Who can ever foretell

Robert Coles writes about Anna Freud:

"A year later I was in medical school, where I fastened my hopes on pediatric work with children. During internship and residency in pediatrics and child psychiatry, I became especially interested in the ways children struggle with severe illness - their moods, their hopes and worries, as they lay sick in the hospital. It was then that I had occasion to hear Miss Freud again. She had come back to America, and was now talking about her work after the Second World War with children who had survived concentration camps. This talk was less "public"; it was given in the seminar room of a Boston hospital. I had been invited to attend by an older physician, a surgeon who had taken an interest in psychoanalysis and, as a matter of fact, had been analyzed by a prominent colleague of Anna Freud's father, yet another "refugee" who had found his way during the late 1930s to the United States.

The small room was crowded with about forty people, almost all physicians. I was once more struck by the directness of the speaker, her evident command of her subject, her willingness to share her knowledge with us in such an accessible manner. Each sentence seemed a perfectly formed jewel, sparkling and delightful to contemplate. An uncanny mixture of relaxed self-assurance and intense dedication emanated from this small, still, thin woman, plainly dressed, her voice strong but not insistent. I still remember the talk, and I still remember a sudden desire, afterward, to ask a question about a girl I had come to know, a patient at Children's Hospital in Boston. This girl had a serious diabetic condition, and yet seemed so resolutely cheerful and confident that all of us - nurses, social workers, doctors - wondered what "really" crossed the child's mind when she was alone, when she was not putting up such a valiant show of outgoing optimism. I didn't expect Miss Freud to say what our young patient was thinking, but all of us at the hospital were worried about her future psychological prospects, and so I did ask about prognosis - about the likelihood of psychopathology developing in a year, two years, or even farther along.

Even now, I can see as well as hear Miss Freud's response. She put her hands on her papers, moved them slowly, deliberately, but with increasing animation. Her message was pointed - and a real challenge for the young doctors in the audience who were accustomed to receiving categorical or specific advice: "Who can ever foretell what a child will be like in the time ahead?"

I wrote the words down, and found them quite unsatisfying - the kind of remark actually, one of my grandparents would make out of the stoic surrender of old age. I was convinced that she was the very one who could with reliability and accuracy do such prophesying. But she persisted and reminded us, at length, how difficult it can be for even the best-informed observer of any given child to know what tomorrow will bring in the way of psychological adjustment, or the lack thereof."