Childrearing, Culture and Mental Health:
Exploring an Ethological-Evolutionary Perspective in Child Psychiatry
and Preventive Mental Health with Particular Reference
to Two Contrasting Approaches to Early Childrearing
Peter S. Cook, M.B., Ch.B., M.R.C.Psych.,
Address in 2001:
Med. J. Aust. Spec. Supp., 1978, 2: 3-14.
A shift of historic significance in some aspects of Western attitudes to childrearing is occurring. In this period of transition the coexistence of two contrasting approaches to childrearing has given rise to much contradiction and confusion in the advice offered to parents. This paper seeks to explore some mental health aspects of this situation from an evolutionary and historical perspective. The term "phylogenetically-" or "ecologically-determined maladjustment" has been proposed for that particular kind of disturbance in an organism, or in a population, which is due to the fact that the environmental conditions have deviated significantly from those to which the species has become genetically adapted through evolution. This concept, which is a corollary of Darwinian theory, has health implications and appears relevant in psychiatry both for understanding psychological disturbance and for promoting mental health. It is particularly applicable in early childhood. I suggest that childrearing in English-speaking societies is emerging from an era in which many widely held beliefs, values, attitudes, and practices have been so out of harmony with the genetically influenced nature and needs of mothers and their developing children that they have contributed to conflict, stress, and emotional and behavioural disturbance in the infant and developing child. An attitude of basic distrust towards the human biological "givens", combined with a belief in coercion, have characterized this approach to childrearing, which is here termed the "basic distrust orientation". It is undesirable that developing countries, seeking beneficial, scientifically-based advances, should also inadvertently and unnecessarily import some of these tenets and practices which may be prejudicial to mental health. The basic distrust orientation is contrasted with a "trusting cooperative" approach to early childrearing which appears to be more in harmony with the nature and needs of developing children and their parents. These principles are relevant to the diagnosis and therapeutic management of emotionally disturbed children. They also suggest guidelines for the promotion of mental health. It is necessary to understand and respect the biological "givens", together with the potentials of such in-built regulatory mechanisms as have evolved, and then to cooperate with them, rather than work against them in the approach to early childrearing, family life, and the social settings in which they occur. In many ways this can be, and is being, done now.
An essential theme of this paper is that to promote mental health we must learn to understand and work with nature rather than against it, especially in the care of infants and young children. De Mause,  in The History of Childhood, considers that from the mid-twentieth century, the traditional Western mode of childrearing, which has emphasized moulding and socializing the child, began to be replaced by a different mode, more concerned with helping the child.
It appears that the present period is one of transition, and the coexistence of two different approaches to childrearing which have some fundamental points of contrast, as will be discussed later, gives rise to many contradictions in the advice offered to parents, and causes much confusion. This problem is seldom clearly acknowledged in books about childrearing, though it is recognized by Spock in the following statement:
This paper endeavours to explore some mental health aspects of this situation from an evolutionary, and from an historical perspective, developing the thesis that an approach is now emerging which appears to be much more in harmony with human emotional needs and conducive to mental health than the approach which has prevailed in the past. An important corollary of this situation involves the desire of "developing" nations and societies to share the benefits of Western medicine and technology. There is a possibility that, along with beneficial scientific advances, Western societies tend to export some of their traditional practices and childrearing tenets which cumulatively may be prejudicial to mental health through their impact on parenting behaviour and child development.
Some of these ideas and practices are not scientifically based, are not an essential part of the benefits sought by the developing societies concerned, and they may be quite alien to the traditions of these societies. Moreover they are being questioned increasingly in the Western societies where they originated. Some examples of these ideas and practices include: the separation of a mother from her newborn baby in the maternity hospital; scheduled feeding, usually four-hourly, with consequent reduction in suckling opportunities, sometimes prejudicing lactation; a reluctance to pick up crying babies for fear of "spoiling" them; the placing of infants in separate rooms at night; the tendency to reduce mother-infant contact and to interfere by day and by night with natural patterns of attachment behaviour; and a concern to mould children's behaviour from an early age.
In the past the attitude to such matters has been influenced by the doctrine of cultural relativism. This view has suggested that it is inappropriate to make value judgements about our own or any other society's patterns of culture in such matters as its childrearing practices, since these are assumed to follow a pattern which best suits the people in the society concerned. However, as Huxley  pointed out, this doctrine neglects the lessons of biology. One theme I explore here is that a biological approach offers a more fundamental perspective from which to evaluate various aspects of Western culture relevant to childrearing, and also to evaluate the desirability, or otherwise, of their adoption in developing countries. Some principles arising out of an evolutionary perspective are outlined, and I then relate these principles to some areas of childrearing which are relevant to mental health.
