today it has changed its name and became Medical Life Publishing House. It has facilitated the publishing of many books in all medical specialties. In addition, we must mention the books and NPI courses from 1951 by Dr M. Muller (Cluj), Dr. St. Stossel (Timisoara) and Dr. Ghiran (Cluj).

In 1976, Volume I of a vast work “Psychiatry” by
Prof.DR. V. Predescu (Medical Publishing House) appeared, where, the beginning chapter, “History and present orientation”, presented the fi rst valuable data since antiquity until the moment of publication about the evolution of psychiatry. Th e two volumes of this treatise had the contributions of the psychiatrists St. Milea, Sanda Magureanu and Constantin Oancea.

We consider Gheorghe Marinescu (1863-1938), as the father of paediatric neurology in our country, due to his description of the case of two children with the disease bearing his name. In 1920, Prof. Gh. Marinescu was co-author to “International Treatise on Neurology and pathologic Psychiatry”, where neurological diseases of children are described, too. After World War II, we should mention the contribution to paediatric neurology due to the fi rst professor in this specialty, Paul Octavian from Cluj, and to Dr. Beatrice Pruskaner from Bucharest, both of them authors of the fi rst books on child neurology in Romania.

At present, many things have changed in this specialty. If in the beginning the diagnostic process started with the anamnnesis and motor function examination (clinical examination) -walking, osteotendinious and cutaneous refl exes, sensorial testing – , today, besides classic information there are transfrotanelar echography, cerebral, medullar or muscular MRI and other more precise investigations. Many new things are expected from genetics, medication and especially from the neural stem cells.

We should keep in mind that npi specialists were trained in specialty secondary stage at the Departments of Neurology and Neorosurgery, thus the graduates were able to solve cases of epilepsy, too. In the year 1967, Dr. Horia Radu founded Th e Neuromuscular Pathology Hospital in Valcele, as a unit directly subordinated to the Ministry of Health (M.H.).

The Child Neurology Section at the hospital Gh.Marinescu from Bucharest was created in 1981, under the direction of Dr. Gh. Popescu-Tismana, it became Clinic under the direction of Prof. Sanda Magureanu and now of Senior Lecturer Dana Craiu.

In Timisoara, studies on the isolated, co-sanguine populations from Banat and from other parts of the country, initiated by Dr. C. Lupu in 1964-1965, offered a map of the genetic diseases in this area. Since 1995, a team of specialists (C. Lupu, Axinia Corcheș, Maria Pau, etc) supported by EAMDA (European Alliance of Muscular Distrophy Association) and by WMS (World Muscular Society), have described over 100 cases with recessive sensorial – motor neuropathies specific to the groups of Rroms (gypsies) and the neuropathy with dominant macular-retinian degenerescence, and these diseases have been included in the human genome.

Among the forerunners, we must mention the closest associates in child neuro-psychiatric approach, our fellow psychologists, speech therapists, rehabilitation specialists, sociologists, psycho-pedagogues, theologians, psychotherapists, forensic physicians, ENT specialists, ophthalmologists or artistic collaborators like plastic artists, puppet theatre artists, etc.

The subject is open to discussion and we propose that each specialty listed above should submit presentations of its forerunners for publication in our magazine. Among the psychologists and speech therapists who helped build our specialized teams, I must mention Alex. Sen (Bucharest) who introduced the Binet-Simon and Wechsler tests into daily use in our network; Nicolae Mărgineanu (Cluj Napoca) who was a connoisseur of child psychoanalysis; Dumitru Mărgineanu (Timisoara) who contributed to the introduction of the new concepts of modern psychology; and many others across the country whom we can write a book about. Speech therapists like A. Calavrezo (Bucharest) and P. Chitulea (Timisoara) made also notable contribution in associated teams. In our field, rehabilitation started in health resorts like First of May – Oradea, Techirghiol, Târgovişte, Vâlcele, Dezna, and now in rehabilitation-stimulation centres opened in all district capitals. It is well known the School of Dr. N Robănescu, continued by Dr. Liliana Pădure and Dr. Ligia Robănescu in București and other services all over the country. We expect that all specialties mentioned above should describe their own history in our magazine.

