"A DOCTOR OF THEIR OWN": THE EMERGENCE OF ADOLESCENT MEDICINE AS A CLINICAL SUB-SPECIALTY, 1900-PRESENT

Heather Munro Prescott, Ph.D.
Cornell University, 1992


This dissertation explores the history of adolescent medicine in the United States from the early 1900s to the present. Using published medical literature, oral histories, patient case records, and popular culture sources, this dissertation argues that adolescent medicine was shaped not only by biomedical advances and intraprofessional problems, but also by concerns about American youth culture; changes in the structure of the American family; gender issues in science and medicine; and most importantly, adolescents' own views of medical care.

Part One argues that gender issues played a critical role in the emergence of adolescent medicine. Although researchers in the field of child development understood the unique health care needs of teenagers well before the first adolescent clinic was established in the early 1950s, the close association between adolescent research and a female-dominated child welfare tradition initially led pediatricians to devalue the work of developmental researchers. It was only during the 1940s and 1950s, when professional problems in pediatrics intersected with anxieties about youth culture and delinquency, that pediatricians began to seriously consider the implications of developmental research for adolescent health care.

Drawing on the case records of 432 patients who were treated at the Adolescent Unit at Children's Hospital Medical Center in Boston, which was the first adolescent health care facility in the United States, Part II examines the role that adolescent patients and their families played in the emergence of adolescent medicine. The majority of the Unit's clientele were upper-middle-class parents who used the facility as a means of dealing with delinquency and other forms of unacceptable teenage behavior that threatened the family's social standing. At the same time, the Unit's staff recognized that winning their young patients' approval was essential to the latter's compliance with medical advice, and that autonomy from parental influence was a crucial component of normal adolescent development. As a result, physicians favored a clinical style that often thwarted the wishes of parents who used the clinic, and actually increased adolescents' independence from parental control.


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