Health and an Evolutionary Perspective:
Boyden has emphasized that the insights provided by the study of human biology can contribute substantially to understanding and overcoming health problems. The medical approach traditionally consists of recognizing an undesirable form of ill-health and attempting to find the cause, or at least a cure, whereas the biological approach works in the other direction. It involves viewing modern humans in an evolutionary perspective, noting the biologically significant environmental and behavioural changes imposed on them by their culture, and inquiring into their biologically determined reactions to these changes.
Humans, who have evolved over millions of years from other primates, have lived for most of their history as hunter-gatherers. About 10,000 years ago some humans began to adopt a different way of life. This period (about 400 generations) is too short for any substantial changes to have occurred in the human phylogenetically-determined characteristics: that is, the genetic characteristics of Homo sapiens which result from the evolutionary history (or phylogenesis) of the species.
Boyden proposed the term "phylogenetically-determined maladjustment" (or simply "phylogenetic maladjustment") for that particular kind of disturbance in an organism or population which is due to the fact that the environmental conditions have deviated significantly from those to which the species has become genetically adapted through evolution. He pointed out that this principle is of great importance in understanding patterns of health and disease in humans and other species. It appears relevant to psychiatry both for understanding psychological disturbance and for promoting mental health.
Boyden and his co-workers[9,10] have acknowledged that this term is unsatisfactory since it is not the phylogenesis but the environment which is at fault in not matching those biological requirements which have been determined during the phylogenesis or evolutionary history of the species. Unfortunately a satisfactory term embodying both the phylogenetic and the environmental components of the concept has not yet been devised. Hence, the term "ecologically-determined maladjustment" is used here instead*, bearing in mind that an evolutionary perspective is implicit in the word "ecology".
Despite problems of terminology the principle itself is a corollary of the Darwinian theory of evolution which states that species become, through natural selection, increasingly well adapted to the environment in which they are evolving. If environmental conditions change the species is likely to be less well adapted to the new conditions, and physiological or behavioural maladjustment may occur. In nature, if environmental changes persist, maladjustment leads in the long run to a fall in population, and eventually to extinction, or through natural selection to genetic adaptation to the new conditions. In the human species exposed to the new conditions of civilization, however, neither of these solutions has resulted, because the changes have occurred too rapidly for appreciable genetic adaptation and also because the human species has recourse to a further adaptive process known as cultural adaptation.
In cultural adaptation society introduces measures aimed to counteract or eliminate the signs of "ecologically-determined maladjustment". These measures may be either corrective or antidotal (that is, symptomatic). Corrective measures aim to reverse the unsatisfactory biological conditions ultimately responsible for the state of "ecologically-determined maladjustment". In antidotal measures these underlying causes are ignored, and adaptation is simply directed at a symptom or at an immediate cause of the disorder. For example, dental cavities arising from an excess of carbohydrates in the diet may be approached by appropriate changes in the diet (corrective adaptation) or by developing a profession skilled in filling cavities (antidotal cultural adaptation). One of the disadvantages of antidotal adaptation is that by merely treating the symptoms of a disorder which is due to deteriorating environmental conditions we may be allowing the conditions to continue to deteriorate. Boyden points out that doctors and policemen are usually agents of antidotal, rather than corrective, responses to "ecologically-determined maladjustments".
Clearly the urban environment of modern humans deviates extensively from that to which they have been biologically adapted through evolution. Many advantages of civilization appear obvious, and few people would forego them. Nevertheless, a deeper understanding of biological processes demonstrates that it may be difficult to determine the full extent of the benefits and the disadvantages which will arise from any given deviation from the evolutionary environment. If we review our cultural environment in a biological perspective, areas of deviation appear which involve a significant and unnecessary risk of "ecologically-determined maladjustment" without adequate compensatory benefit.
"Ecologically-Determined Maladjustment'' and Childrearing
Important comparisons have been made between the hunter-gatherer way of life and that of modern urban humans  but unfortunately little attention has been given to those differences which particularly affect the child from birth onwards. Since childhood, especially infancy, is the formative and most vulnerable period of life, "ecologically-determined maladjustment' is likely to be particularly significant then. The general principle of "ecologically-determined maladjustment" may be applied to psychological maladjustment in childhood in the following way.
It is increasingly recognized that Homo sapiens, as well as other animal species, is genetically biased to behave in ways that promote individual and /or population survival in the environment to which the species was originally adapted through natural selection.[6 13-18] Psychopathology may arise from a mismatch between the genetic influences and biases underlying the needs and behaviour of the developing human being on the one hand and the provisions and demands of the environment on the other. In childhood, disturbances of development are likely to occur in proportion to the extent to which the rearing environment differs in significant ways from the original environment of evolutionary adaptedness, and especially when the rearing environment cuts across the grain of behavioural tendencies which are deeply rooted in the species because of their important survival functions . These findings are contrary to an assumption that is commonly held: that our species is infinitely modifiable. Of course, other factors, including individual vulnerability, affect the outcome in any particular case.