Communism meant sacrifi ced generations and victims especially in psychology, psychiatry and child neuropsychiatry. We have lived transition periods again and again, suff ering from evil changes and persistent eff orts and political pressures. We were required to perform a large number of consultations, without having any sociological support; we had to hospitalize and to support hospitals for “chronic and irrecoverable children”. In addition, all the failures and tragedies of that antisocial and inhumane system were charged against doctors and psychologists. International participations were not possible. Prof. Milea could hardly get the approval to participate to a Congress in Delhi, in 1983 and Dr. C. Lupu at the EACD Congress in Varna in 1989, where I met specialists like Sir M. Rutter, C. Christozov, G.Golnitz, Remschmidt, for the fi rst time.

Paragraful acesta apare si mai sus, pagina.5 jos

Titulatura specialității noastre a parcurs la noi ca și în alte țări denumiri ca: neuropsihiatrie infantilă (npi), neuropsihiatria infanto-juvenilă, psihologie medicală, psihiatria copilului, adolescentului și familiei sale, sociopediatrie, alături de neurologia pediatrică, etc.

It is important to enumerate the Meetings and Conferences in our specialties organized and implemented with serious eff orts and materials by npi specialists from the respective centres:
• 1958 – the fi rst Meeting for “Infantile Neuropsychiatry and Endocrinology”, organised in Iasi – Socola Hospital; it had as special honorary guest Prof. G. E. Suhareva (Moscow). Th e session was classifi ed in that year as USSM meeting with the theme “Schizophrenia in children”. Unfortunately, we do not own any documents relating to that meeting. Th e organiser of the session was Conf. S. Blumenfeld.
• 5 years after that, in 1963, the National NPI Congress is organised in Timisoara, with guests from all over Romania. Th emes: Th e organization of NPI services, Th e limit intellect, Speech disorders in children. Th e works took place in Th e Amphitheatre of the “L. Pasteur” Hygiene Institute, and Dr Eliza Ionescu, Dr. P Arcan, Dr. C. Lupu and Dr. Peter V., Dr. Gertrude Habenicht were organisers.

The period 1963 – 1976 could be named “of rooting and organizing” at the level of administrative regions of Romania. Hospitals (asylum type) have been
founded in Jimbolia –Lugoj, Păclişa, Siret, Cadea, Dumbrăveni, etc. Th e professional events were local: USSM Communication Meetings, presentations of clinical cases, the establishment of the NPI Circle from Bucharest between 1965 and 1967.

Starting with the years 1965-1966, in the University Centres, Communication Sessions took place, where child neuropsychiatrists participated, too, within the frame of USSM. In Bucharest, Annual Conferences with pre-established themes were organised (for example “News in the treatment of psychoses”, “Psychogeneses”) where there were always guests from the other Romanian regions. Th e same conduct was in use in Cluj, Timisoara and Iasi. We point out the professional–scientific activity of our colleagues from the Sections of Neurology, Psychiatry and Child Rehabilitation from Sibiu. Since 1967 – 1968, they have organised courses and annual symposia with their own themes focusing on neurology and developmental psychiatry, and since 1998, these professional events were developed in cooperation with Kinderzentrum from Munchen. Th e initiative and continuity of these activities from Sibiu are exemplary.

In 1972, by a decision of the Ministry of Health, the foundation of LMSs (Laboratory for Mental Health) was decided, namely the transformation of the npi consultation offi ces within the County Policlinics into these new units. Thus, in Romania, some LMSs appeared, which brought nothing new, because everything (headquarters and staff ) stayed in place, there was no new facility.

The next national meeting was organised after 13 years also in Timisoara. Seeing that nobody took the initiative of organising a republican npi event, the same group of 1963 summoned in the following years:

• 1976 – National Conference of Infantile-Juvenile Neuropsychiatry at Timisoara. Th e proceedings took place in Aula Magna of the West University from Timisoara.
Themes: Neurotic reactions, neurosis, neurotic and psychopathic development, 10 years of activity of the Infantile-Juvenile Neuropsychiatry Clinic Centre from Timisoara.

• 1977 – The National Congress of Timisoara, Location: Modex Hall,
Theme: Adolescence Psychopathology.

• November 1977, another Conference in Iasi
Theme: the problems of the child and adolescent
Starting with the year 1980, annual Conferences, Meetings and Congresses have been organised.

• 1980 (Cf. St.Milea) Th e NPI National Conference, Bucharest.
Theme – News in Paediatric Psychiatry
The proceedings took place at Gheorghe Marinescu Hospital. Also in 1980, Arcan P. and Ciumageanu D. published the monograph entitled “Th e Mentally Deficient Child”.

