Maternal Deprivation and Its Impact on Mental Health: Origins and Implications, Slides of Psychiatry

Download Maternal Deprivation and Its Impact on Mental Health: Origins and Implications and more Slides Psychiatry in PDF only on Docsity!

Part I

ADVERSE EFFECTS OF MATERNAL DEPRIVATION

CHAPTER 1

SOME ORIGINS OF MENTAL ILL-HEALTH

Among the most significant developments in^ psychiatry during the^ past

quarter of a century has been the steady growth of evidence that the quality

of the parental care which a child receives in his earliest years is of vital

importance for his future mental health. Such evidence came first^ from the psycho-analytic treatment of adults and then from that of children.

It has been greatly amplified during the past decade by information gathered

by psychologists and psychiatrists working in child guidance and child

care-two fields affording^ unrivalled^ opportunities^ for^ first-hand^ observa-

tion both of the developing child and of his milieu.

Largely as a result of this new knowledge, there is today a high level of

agreement among child-guidance workers in Europe and America on

certain central concepts. Their approach^ to^ cases,^ their^ investigations,

their diagnostic criteria, and their therapeutic aims are the same. Above

all, the theory of etiology on which their work is founded is the same.

The basic principles of this theory of the^ origins of mental health and

mental illness will be discussed more fully later. For the moment it is

sufficient to say that what is believed to be essential for mental health is

that the infant and young child should experience a warm, intimate, and

continuous relationship with^ his mother^ (or permanent^ mother-substitute)

in which both find satisfaction and enjoyment. Given this relationship,

the emotions of anxiety and guilt, which in excess characterize mental ill-

health, will develop in a moderate and organized way. When^ this^ happens,

the child's characteristic and contradictory demands, on the one hand for

unlimited love from his parents and on the other for revenge upon them

when he feels that they do not love him enough, will^ likewise remain of

moderate strength and become^ amenable^ to^ the^ control of^ his^ gradually

developing personality. It is this complex, rich, and rewarding relation-

ship with the mother in the early years, varied in countless ways by relations

with the father and with siblings, that child psychiatrists and^ many others

now believe to underlie the development of character and of mental health.

A state of affairs in which the child does not have this relationship is

termed ' maternal deprivation '. This is a general term covering a number

of different situations. Thus, a^ child is^ deprived^ even^ though^ living^ at

home if his mother (or permanent mother-substitute) is unable to give him

the loving care small children need. Again, a child is deprived if for any

MATERNAL CARE AND MENTAL HEALTH

his mother and his father are used as the focal point, data of far greater precision emerge, and much that is obscure in the origins of mental illness begins to become clear. An illustration of the fruitfulness of this stand-

point is a recent study by Stott,137 who has published the full case-histories

of 102 persistent offenders aged between 15 and 18 years who were in an English Approved School. In this comparatively large series he has demon- strated clearly how anxieties^ arising from^ unsatisfactory relationships^ in early childhood predispose the children to respond in an antisocial way

to later stresses. Most of the early anxiety situations noted by Stott are

particular aspects of maternal deprivation.

Naturally, parent-child relationships have^ many dimensions^ and there

are many other ways besides deprivation, arising from separation or outright

rejection, in which they may become pathogenic. The commonest are^ (a)

an unconsciously rejecting attitude underlying a loving one, (b) an excessive

demand for love and reassurance on the part of a parent, and (c) a parent

obtaining unconscious and vicarious satisfaction from the child's beha-

viour, despite conscious condemnation^ of^ it.^ These^ themes, however,^ do

not concern this report ; nor does it treat in detail the child's relation to

his father. The reason for this is that almost all the evidence concerns the

child's relation to his mother, which is without doubt in ordinary circum-

stances by far^ his most important^ relationship during^ these^ years.^ It^ is

she who feeds and cleans him, keeps him warm, and comforts him. It is to

his mother that he turns when in distress. In the young child's eyes father

plays second fiddle and his value increases only as the child's vulnerability

to deprivation decreases. Nevertheless, as the illegitimate child knows,

fathers have their uses even in infancy. Not only do they provide for their

wives to enable them to devote themselves unrestrictedly to the care of the

infant and toddler, but, by providing love and companionship, they support her emotionally and help her maintain that harmonious contented mood

in the aura of which the infant thrives. In what follows, therefore, while

continual reference will^ be made to^ the^ mother-child relation,^ little^ will^ be

said of the father-child relation ; his value as the economic and emotional support of the mother will be assumed.

Theories which place the origins of mental disturbances in these^ intimate

domestic events are, of course, in strong contrast to the theories which stem

from the German school of psychiatry. These stress constitutional and

inherited factors, at times to a point reminiscent of Calvinistic predestina-

tion. Suffice it to (^) say that evidence for these extreme views does not exist

and that the relative weights of nature and nurture remain still to be deter-

mined. In this connexion, it is useful to remember that recent work in

embryology has produced a steady accumulation of evidence that patho-

logical changes in the embryo's environment may cause faults of growth

and development exactly resembling those that in the past have been ascribed

to pure genetic causes.45 This is a finding of great importance, which, as

J. BOWLBY

will be seen, is exactly paralleled in psychology. It is to be emphasized, however, that such findings in no way contradict theories postulating the adverse influence of^ hereditary factors, except in^ so^ far^ as these are^ held^ in the extreme form that hereditary factors alone account for all differences in

human behaviour. Indeed, all those subscribing to the views set out in

this report believe that in the final^ analysis hereditary factors will be^ shown

also to play a part and that the greatest scientific progress will be made when the interaction of the two can be studied. A second far-reaching biological principle also stems from embryology,

namely, the discovery that the harmful effects on^ the^ embryo of trauma,

intoxication, infection, and other potentially damaging processes vary not only with the nature of the offending agent and the structure and function of the tissue mainly attacked but also with the maturity^ of^ that^ tissue. In the psychological field this principle is illustrated in the now classic

work of Hunt,79 who demonstrated experimentally that the starvation of

rats on the 24th day of life left traces on behaviour clearly discernible in

adult life, while a similar experience at 36 days had no such effect.

Finally, it may be noted that in the physiological sphere it has been

observed that the evil effects on an organ are especially far-reaching when

noxious influences operate during its earliest phases of development, as

for instance in the case of rubella where maximal damage is caused at

the eighth week of foetal life. The identity of the biological principle at

work here and that invoked by psychiatrists who^ impute far-reaching

effects to certain emotional experiences occurring in the earliest phases

of mental functioning, as early as the first six months of life, will be apparent.

It may be said, therefore, that these theories, so far from being inherently

improbable, are strictly in^ accord with accepted biological principle.