Liedloff  discussed some of the above issues in terms of the "inherent expectations" with which the human infant confronts life, the design of a species being a reflection of the environmental conditions to which it has become adapted or has come to "expect" through the ' continuum" of its evolutionary history. If an infant is exposed to a stressful situation for which it has not been prepared by its evolutionary history the limits of its adaptive capacity may be strained or exceeded.
In relation to the genesis of psychopathology this appears to accord with the formulations and research reports of Janov [20,21,22] and Holden  which suggest that neurotic and psychosomatic disorders arise from an overload of physical and psychological pain which cannot be integrated by infants and young children. Janov terms this "primal pain", and Holden reports that there are a number of physiological correlates of neurosis which are measurable, and, conversely, physiological changes which occur, as neurosis is reversed in primal therapy.
The "Contragenetic" or "Basic Distrust" Thesis
I have been exploring a specific application of the above principles, namely the thesis that childrearing in English-speaking societies, and to varying extents in some others, is emerging from an era in which many beliefs, values, attitudes, practices, and related features of the social settings, have been so out of harmony with the genetically influenced nature and needs of mothers and their developing children, that they have contributed to conflict and stress in parent-child interactions, and thus to psychological and behavioural disturbance both in the child and in his or her parent(s). Many of these ideas and their derivatives cluster together and appear to stem from an underlying distrust or misunderstanding of, rather than respect for, nature as represented in the human biological data or "givens". This approach may therefore be referred to as a "contragenetic" or "basic distrust orientation" since it encourages a tendency to work against nature rather than to co-operate with it .
Some relevant material may be considered as three overlapping topics as follows.
1. Practices relating to Childbirth, Lactation, Early Mothering and Attachment
Each of these processes depends on mechanisms which humans share with other primates. The survival of all mammalian species has depended on effective mating, delivery, and lactation. There appear to be important elements of satisfaction in each of these aspects of reproductive function which are normally associated with release of the hormone oxytocin. These mechanisms have a long evolutionary history of successful functioning. There are other biological mechanisms whereby events such as the arousal of fear may inhibit these processes. Some of the mechanisms, for example those involved in lactation  and mother-infant bonding , are also very sensitive to disruption by environmental conditions when these deviate too far in some significant way from the conditions which prevailed in the evolutionary environment.
Childbirth and Lactation
Thus pleasurable, sensuous stimulation in breast feeding is an essential aspect of the natural mother-baby pair bond. For many mammals "continuous association with actively suckling young is necessary for the development of normal maternal behaviour. In other words, the mother's behaviour is dependent on stimulation by the young" [27, 28]. Yet maternity hospitals are seldom organized with this in mind. Separation of the newborn baby from its mother appears to be a significant source of "ecologically-determined maladjustment", through interference with mechanisms which have evolved to initiate mothering behaviour. Klaus and Kennell  report many studies showing that mothers who have close contact (preferably skin-to-skin) with their babies during the first hours and days after delivery are more likely to breastfeed their young and they also show significant long term differences in mothering behaviour compared with those mothers who had a "routine" separation from their babies in maternity hospital. These findings accord with those in many mammals, which reject their young after neonatal separation. The evidence suggests that neonatal separation may contribute to mothering disturbances, including child abuse and failure to thrive. There is also evidence cited by Klaus and Kennell  suggesting that exclusion of the father from early contact with his new baby adversely influences the development of his feelings, attachment, and behaviour as a parent.
Some other maternity hospital practices which lack scientific justification and appear to be potentially harmful are reviewed by Haire  in The Cultural Warping of Childbirth. She concludes:
Many of these practices cut clumsily across the fabric of hormonal and other mechanisms which have evolved to promote healthy mother-infant relationships . An important example is afforded by the adverse effects which pain-relieving drugs administered during labour and delivery may have upon the behaviour of the newborn. They may suppress the baby's sucking capability past the critical period for establishing an effective sucking reflex [25,30,31,32].
In relation to feeding, natural selection has ensured that in an appropriate environment every organism normally has mechanisms to regulate the nature and timing of its food intake. Western medicine has not yet overcome a distrustful urge to regulate an infant's food intake in arbitrary and artificial ways. The restriction of infant feeds to a four-hourly schedule, without night time suckling, lacks biological precedent and scientific justification . The custom distresses some babies, and contributes to failures of breastfeeding. The widespread early failure of lactation in Western societies appears to be both an example, and in its turn a further source, of "ecologically-determined maladjustment". All mammals have been selectively bred for successful lactation. Homo sapiens being no exception, a sudden extensive failure in this area must be environmentally determined [25,34,35] Moreover, the increasing substitution of cows' milk for breast milk disregards the molecular precision with which evolutionary processes have matched the natural formula to the needs of the infant, and there is accumulating evidence of many subtle differences, with the potential for immediate and later adverse effects. There is also evidence that the early introduction of a mixed diet before four months may be harmful [36,37]. The National Health and Medical Research Council in Australia stated :
Early Mothering and Attachment
Disorders of attachment behaviour and the consequences of preventable mother-child separation [6,14,39,40] may be seen as examples of "ecologically-determined maladjustment". I suggest that the attachment to transitional objects, such as cuddly blankets, described by Winnicott  may be a minor example, arising from the relative lack of parent-infant body contact which frequently occurs in Western societies. Natural selection has ensured that all mammals have mechanisms to keep the young by the mother. Baby primates maintain body contact and, ascending the evolutionary scale, progressively more help is required to achieve this. Born at a stage when most mammals would remain in the uterus, the attachment between human babies and their mothers is dependent on highly developed mechanisms, involving body contact and the mothers' response to crying, sucking, smiling and babbling. It is therefore important that this natural response should not be stifled. It is not until much later, perhaps three years of age, that the infants will follow their mothers for a sustained period, as "lower" mammals do from birth.
