The interaction of internal and external factors in producing psychopathology

When we treat or discuss child patients who have been referred to us for help with a wide variety of mainly neurotic disturbances we usually take it for granted that a host of factors, both internal and external, have combined and contributed to produce the clinical picture presented by any child at the time of referral. But although it is the endeavour of every diagnostician and of every therapist to tease out, either at the diagnostic stage or in the course of the ongoing treatment, the multiple pathogenic factors which were responsible in bringing about a particular disturbance, every diagnostician and clinician knows only too well from his experiences what an intricate and difficult task this is. This is due both to the complexity in the functioning of the mental apparatus and to our lack of sufficient knowledge of the internal effects of a developing child's earliest experiences.