Parents in the hospital

At the bedside of the sick child deals with the history of parents’ presence with their hospitalized children and its consequences. Sarra Mougel favored observation and spent a year and a half in a general pediatric service (three or four days a week) and two periods of six and four months in a pediatric hepatology service. The material collected consists essentially of informal conversations between the author, parents and/or caregivers. Its perspective is operated by a historical work and a sociological theorization which is mainly nourished by two sources: on the one hand on the work in medical sociology of American interactionists (Eliot Freidson, Erving Goffman and especially Anselm Strauss), on the other on the works of François de Singly in sociology of the family and the individual.

The book starts from a questioning of the opening of pediatric hospital services to parents, which has long encountered significant resistance from medical teams, especially in the case of France. The first chapter takes up this evolution in detail and distinguishes three major periods. During most of the XIX^e Century, hospitals adopted a relatively restrictive hospital visit policy, although the bother of a certain liberality. The presence of parents in the hospital is seen as a minor element, which risks causing over-work for services often lacking cruelly of staff. From the 1880s, following the Pasteurian revolution, fear of infections led hospitals to drastically limit the possibilities of visiting the hospital (generally two hours on Thursdays and Sundays in France). If this restrictive policy continues until the day after the Second World War, the period of the interwar period saw the birth of the globe of initiatives to the four corners to open pediatric services to parents, in particular to mothers. After 1945, René Spitz’s work on “ Hospitalism “And John Bowlby on” maternal deficiency Come into a scientific language, more convincing for the medical profession, the already widespread idea that the success of the hospitalization of a child also derives from psychological factors, on which the regular presence of his parents plays positively. In France, while this work quickly arouses intense debate between professionals, the policy of quasi-fermeature of services to parents is maintained much longer than than in Britain or the United States. It was even necessary to wait for a 1983 circular to explicitly affirmed a right to visit the parents.

The second chapter is interested in the translation in fact of this opening of pediatric services and underlines on the one hand the diversity of the methods of presence of parents with a hospitalized child, on the other the ambivalence of caregivers in the face of this presence. The latter tend to both transform the right of visit into a duty of presence (and therefore to castigate the absent mothers) and to complain about the invasion of the service by the parents, against which they fight in particular by promoting their installation as little as possible (accommodation and poorly adapted restoration services, absence of bed and choice of armchairs uncomfortable for the parent who wishes to stay at night, criticism of parents who “ believe at home »). The result is a difficult position for mothers (which are by far the most present, the fathers being most often there “ in support »), Which we expect a dedication to the child who also facilitates the work of caregivers (for example by helping the child to” master your feelings During care). The following three chapters wonder about the relationships between parents and professionals who arise from this cohabitation, so to speak forced. The profane work of parents, although it is free and little recognized by caregivers, would be one of the conditions of possibility of professional work and would allow an acceleration of the child’s hospital trajectory while maintaining the unit of its biographical trajectory. Among the reasons for recurring tensions between parents and professionals, the author highlights the power of control that parents have on the work of caregivers. Conversely, it also shows how caregivers control and assess parental educational work.

In conclusion, Sarra Mougel is emancipated from the framework of his survey data for on the one hand to pose hospitalized childhood as a paradigmatic figure of contemporary childhood (vulnerable and object of a development project towards gradually acquired autonomy), on the other hand to campaign for a real policy of opening services to parents who take into account the material conditions of their presence (improvement of accommodation and restoration services), their role in the therapeutic process (Let them participate more in care, allow them broader access to information and decisions) and the difficult articulation between hospital life and daily life (proposal for specific leave for hospitalized children).

The parents’ presence seems at first glance a detail in the hospital world, which certainly causes a number of tensions and anecdotes, but which is far from media or considered fundamental subjects. Attentive analysis of what is happening concretely in pediatric services nevertheless opens up reflection on crucial questions: how the interest of the child is built and interpreted, and in this case the sick child ? How the roles of parents and professionals are distinguished and clarified ? How do social power relations (between sexes, between social circles, between cultures, between professional categories) are exported in the particular framework that is the hospital ? The last chapter is particularly interesting and shows how the displacement of the interest of the child’s body towards his psyche has considerably widened the areas of legitimate intervention of caregivers. These proceed, more or less explicitly, to a social identification of the patients and their family entourage in order to determine those who need to learn their role as parents, that is to say to integrate the standards of education and childcare currently valued, which mostly refer to the autonomist standard analyzed in particular by François de Singly (“ make “Rather than” do in place of »). This identification, although it is often based on social criteria (more marked suspicions towards popular families), even racial (suspicions of foreign families, in particular if they are seen as culturally distant), is expressed in team meetings and informal discussions almost entirely in a psychologized form and essentially targets mothers.

However, it can be regretted that variations in the attitudes of parents and professionals are more described than analyzed. Why are some parents more present than others in the hospital ? With what type of parents do caregivers feel most comfortable ? How are the differences in attitude between fathers and mothers are built and rebuild ? Between parents and grandparents ? What specific role plays the social belonging of each other ? The very numerous extracts from the field journal certainly give the flesh to the subject, but they are not always commented and present to the reader a multitude of individual cases, stripped of almost any social attribute, coming to support the reasoning of the author. How are these individual cases generalizable ? What are the individual characteristics that explain the observed interactions ? What are the specific characteristics of the hospital and the services surveyed ? What are the social trajectories of caregivers and families met ? Without being able to rely on these elements, we are reduced to reading the observations reported as oppositions between “ parents “And” professionals “, While we can assume that many other sociological variables would be more enlightening and would allow to go beyond these encompassing categories. Often based on these socially disembodied words, the point of view of the author sometimes seems to dissolve in that of one or the other. Thus, the use of the duration of the hospital trajectory as a criterion for evaluating the effects of the parental presence ready for discussion, as it is in line with the recent managerial reforms of the hospital which aim, among other things, to reduce hospitalization durations, with a double objective of unclogging hospitals and cost reduction.

These criticisms are however to be taken with care, as the object of study chosen by Sarra Mougel turns out to be rich and carrying multiple questions. How to describe and analyze in a few hundred pages a phenomenon as complex as the relationships between parents and professionals in the evolutionary framework of today’s hospital ? How to jointly take into account the effect of professional hierarchies, family configurations, historical developments specific to the French hospital, specificities of the services studied, without running the risk of losing the reader and missing master threads ? However Sarra Mougel avoids the pitfall of dispersion. His work is in fact remarkably articulated, provided that he does not tell us about all the interactions that are formed “ at the bedside of the sick child “, But general consequences of the eminently ambiguous opening of pediatric services to parents. In continuity of the historical chapter which brushes all in nuances an opening operated to retreat by the medical teams, the entire book describes with precision how this fundamental ambiguity (which is well at the end of the premises to the parental presence) is declined in a multitude of tensions between parents and professionals. It is this situation of poorly assumed and not very supervised co-presence which is the central object of the book and it is it which makes the unity and the success of this stimulating work.