Non-nutritional sucking appears to be an integral part of attachment behaviour, serving to maintain close contact with the mother. When old enough to venture away for short periods primate infants frequently reunite with the mother, especially at any sign of danger, when they cling and suckle. All primate infants, including humans in some societies, spend much time suckling a nipple or a nipple-like object, although for much of that time they are not obtaining food. Babies who are able to engage in non-nutritional sucking are more likely to be content and relaxed than those who cannot [6,40,42]. Ironically, for all its so-called "permissiveness", our society seldom permits attachment behaviour to develop naturally with a sensitive responsiveness to the signals and promptings which infants and young children display .
Another area due for review in a biological perspective is the question of where an infant should sleep, and whether parents should rock or carry infants to help them to go to sleep. Spock  positively advises against walking a baby to sleep, and rocking cradles have gone out of fashion after a misguided paediatric campaign starting in the 1890s . Yet babies certainly love being walked and rocked to sleep. Similarly, Harlow's  infant monkeys showed a marked preference for cloth "mothers" which rocked rather than for those which remained still. Whiting  observed that in most societies the world over, infants sleep beside or near their mothers during the nursing period. In Western societies, however, it has become customary to warn mothers that the sooner babies are sleeping in their own rooms the better, and that taking an infant into the parents' bed is certainly undesirable. This comparatively recent notion is consolidating into a peculiar taboo of our culture which appears to be unique in human and mammalian history. Newson and Newson  recorded the conflict and apologetic guilt which British parents may feel about breaking this taboo. Although young humans would have evolved with an awareness of sexual intercourse, Fenichel  advised: ''It is good to avoid letting children witness sexual scenes between grown-ups". Such opinions, stemming from experiences in cultures where psychosexual disorders are endemic, have recently, in Western societies, been extended to the point where semi-official paediatric advice is that "the new baby should have a sunny, airy room to himself" . There is apparently no scientific evidence to support such recommendations which lack biological precedent. Rees, after offering similar counsel in a psychiatric textbook adds: "Common problems of sleeping are insomnia, night terrors and sleep walking". He might have added rocking and head-banging which raises the question of the function of the cot in implementing these beliefs.
De Lissovoy [5152} found that, of a large series of full-term babies born in New York, 32% of the boys and 22% of the girls were persistent rockers and head-bangers. He repeated the study twice with essentially the same results,  but found no satisfactory explanation for it. He noted that Margaret Mead never saw this behaviour in the non-Western societies she studied. I suggest this behaviour is a manifestation of "ecologically-determined maladjustment". Mason et alii  stated that one of the most striking characteristics of the maternally-deprived young primate is some form of habitual rhythmic movement, usually rocking or swaying of the body, and the evidence suggested that such repetitive stereotyped behaviours were related to deprivation of stimuli from the mother. De Lissovoy's illustrations all show the infant confined in a cot or play pen. From the infant's point of view, this may be a cage restricting movement and natural patterns of attachment. The early environment of these infants appears to depart in significant ways from the biological norm .
In discussing the relationship of culture and emotional disturbance, Montagu recalls Bostock's  interpretation that the human gestation period is not completed until about eight to 10 months after birth. Certain characteristics of the mother and baby have been reciprocally selected, forming a "symbiotic" unit for many months after birth, with body contact, support, and breastfeeding being natural features of this "exterogestate" period.[36,57]. These are qualities of the normal early environment of all non-human primates and of human infants in many non-Western societies [44,58]. Liedloff  has described this as the "in-arms" stage of human development. In societies with this type of close mother-baby contact, infants cry much less than in those societies which follow traditional Western patterns.[58 59] In this context the trend of some Western mothers (and fathers) towards increased carrying of their infants with perhaps the aid of a suitable cloth device or sling appears to be a healthy one. Similarly, with increasing recognition of the customs in other cultures, Western parents are being invited to adopt a more relaxed and less anxious approach to close parent-infant sleeping arrangements [19,61,62].
