Childrearing, Culture and Mental Health
The "Contragenetic" or "Basic Distrust" Thesis (continued)
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:
In order to form the minds of children the first thing to be done is to conquer their will ... Heaven or hell depends on this alone. So that the parent who studies to subdue it (self-will) in his children, works together with God in the saving of a soul: The parent who indulges it, does the devil's work ... This, therefore, I cannot but earnestly repeat, ... Break their wills betimes; begin this great work before they can run alone, before then can speak plain, or perhaps speak at all. Whatever pains it cost, conquer their stubbornness; break the will, if you would not damn the child. I conjure you not to neglect, not to delay this! Therefore, (1) Let a child, from a year old, be taught to fear the rod and to cry softly. In order to do this, (2) Let him have nothing he cries for; absolutely nothing, great or small; else you undo your own work. (3) At all events, from that age, make him do as he is bid, if you whip him ten times running to effect it ... Break his will now, and his soul will live, and he will probably bless you to all eternity [7 3].
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:
Self-control, obedience, the recognition of authority, and, later, respect for elders are all the outcome of the first year's training ... The baby who is picked up or fed whenever he cries soon becomes a veritable tyrant, and gives his mother no peace when awake; while, on the other hand, the infant who is fed regularly, put to sleep. and played with at definite times soon finds that appeals bring no response, and so learns that most useful of all lessons, self-control, and the recognition of an authority other than his own wishes ... the conscientious mother has to be prepared to fight and win all along the line, in matters small and great .
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:
The perfectly normal baby is almost completely egocentric greedy, dirty, violent in temper, destructive in habits, profoundly sexual in purpose, aggrandising in attitude, without conscience or moral feeling. His attitude to society is opportunist, inconsiderate. domineering and sadistic. In fact, judged by adult social standards the normal baby is for all practical purposes a born criminal.
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.
It may occur in mild forms and mixed with other orientations. Its characteristics include the following:
I. Beliefs and ideas which may restrain maternal responsiveness to the child's communications.
Totally dependent infants indicate their needs by signals or non-verbal communications. Their mothers normally have an urge to restore their children's contentment and equilibrium, gaining "instinctive" satisfaction in soothing their distress and in keeping them more or less content. The spontaneity of this natural mother-infant reciprocation may be interfered with, perhaps from birth, by such ideas as the belief that the interests of mother and infant are in conflict. For example, the mother is thought to need protection from the demands of her baby by separation in the maternity hospital "to give mother a rest". Breastfeeding may be regarded as an unwelcome tie for the mother, and separate sleeping arrangements at home for mother and infant are thought desirable. The belief in day care placement to relieve mother of her child appears to be sometimes an extension of the same idea.
The doctrine of "spoiling" is another belief system which may restrain maternal responsiveness. An underlying notion is that infants request more attention and satisfaction than they need and that responding to these requests will "spoil" the child and produce characteristics such as: undesirable habits of feeding, playing and sleeping; increased desire for attention and attachment; defects in socialization, with increased self-centredness, wilfulness and dominating tendencies; and delay in developing obedience, tolerance of frustration, and consideration for others. These ideas lead to an anxiety to avoid "spoiling" or ''giving in" to the baby or young child and a reluctance to pick him or her up, thus interfering with natural patterns of satisfaction, especially in relation to body contact and attachment
For example, Ritchie and Ritchie  found that 69% of their sample of New Zealand mothers believed in the doctrine of "spoiling". The authors state that this term conveys the essence of the fears these mothers had about the effect they are having on their children. Because of it they hold back quite natural feelings of love and warmth, or avoid demonstrating such feelings. This concept is the "key to understanding their suspicion of outward displays of affection their reluctance to let relatives cuddle the child, or actively enjoy its reactions themselves" . In England and Australia, the same fears may be observed and they appear widespread in, though not confined to, Anglo-Saxon cultures. Yet it is rare to find parents who have reflected about how this distrustful approach appears to the infant. It does not seem to occur to them that infants' desires for attention attachment, cuddling and play might operate on the same principle as other biological drives, such as hunger: that when they have had enough they are satisfied. Perhaps this is because normal infants have a considerable appetite for such care, but it does not follow that such desires are insatiable.