• 1981 – National Conference from Siret. The proceedings took place at the NPI Hospital and at the Siret Cultural House (Suceava County).
Theme: Healthcare and Treatment in NPI hospitals.
Organizer: Dr. Georgie Popescu

• 1982 – Th e NPI National Conference in Lugoj, organized on the occasion of the 25-year anniversary of NPI hospital,
Theme : Th e child with behaviour disorders and delinquency. Organisers: L. Borbil, Dr.R Pârvulescu, Dr. Cătăniciu Florica and the Lugoj team.

• 1983 National Conference in Cluj Napoca with the theme “Cerebral Critical Manifestations”, the hosts being Conf. V. Ghiran, Conf. O. Pavel. Dr. Elena Benga and the Cluj team. The venue was Students’ Cultural House.

• 1984 – National Conference in Bucharest, with the theme: “News in the diagnosis and therapy of infantile psychoses”. Our hosts were .Senior Lecturer Șt. Milea, Dr. C. Oancea, Dr. Ștefan Margareta, Dr. Sanda Măgureanu and their colleagues, and the venue was the “Gh. Marinescu” Hospital.

• 1985 – Timisoara Conference, organized on the 20-year anniversary of the Neuropsychiatry Clinical Centre for Children and Adolescents of Timisoara. The main theme was dedicated to the Syndrome of minor cerebral lesion: instrumental disorders, oral and written language skills, dyspraxias, disgnoses, and disharmonies. For the first time, a volume collecting the reports and communications presented at the conference was published. Host: Dr. C.Lupu and his team.

• Also in 1985: Th e USSM Session in Sibiu, with the theme: “Effi ciency and value in exploiting the cognitive processes”.

• 1986 – Bucharest, NPI National Conference with the theme: “News in Psychopathology of Anxiety in Child and Adolescent” The same hosts as in the
preceding Bucharest conferences.

• 1987- Târgu-Mureș, Theme: ”Subacute sclerosing panencephalitis (PESS)” Venue: Youth Culture House. Host: Conf. B. Asgian, Dr. Voica Foișoreanu and their team.

• 1988- Oradea- Conference in Băile Felix; Venue: Felix Hotel; Theme: ” Family and Child psychopathology” Hosts: Dr. Monica Platon și Dr. S Kecskemeti and their colleagues and honorary guest was Prof. Dr. E. Pamfi l.
In the year 1988, Volume 6 of the Paediatrics Treatise is published to which Șt. Milea contributed with the up-to date presentation of child and adolescent
psychopathology, including the chapter of paraclinical investigations in neuropsychiatry, the latter in collaboration with I. Roman. Th e chapters in Th is Treatise are the first in Romania that we may define as the foundation of Child and Adolescent Psychiatry published at a high level.

• 1989 – National Conference of Child and Adolescent Neuropsychiatry from Călimănești – Căciulata (Vâlcea County). Th eme: ”Reactions, neuroses, and neurotic developments”. Honorary guest: Prof. V. Predescu from Bucharest. Organiser: Dr. Corneliu Lăzărescu from Râmnicu Vâlcea. Venue: Hotel Căciulata.

• The directors of hospitals, chiefs of departments, teachers and many guests participated in Bucharest to the National Conference “150 Years of Romanian Psychiatry” organised by USSM and MS, having Dr. C. Gorgos as host. Th e venue was the new “Bucharest” Hotel. All the communications were published in the Neurology, and Psychiatry and Neurosurgery Journal Nr. 3 of 1989, including the presentations on the NPI history.

• Also in 1989, in Timișoara Dr. C. Lupu organised the first and (only) course on “Forensic Expertise in Teenagers”.
The Revolution and fall of the communist regime followed; this situation could change our lives and it brought hopes for the future.

• In January 1990, immediately after the Revolution of December 1989, mass media announced through all its channels: written press, radio, television, that the citizens have the right to organise themselves in Associations. Taking the initiative, I summoned the annual analysis meeting of the Methodological Centre from Timisoara at the Arad NPI Section, on 26-27 January 1990, and Dr. Judith Krisbai, the Chief of that Section, was our host. We proposed there to set up a medical association of Child and Adolescent Neuropsychiatry (CANP) and Associated Professions. All the participants accepted the proposal, signed applications and decided that the foundation date should be January 30, 1990, when the news went to press.