Ainsworth [l2] described the identification of "tender, careful holding" behaviour which engendered in the baby a positive response to physical contact. This positive response in turn inspired the mother to affectionate display which consolidated the baby's pleasure in contact -- a virtuous cycle. Babies so handled did not become spoiled, over-dependent and unhappy when not in contact; even during the first three months, they would protest less frequently when put down. By the end of the first year the babies who most enjoyed physical contact were also cheerful about its cessation, and ready to turn to independent exploratory play. Ainsworth discusses this in the context of studies such as the following by Blurton Jones  and Konner .
The relevance of animal studies to human psychobiology is a complex matter and they must be interpreted with caution , but findings such as those in Blurton Jones  are important. He posed the question whether humans had evolved as one of the species in which the mother caches (that is, hides) the infants in a safe place returning periodically to feed them, or as a carrying species in which the mothers carry their infants wherever they go and feed them frequently, as do monkeys and apes. He compared humans with members of caching species on the one hand, and with higher primates on the other, and concludes from a number of anatomical, behavioural and physiological indices (including composition of the milk) that the human species is indeed pre-adapted to be a carrying species. The human species shows features in both the mother and the baby which are typical of those mammals in which the young feed almost continuously.
Konner  studied the African Bushmen who live by hunting and gathering, the mode of adaptation throughout the evolution of humanity until recent times. He found that from the first weeks of life the infants, when awake, are carried on the mother's hip, or side, in a sling. The babies cried very little and their mothers responded promptly to their signals. Despite our traditional expectations the children did not emerge as spoiled and overdependent. Konner states :
Institutional Day Care-of Infants
The practice of placing infants in day care centres for most of the day without a mother or relative requires consideration in an evolutionary perspective and in the light of studies such as those cited above . Since such arrangements involve multiple significant deviations from the environment to which the infant is biologically adapted, they should be viewed with caution, and the burden of proof that such deviations are harmless should lie with those who advocate them. Full day care of the infant is often recommended as the answer to an already unsatisfactory situation. In this case it should be recognized that this is in many ways an antidotal rather than a corrective remedy in terms of the distinction described earlier. Antidotal or symptomatic remedies are more likely to have undesirable "side effects", and require careful study. Definitive research is peculiarly difficult in this area. Though some studies have reported no differences, Blehar  using a sensitive test, found that full-time day care made for child-mother relationships of an anxious quality in comparison to those of home-reared children of the same age. She attributed this to the repeated, long, daily separations involved in day care.
2. The Basic Distrust Orientation to Childrearing
I suggest that in many of the disorders seen in paediatrics and child psychiatry, difficulties of the type outlined in the preceding section have been compounded by continuing parent-child conflicts many of which stem from the philosophy of childrearing which is here termed the basic distrust orientation.
This may be defined as a system of childrearing tenets which stem from an attitude of distrust towards the human biological "givens", combined with a belief in directive childrearing techniques. It may begin to operate any time after birth and continue throughout childhood. As the expressions of this orientation are less sharply focussed today than in the past, it may be clearer to introduce it in a brief historical perspective.
A. The basic distrust orientation in the past.
Western cultural beliefs about childrearing are seldom considered in the light of the underlying assumptions and traditions from which they have arisen. Wolfenstein  has documented the marked changes in official advice on childrearing in the United States between 1914 and 1951 as reflected in the official publication Infant Care . Many of these changes appear to represent a movement away from a basic distrust orientation towards a greater basic trust in, and understanding of, the biological "givens". They represent a trend towards working with nature rather than against it. This trust-distrust dimension is significant in many aspects of childrearing. It is important to recognize the developing view of the nature of humans which underlies such changes.
A somewhat negative, distrustful attitude to the body, or to the "flesh" and its desires, as a source of evil, has been deeply influential in Western culture. Much has been written about the impact of this on sexuality, [68,69,70] but its influences on the handling of infants and young children have not been adequately recognized.
The Newsons [71,72], discussing the social context and prevailing moralities draw attention to the belief of John Wesley (1703 - 1791)  that the child's eternal destiny depended on breaking its will. In a sermon "On Obedience to Parents" Wesley quotes a letter from his mother, Susanna, saying:
It is unlikely that any contemporary Christian theologian would support such conclusions which appear quite alien to the attitude to children portrayed in the Gospels of the New Testament. However, the views in Mrs. Wesley's letter follow a theme that can be traced in Western Christianity from the time of Augustine (354-430 A.D.) who after "a curious study of child psychology"  added to the gradually developing idea of original sin, the concept of "guilt attaching even to the newborn child by reason of the depravation of his nature" [74, 75, 76]. Similar ideas appear in the teaching of Calvin (1509-1564) about infants, that "their whole nature is a sort of seed of sin and therefore it cannot but be hateful to God" . These beliefs have been reflected in official church teaching  and have powerfully influenced the way in which children's behaviour has been perceived and handled.