Our association was to be called “The Romanian Society for Child and Adolescent Neurology and Psychiatry” (RSCANP) having as members physicians and colleagues from associated professions who work in the CANP clinics and offices, as well as colleagues from other specialties who may subscribe as sympathisers or sponsors. The first satute was conceived by Prof. Dr. V. Ghiran was recorded in Associations Register in 1993

In 1990, everywhere in the country people were reticent in organising public meetings due to the violent events that followed December 1989 (the revolution, the miners’ attack), so that nobody off ered to organise a congress.

• Still, we designed a programme and, on April 6 – 7, 1990, against all uncertainties, we met at Lugoj in an inter-county symposium with the theme “Emergencies in Child and Adolescent Neuropsychiatry” and for the assisting staff the theme was “Neuromotor stimulation and rehabilitation”. This was the first event under the aegis of RSCANP
Our honour participant was Prof. Dr. Mircea Lăzărescu, the hosts were Dr. L. Borbil and his colleagues from NPI hospital in Lugoj. For case presentation, we invited to Timisoara the 11-year-old Laurențiu C. who had been recently operated in Italy for a correction of his severe kyphoscoliosis due to DPM Duchenne.
In the years that followed, the training of secondary and resident physicians continued at the university centres from București, Cluj-Napoca, Târgu-Mureș și Timișoara. Also, doctoral studies could be organised in those centres. Th e meetings and National Conferences became Congresses, and we shall continue now to enumerate them.
As, in 1990, RSCANP was at its beginnings, preparations were made in order to offi cialise its status, which lasted until 1992 when, at the NPI National Conference in Păclișa Prof. Dr. V. Ghiran was elected Chairman by the General Assembly. Th en, the Cluj County Law Court entered RSCANP in the Associations Register, while Th e Ministry of Health gave its approval in 1993. Th e next presidents were Prof. Dr. St. Milea, Prof. Dr. T. Mircea, Dr C. Lupu, while Dr. Axinia Corcheş is currently the president since 2009.

—Since 1998, at the initiative of Prof. T. Mircea, The RSCANP Journal was published quarterly and this is its 13th year of publication.
—Here is the list of conferences and congresses organized by RSCANP since its birth:
—1990-Lugoj, the fi rst professional event under the aegis of RSCANP
—1991-Sibiu,
—1992-Păclișa, fi rst conference with international participation, honorary guest being Prof Brian Neville (London),
—1993-Timișoara,
—Between 7 and 11 October 1993, the 16th National Conference and Congress I of RSCANP with International Participation. Venue: The State
German Theatre from Timișoara.
—Themes: Emotional disorders in children and adolescents
—Neuropsychiatric assistance for motor impaired individuals

Psychotherapy of affective disorders in children and adolescents.

Together with 180 colleagues from Romania the following guests from abroad participated too: Prof. Michel Basquin (Paris), Prof. Harry Zeitlin (London), Prof. F. C. Verhej (Holland), Bernard Vorizgot, Bianca Plaoutine, Poggionovo Marie- Paul, pauline St. Leger, Lemurel Jean-Bernard, Dusanter Yves-Michel, Henri Donadieu (France), Charles Bright and Patricia Bright (U.S.A.), Margaret Lynch (London), Michel Shoater, Julie Davidson, Shamala Pillay (U.K.), Dr. Marcus Onken Wapertal –Arath, Marianne Sostman, Werner Wollek, Ulvike Dudziak (Germany), Niko Bouman (Holland), Mary Reeds (Norway), Nadia Peristeri, M. Ruchon, Maria Shore, Nano Virgiil and Elida Congonji (Albania), Steen Dam, Ulla Ipsen Michel Hansen (Denmark). Th e participants had a pleasant visit to “the House with Open Windows” hosted by Dr. Violeta Stan, and were offered a Symphonic Concert conducted by George Cristian Neagu, at Th e Capitol Hall, with music by Fr. Haendel, F. Mendelson and J. Brams. Th e “familial” festive dinner took place in the dining hall of CANP Clinic from Timisoara.

Due to its importance, the opinion was that this event might be considered the First RSCANP Congress.