Newson  suggests that the concern to eradicate the devil in the child finds many echoes in the hygienist movement which dominated childrearing practice in the 1920s and 1930s. She points out that the movement can be well represented by the early editions of The Mothercraft Manual  which was influential in England as well as in other countries as the main vehicle for the teachings of Truby King . She states that Susanna Wesley might well have approved the following passage, in which the emphasis is different but the spirit is the same:
Newson and Newson  add that in some ways the advocates of behaviour modification with children seem to carry on the Wesley-Truby King tradition.
Psychoanalytic theory also has, until recently, [6,14] failed to take account of the evidence that humans evolved as social animals with all that this implies [18,82,83]. As recently as 1960, the leading psychoanalyst, Glover , endorsed what he had written many years earlier that:
Psychoanalytic theory, clinically derived, postulates that the "id" is normally like this, almost by definition. The possibility that this state of the infant may be partly a pathological situation, in reaction to culturally induced frustrations, does not appear to have been adequately taken into account.
Though other streams of thought are modifying the traditional authoritarian approach, the basic distrust orientation is still very much alive today in the minds of many mothers of Anglo-Saxon background, and it includes some, or all, of the ideas described as follows.
B. The basic distrust orientation as it may present today.
3. Social Settings Relevant to Parenting Behaviour which may Contribute to "Ecologically-Determined Maladjustment"
In pursuit of certain beliefs and values, Western societies have given insufficient attention to many variables of the social settings relevant to parenting behaviour. The important question "What qualities of the environment and social settings promote healthy and mutually satisfying parent-child relationships?" is seldom asked. Detailed consideration is beyond my scope here, but l suggest that the conditions which often prevail form an environment which is so biologically deviant that they may contribute to "ecologically-determined maladjustment" through adverse effects on parenting behaviour. For example, inadequacies in the following areas are common:
Affluence may help to improve some of these variables, but so far this has not generally occurred. Many materially poorer and even non-literate societies have made better provision in many of these respects than most so-called affluent societies.
A Trusting, Cooperative Approach to Childrearing: The "Bio-Psychological Revolution"
Though many parents, including those of a majority of disturbed children, still display the basic distrust orientation today, it no longer represents the childrearing ideas of some other parents and of many professionals who are concerned with child development. Intermingled, to an increasing extent, is a different approach which has been softening the rigid authoritarianism of earlier times.
It may be termed a trusting, cooperative approach, and some of its characteristics, and ways in which it contrasts with traditional attitudes are outlined below in the Table. From an orientation of basic trust in the biological givens influencing the needs and behaviour of the developing human being, infants are seen as being immature, dependent creatures who seek gratification and satisfaction according to their needs. They often behave in ways that are influenced by mechanisms whose function is to ensure that their needs are adequately met. Gratification is seen as leading to satisfaction and contentment rather than to "spoiling".
Table: Two contrasting approaches to early childrearing deriving respectively from attitudes of distrust and trust towards the genetic influences underlying the needs and behaviour of the human infant
The emphasis in the parents' basic goal is to enjoy a good relationship with the child, and help to produce a "whole" healthy person who is also likely to be sufficiently "good". The quest for obedience and conformity is not a prevailing emphasis as in the basic distrust orientation.
The method of childrearing aims to satisfy the young child's needs and develop a cooperative, mutually satisfying, affectionate relationship, in which the potentialities of the child and parents unfold, blossom and gradually mature. The developing capacities for self-regulation are respected and encouraged.
The parents teach avoidance of common dangers and gradually encourage a disposition to consider and respect the needs and feelings of others' through experiencing this consideration within the family.
The child's point of view is more likely to be understood, and parental requests take into account the child's feelings and capacities so that hostility and negativism tend to be minimized. The child's feelings are accepted in the expectation that sufficient self-control will be achieved as appropriate to the child's age. (The options of exercising authority and sufficient force are still available if essential.) Inconsiderate behaviour is discouraged but the quality of relationships tends to make punishment inappropriate and it may be seldom or never needed [19,86, 88,91,92].
This approach is based on a different view of the nature of the child and is more in accord with modern understanding of child development. It appears less alien to the traditions of many non-Westernised societies, including those of two hunter-gatherer groups whose mother-infant interactions have been studied [63,93,94,95]. It is also more compatible with a contemporary Christian understanding of interpersonal relationships . It has much in common with that identified by the Joint Commission on Mental Health of Children  as characteristic of families with emotionally healthy children.
Western society is belatedly realizing the need for an ecological revolution in its approach to nature. In a comparable way modern insights from a variety of disciplines appear to be offering a more healthy approach to humans' understanding of themselves, particularly in relation to childrearing and the parent-child relationship. This movement in human awareness may be described as a "biopsychological revolution", since it involves viewing human development in an evolutionary perspective. From this perspective the healthy newborn baby may be seen as the culmination of the selection process in social situations over millions of years. By natural selection even minimal inherited inadequacies tend to be eliminated over such a long period, while beneficial characteristics tend to be perpetuated in the genetic structure of the young. Therefore each universal feature which has been retained may be of potential value. This line of reasoning can be applied to every detail of human anatomy and physiology and also to some aspects of emotion and behaviour [13,17,97,98,99]. Each one of our direct maternal ancestors, in an unbroken sequence of generations extending back to the emergence of mammals, survived a rigorous selection process and suckled young that grew to maturity while others were eliminated in every generation. When we consider the implications of such a pedigree, an attitude of respect for, and trust in, the outcome of this process seems appropriate. The type of approach outlined on the right side of the table is consistent with an attitude of trust in the infant's biological "givens", including their behavioural aspects. Thus when confronted with an infant displaying a strong urge to do something or have it done for him, it can be illuminating to consider whether this urge may have some genetic component, being adaptive and of value for the child's development [63,100]. This point of view is neatly expressed in the saying: "A baby's wants are pretty much the same as its needs".
The evolutionary process has favoured a good, healthy "fit" between the infant and the people who form its environment because a good fit has survival advantages. To achieve this it appears that many reciprocal mechanisms, which we are only beginning to understand, have evolved as components of the healthy mother-child relationship[18,25]. Consequently, a mother normally derives satisfaction from that kind of relationship which also satisfies the infant's requirements. A lack of this good ''fit" is described by Balint  as an early source of serious emotional disturbance.
In Western societies a partial breakdown in these natural processes of mothering behaviour appears to have occurred on a considerable scale. Yet of all the roles that people can play in modern society there is probably none that accords more closely with the design of a human being than that of bearing and nurturing an infant. Mammals display mothering behaviour through the development, in a facilitating environment, of drives arising from their physical structures, and not through any sense of duty or obligation. There is reason to believe that the fundamental human equipment is no exception. It has the same plan with some added refinements since natural selection does not favour a deterioration in such essential processes. From this perspective follows a concern to respect the biological "givens" and facilitate the processes by which good mothering behaviour normally develops. Wherever appropriate the relationship with the male should be regarded as included in this discussion. It appears that in humans there also may be biological mechanisms in the males whereby early contact with the baby helps to elicit feelings and behaviour which promote good fathering . Freedman  states that among most primates the care of the young is largely the female's job and only in the gibbon and man is there cooperative care of the young by a male and female unit.
It is increasingly recognized that the foundations of mental health and sound personality development are laid during early childhood. However it is not generally understood that this does not require the parents to strive for early versions of the finally desired behaviour since infancy is not so much a prime opportunity to mould the child but rather a time to seek to satisfy the infant and enjoy the unfolding of many built-in qualities in the setting of trusting and mutually rewarding relationships. These qualities which give joy to, or "reward", the parent are normally present precisely because their appeal to adults and the adults' nurturing response have been adaptive and of survival value to children as a selective advantage in human evolution . What are being laid down in infancy are the broad bases of interpersonal relationships and the quality of the emotional and fantasy life. From these will be derived the later attitudes to people and the ways in which they will be perceived.
The need for children to develop a ''basic trust" in their parents is emphasized as an important "psychosocial task" or "crisis" [1,102]. However it is seldom acknowledged that parental attitudes involving basic trust in the nature of children are a logical precondition for this development, and that, conversely, parental attitudes involving basic distrust are obstacles for children in this "task". Thus, to promote psychological health, the requirement appears to be that young children's biologically-determined needs should be met in such a way that they will feel adequately satisfied, accepted and loved for what they are, especially in the first year or two of life. A minimum criterion of "adequacy" might be that distress in the infant should not reach a level at which pain or feelings such as anxiety, rage, or guilt bring into action pathological mechanisms in the infant, or vicious circles of negative interaction in the parent-child relationship.
It is the responsibility of the medical and allied professions (including social planners) to facilitate the healthy aspects of these processes, seeking to protect from pathology while avoiding unnecessary interference with the patterns of nature . The traditional axiom primum non nocere, first and foremost do no harm, applies here. During infancy, which in Rheingold's  definition lasts until speech is normally acquired, the appropriate management of children for good mental health appears to be determined more directly by their biological needs than by the future requirements of the society in which they live. This is contrary to assumptions based on the doctrine of cultural relativism. If subhuman primates and many non-literate peoples can normally supply the basic early requirements for the healthy psychological nurture of the young, it should be possible to use the amenities of civilization to create an environment which will enhance rather than jeopardize successful mothering.
When considering social learning it is important to recognize that, since humans evolved as social animals, we build on processes with a long biological history. It follows that it is likely to be fruitful to study in-built mechanisms which have the potential to regulate interpersonal behaviour, since these would be relevant for childrearing [16,18,42,87,88,97].Thus Ainsworth et alii  state:
This accords with the concept of the "innate sociality" of the child as described by Liedloff .