—1994-Brașov,
—1995-Reșița,
—1996-Cluj-Napoca,
—1997-Săpoca-Ojasca (Buzău),
—1998-Târgu-Mureș,
—1999-Craiova,
—2000-Miercurea-Ciuc,
—2001-București,
—2001-Sibiu,
—2003-Timișoara,
—2004-Băile-Herculane,
—2005-Gura-Humorului (Suceava),
—2006-Neptun, (Constanța),

—2007-Sinaia,
—2008-Băile Felix (Oradea),
—2009-Timișoara,
—2010-Târgu-Mureș.

We must remind you that the themes discussed at our congresses were very important for all members. All the classical and actual aspects were debated, including problems of rehabilitation and of therapies. Many of the congresses dealt with important psychoanalysis and neurologic genetics issues. Following this article, all the RSCANP annual manifestations are to be described in a detailed material, which will be published in our Journal. At the Târgu-Mureș Congress (Sept 2010), the participants may view on slideshows and exhibition boards diff erent aspects of the RSCANP Congresses after 1990.

In its twenty-year existence, RSCANP contributed to the assertion of our specialties, and to the emancipation from satellite tutelage, imposed by obsolete concepts. As St. Milea tells in History of Infantile Neuropsychiatry, in the RSCANP Journal and at The History Conference from Oradea, 2009, before 1990, the information and the relationships with specialists from abroad were limited strictly. The scarce contacts took place under difficult conditions. Among the few openings to international experience in our field, mention could be made to Prof. V. Ghiran’s doctoral studies in Prague, in the period 1962-1965 and Prof. Șt. Milea’s doctorate in Moscow in 1967-1970. Prof. Șt. Milea’s participation in Delphi Congress in 1983 and Dr. C. Lupu’s participation in ESCAP Congress in Varna, in 1988 were full of obstacles. At Varna, I was very happy to be able to meet remarkable personalities in our field like Sir Michael Rutter, Prof. Christozov (Sofi a), Prof. G. Golnitz (DDR), Prof. Remschmit, but in order to leave the country I received the passport in the last minute. The few specialists who were allowed to go abroad on study visits had the obligation, at the return from their trip to give the green passports back to the authorities.In 1969, MS approved a trip to France called “exchange of experience” of 1 month, 1st -30th October, to Dr. Eliza Ionescu, with the aim to inform the “management board” on the organisation of child psychiatry in various French institutions. She visited The “Rochefoucauld” Institute of Psychiatry, Alfred Binet Centre, Prof. G. Heuyer’s Clinic from Salpetriere, Ambulatory Service from Montpellier, a series of medical-educational institutions, Mairet Clinic from Montpellier etc. In the her report on the visit, Dr. Eliza Ionescu showed the principles of child and adolescent assistance in France:
—Ambulatory assistance and therapy come first,
—Children’s lives, either in their family environment or in day care units, come first,
—The use of relevant statistic data from territorial assistance,
—De-hospitalization and abolishment of big hospitals with legal support and without haste.

After 1989, the borders of our prison opened so that in the 20 years (1990 – 2010), the sponsored or private participations to International Congresses, courses, and professional visits have been possible. All these events have been important both professionally and culturally. Th ey offered the opportunity for us to meet our peers from other countries, to know their work methods, possibly, to make a presentation, and to find out the much-needed news in our fi eld, which could be shared with colleagues at home. However, many of these participations have been forgotten, too few have been presented in our magazine or in the weekly Medical Life, so that we do not possess a chronology of Romanian participation in the international scientific life. I want to invite you, in future, to send to RSCANP Journal or to Medical Life weekly such information for the benefi t of all the colleagues and in order to highlight your sponsors.

Starting with 1948, when Conf. Dr. Florica Bagdasar launched the courses “Th e Psychology of Normal and Pathologic Child”, they have been taught in the same year in Iasi, too, by Conf. S. Blumenfeld, in Cluj by Conf. M. Muller and in Timișoara by E. Pamfi l. We present now the present “picture” of the disciplines of Child and Adolescent Psychiatry and Neurology taught in the Romanian Medicine Universities. Thus, the list of the specialists in our field who work for the Ministry of Education, too, is the following:

—University of Medicine and Pharmacy “Carol Davila” Bucharest:
—Paediatric Neurology – Conf. Dana Craiu and Consultant Prof. Sanda Măgureanu
—Child and Adolescent Psychiatry: Prof. Iuliana Dobrescu and Consultant Prof. Șt. Milea, member of the Medical Academy. University Assistants : Grozăvescu, Mateescu
—University of Medicine and Pharmacy “Iuliu Hațiegan” Cluj-Napoca:
—Child Neurology Conf. Alex Cristea and assistants MD Mihaela Vinţan, MD Monica Berecki.
—Child and Adolescent Psychiatry: Conf. Viorel Lupu and assistants MD Elena Predescu.
—University of Medicine and Pharmacy “Victor Babeș” Timișoara:
—Child and Adolescent Psychiatry: Prof. Tiberiu Mircea, assisted by Ș. L. Violeta Stan, Prep. Laura Nussbaum.
—University of Medicine and Pharmacy Târgu
—Mureș: prof. MD Viorica Foişoreanu
—Child and Adolescent Psychiatry University of Medicine and Pharmacy “Grigore Popa” Iași:
—Child Neurology: Prof. Georgeta Diaconu.

Although a Museum Centre and the RSCANP archive in Timisoara have not been achieved yet, the concept is still valid, in order to preserve the photograph albums, the biographies of our colleagues , the collections of medicine treatments of mental diseases, collections of posters, some books with historic value, objects that belonged to personalities in our profession, rehabilitating devices, documents about RSCANP and about other associations in our fi eld, specialist journals, aspects in the history of epilepsy and so on.

It would be preferable that this Museum Centre should be positioned in an accessible place, to be visited by residents and by other specialists in training or by guests from other countries.

RSCANP activates according to its own Statute and is a member and collaborator of the following organisations:

—EACD: European Academy of Child Disability
—ESCAP: European Society for Child and Adolescent Psychiatry
—IACAPAP: International Association for Child and Adolescent Psychiatry and allied professions
—WMS: World Muscular Society
—ILAE: International League Against Epilepsy
—FIEK: Forschunginstitut fur Epilepsie Kork
—EFNS: European Federation of Neurological Societes
—CLEFRP: Comite de Liaison pour Echanges Franco- Roumains en Psychiatrie
—SRN: Societate Română de Neurologie (Romanian Society of Neurology)
—APR: Asociația Psihiatrică Română (Romanian Psychiatric Association)
—CMR: Colegiul Medicilor din România (The College of Physicians from Romania)
—AMR: Asociația Medicală Română (Romanian Medical Association)
—EAMDA: European Alliance of Muscular Distrophy Association
—APL: Asociația Psihiatrilor Liberi (Association of Independent Psychiatrists)
—Societatea Română Împotriva Epilepsiei (Romanian Society Against Epilepsy)
—Asociația Română de Psihiatrie a Copilului și Adolescentului și Profesii Asociate (Romanian Association of Child and Adolescent Psychiatry and Associated Professions)
—RSCANP collaborates and keeps up a correspondence with:
—SFPE: Societe Francaise de Psychiatrie de l’Enfant
SRP: Societatea Română de Psihologie (Romanian Society of Psychology)
—CEOFPRM: Confederacion Espanola de Oraganizationes en Favor de las Personas con Retraso Mental
—Asociația Psihologilor din România (Romanian Society of Psychologists)
—Magyar Gyermekneurologiai, Idegsebeszeti. Gyermek es Ifj usagpszichiatria Tarsasag: Asociația Maghiară de Neurologia Copilului, Neurochirurgie
și Psihiatria copilului și adolescentului Magyar Association
Of Child Neurology, Child and Adolescent
Neurosurgery and Psychiatry)
—Institute of Child Health London Department of Neurology and Developmental Paediatrics
—Institutul de cercetări Științifi ce Psihiatrice din Moscova- Secțiunea Psihiatria Copilului (Scientific Psychiatric Research Institute from Moscow – department of Child Psychiatry)
—Medicins du monde – France
—Salvați copiii- România (Save the Children, Romania)
—Asociația Balint din Miercurea Ciuc (Balint Association from Miercurea Ciuc)
—FRSH: Federația Română a Sporturilor pentru Handicapați (Romanian Federation of Sports for Handicapped People)
—SOR: Special Olimpics Romania
—Societatea română pentru diagnostic și terapie Vojta din Sibiu (Romanian Society for Diagnosis and Vojta therapy)

The efforts of main personalities from the staff of the respective institutions, make it possible for RSCANP to cultivate its long-lasting relationships of with these organisations and with hospital institutions from Romania and abroad. We have the same good relationships with representatives and managers of firms that manufacture the medicine used in our country. We thank all these friends and colleagues for collaboration and support n we express our wish to develop our cooperation further. We answer to the requests of associations, societies and NGOs that care for children and youth with neurologic and psychic disabilities and for their families.

For many years, we have had a fruitful and constant collaboration with the weekly “Medical Life”, where our colleague in specialty, Dr. Alex Trifan is main editor and an erudite in psychiatry and psychoanalysis. For years, he has supplied us with articles and information, which nourished us both professionally and spiritually. With every issue of the Medical Life under the leadership of Dr. M. Mihailide, our own life is enlightened and enriched.

The history of our specialties does not stop here; we have young teams in all the counties and sectors of the capital, in hospitals and clinics. I would like that the youth, after reading the articles on our history offered by Prof. Șt. Milea, Prof. V. Ghiran, Prof. S. Măgureanu and by the other authors in the fi eld (see bibliography) should write down and transmit us the novelties that should be known by our professional community and published.

We notice that the neuropsychiatric pathology changes and even multiplies, that the access to computerised information is free for everyone, but the organisational and administrative situation is diff erent from one region to another. Th at is why an exchange of good practice is necessary on the present situation of the clinical and ambulatory assistance and on the problems faced by private practice offi ces. RSCANP and its Journal are here to help you.

In this material on RSCANP history, it is important to mention a work in two volumes of great value by Prof. Șt. Milea, PRIMARY PROPHILAXY OF PSYCHIC DISORDERS IN CHILD AND ADOLESCENT (2008-2009). It is the result of his research and of some concepts that he developed and an achievement at national and international level. It presents each aspect of the Specifi c Primary Prophilaxy SPP, which is the only way to reduce risk factors in the life of a child and of an adolescent, with clear and possible recommendation for the strategies of primary prophylaxy where the state, the social organisations, we, the psychologists and the neuropsychiatric physicians together with the specialists in mental health should be involved. At an attentive reading, Prof. Șt. Milea’s texts become stronger by their convincing power and truthfulness.

Our Journal of Child and Adolescent Neurology and Psychiatry, founded by Prof. T. Mircea in 1997,ia a publication created with the aim to inform the physicians and the colleagues in associated professions on the problems of developing child and of his neuro-psychic disorders and on the news in our fi elds. We welcome here the teachers and specialists in the network as well as the young residents, “the beginners”, so as they could “train their hands” for medical publications. “Original” articles are not obligatory, we welcome also reviews, questions and commentaries, or commemorations of events or personalities, aspects from specialised institutions or organisations, and, of course, presentations about congresses or courses.

This invitation is permanent for all the members of RSCANP and for the collaborators from other fields or from other countries. The proposed materials will be composed around actual and/or interesting professional subjects.

In the 64 years (1946-2010) since the foundation of our specialty and 20 years from the foundation of RSCANP (1990-2010), many aspects, concepts have changed and 4-5 generations of active physicians and specialists in associate professions have replaced one another. In these years, we managed to meet and know each other; we have created our professional independence and a position among the other medical specialties.

These qualities are the result of the continuity from one generation to the other, of what we all wanted: to be a family of known and respected professionals. By continuity I mean, we have what to transmit to our followers who will be more informed with the heritage passed on from their ancestors. If there were among us some individuals who thought that “we know everything, we are the beginning in our specialty”, then, they were wrong; they lost their right to “heritage”.

I want to emphasize that all colleagues from the Child and Adolescent Neurology and Psychiatry Network are well-trained professionals, hardworking and humble, while able to take on and solve the complex medical psychosocial cases, which form the substance of our work. Th e majority of physicians, nurses, psychologists, sociologists, rehabilitators are dedicated individuals, interested in contributing to the examination of children, adolescents and families concerned and in establishing comprehensive and useful diagnoses of our patients.

An element of progress appears now, in the first decade of the 21st century: translational neuropsychiatry, which might enlarge the multidisciplinarity of our professions.

We all know how numerous our patients are and how diverse the many problems we have to resolve during a consultation or a hospitalization.

In spite of all these demanding eff orts, we love our profession and, in majority, we benefi t from what RSCANP off ers us. Now we can say that our young but experienced and useful Romanian Society of Child and Adolescent Neurology and Psychiatry deserves our full attention and respect, so we can wish it “Happy Birthday”.

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