A trusting, cooperative approach to childrearing is gaining acceptance and is implicit in much of clinical child psychiatry and psychotherapy. Gordon  has successfully adapted some principles of therapeutic counselling and communication to enable many parents to enrich the quality of their family relationships through greater satisfaction of needs which are biologically based. Recognizing the implicit revolution involved, Gordon states that this involves "nothing less than an entirely new philosophy for dealing with children and youth, a new Bill of Rights for the young".
In the clinical diagnosis and management of emotional disorders in childhood there is need to incorporate the biological perspectives outlined earlier. For example, behaviour modification techniques are often employed in a manner which represents an antidotal rather than a corrective adaptation to symptoms which are often the manifestation of "ecologically-determined maladjustment". Even in the contemporary urban situation there is scope for exploring solutions with a corrective, and not just an antidotal, component. As those people who care for children begin to have a greater understanding of the biological processes with which they are involved, there are many opportunities for considering how to work with nature and not against it. Many of the behavioural problems in infancy and childhood appear in a different perspective, which can be illuminating to those who counsel parents, and to parents themselves.
To the extent that there is validity in the biological approach I have outlined, the appropriate therapeutic management should not infrequently include a component which I suggest may be described as a kind of 'bio-psychological reorientation". This often includes a change from a basic distrust orientation towards a more trusting cooperative approach to childrearing. Such changes help to resolve clinical problems.
Amid the shifting sands of opinions about how infants and
children should be reared, an evolutionary perspective suggests that
there does exist, in the universal aspects of the human genetic
data, a kind of biological "absolute",
"constant", or touchstone against which the
appropriateness or otherwise of a system of child rearing must
sooner or later be evaluated. There is much that we do not yet know
about this biologically given "constant", but we are
reasonably certain that it exists and its behavioural influences and
relevance for childrearing, particularly early childrearing, are
increasingly being recognized. A system markedly out of harmony with
this may be expected to produce a greater level of conflict, stress
and pathology, and there is some statistical evidence to suggest
that, not only in childhood but also in infancy, this situation
exists in some English-speaking societies today [51,52,90]. It is
desirable that this situation be understood and remedied in Western
societies, and it would be most regrettable if, in the meantime, it
were to be transferred to those developing societies where it has
been much less evident.
This publication was produced with the assistance of a grant from the Inger Rice Foundation of the Australian Capital Territory which fosters activities concerned with improving mother-child relationships. The Foundation's generosity is gratefully acknowledged. I am indebted to many people, especially to Dr Ronald G. Every for introducing me to the evolutionary perspective. I am grateful to Professor Barry Nurcombe, Dr David Bell, Dr R. G. Every, Mrs. Annette Hamilton and Mr. P. Ritter for critical assistance with the manuscript, and to Miss Leonie Smythe and Mrs. Barbara Playle for patiently typing successive drafts.
The quotation from Reference 97 was reprinted with permission from Ainsworth M.D.S., Bell, S.M. and Stayton D.J., in The Integration of a Child into a Social World, edited by M.P.M Richards, Cambridge University Press. London, 1974.
Some recommendations arising from the material in this paper were offered in a Report Towards a Preventive Mental Health Program for Children and their Families: Suggested Guidelines, (Chairman: P.S.Cook), published by the Northern Metropolitan Health Region (Sydney), Health Commission of New South Wales, P.O. Box 457, Chatswood, N.S.W. 2067.
Copyright. This paper was first published in the Medical Journal of Australia, Special Supplement, 1978; 2: 3 - 14, who owns the Copyright. Reproduced with permission. Australasian Medical Publishing Company, 71 79 Arundel Street, Glebe, N.S.W., 2037.
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Footnote: In a longitudinal study in Sydney (Cook, P. S., Kiely, P, and Armour, P., unpublished) a multiple choice, child development questionnaire was developed to assess beliefs and attitudes about infant care, on a trust-distrust' dimension as outlined in the Table (that is, it provides a measure of the basic distrust orientation in relation to infant care). This questionnaire was completed by 35 baby health sisters, 43 early childhood educators, and 142 mothers in two maternity hospitals with their first babies. The results suggested that the mothers had significantly more "distrusting" ideas than the professional groups; in fact only one mother gained a score as low (that is, as trusting) as that of half the professionals. On multiple follow-ups over 18 months a sub-group of mothers with the most distrusting scores reported more problems with their infants than a subgroup with the least distrusting scores which were available from this sample.
[A fuller account of this study, with three-year follow-up, was described in Early Child Care - Infants and nations at risk, by Peter S. Cook, News Weekly Books, Melbourne 1997, pp186-7.]
Dr. Peter S. Cook is a retired Sydney, Australia child and family psychiatrist, who writes on preventive child and family mental health. He is the author of Early Child Care: Infants and Nations at Risk (Melbourne: News Weekly Books, 1997).
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