The ideas involved in the doctrine of "spoiling" are seldom critically examined. Though the concept is emphasized in Spock's  Baby and Child Care, of which over 20 million copies have been sold, the word hardly appears in some major texts on child development. However, research studies reviewed by Ainsworth [12, 40,59] suggest that, contrary to popular belief, responsiveness to crying and fostering attachment behaviour, as discussed earlier, do not spoil a child, but rather they make for easier management and healthy development. It is noteworthy that Jolly , influenced by experiences in Africa, consistently tries to dispel the notion of "spoiling", in his Book of Child Care.
II. Beliefs and ideas which may artificially increase maternal demands on the infant and developing child, often without regard for the child's capacities and feelings.
Anxiety about future difficulties in controlling wayward tendencies in the child has led to a disciplinary attitude being projected even into infancy, with efforts to mould the child to a predetermined pattern, in the hope of producing a "good" child who will accept discipline and conform. Perhaps it has been by intruding these notions ever earlier into the mother-child relationship, in fact into the "exterogestate" stage when most mammals would be protected in the uterus, that we have gone most seriously astray. A feeling that the mother should be regulating the baby, especially in the timing of its activities, may lead to continuing conflicts in such basic areas as feeding, elimination, playing, attachment and sleeping. Thus, instead of suggesting that our culture should harmonize with an infant's biology, Sears  states, as if it were axiomatic, that: "The maturing action systems of the human child tend to lag behind the requirements society places on him. His early behaviour is changeworthy in the sense that it is not of a kind to satisfy the standards of conduct established by the culture". Such beliefs, together with a premature impatience to foster independence, may conflict with biologically-based patterns of attachment behaviour, which is seldom allowed to run its natural course in Western societies.
These ideas also lead to a concern to control the older infant's behaviour by training, often reinforced with threats and punishment. Teaching "right" from 'wrong" and securing obedience is often a dominant objective. This approach may apparently succeed, sometimes at a considerable cost, but it frequently leads to increasing conflict, emotional disturbance and rebelliousness. It may produce effects opposite to those which were intended . The vital elements which are being overlooked are the child's feelings and point of view and the quality of the relationship between the parent and child. Many parents still do not know that if they attend to these the other matters tend to fall into place more naturally, and that they can generally stop worrying about them [86,87,88]
The basic distrust orientation has been semi-official teaching for several generations in New Zealand, the homeland of Truby King. I suggest that it contributed to the situation, reported by Ironside and Lewis [89,90], that in one area of New Zealand 10.9% of all babies were admitted to hospital in the first year of life for a non-organic "distress syndrome with multiple signs of dysfunction", such as problems with feeding, crying, and sleeping. There was generally marked anxiety in the mother, and follow-up studies suggested this is a mental health problem of considerable significance. This may well represent an example of "ecologically-determined maladjustment" in which the infant care patterns of the culture precipitate disturbance in some babies and mothers, who may be vulnerable for other reasons.
III. The basic distrust orientation acting as a self-fulfilling prophecy.
Traditionally this orientation has encouraged attention to latent tendencies to "naughtiness", which have sometimes been seen as actively present in every young child. The theory influences the way an infant is perceived, and once this point of view is adopted it tends to become a self-fulfilling prophecy. The more infants sense a danger that their biological needs may not be supplied, the more their biologically-determined survival mechanisms prompt them to seek to control their mothers, apparently confirming the view that they are naturally too selfish, "manipulative" or aggressive. Thus, exaggeration and distortion of necessary biological mechanisms may encourage the perception of the infant as a potential "monster".
Taking the view epitomised by Glover , the ordinary devoted mother, when confronted by normal infantile reactions to her fears of spoiling, may understandably become more anxious. If she is fortunate, if her temperament and that of her infant are equable, and if the balance of love-hate forces in their relationship is favourable, she may obtain conformity, perhaps at the price of a few "nervous" symptoms. When naughtiness is seen as the result of failure to control natural tendencies which are considered to be primitive animal, and therefore bad, her conviction may be reinforced that these must be eliminated by appropriate training, lovingly if possible, but coercion and threats may be needed if resistance is encountered. If this becomes pronounced, violence is justified in what is, after all seen as a good cause. If this doctrine and the related training processes produce a "naughty" or "disturbed" child, this can still be seen as confirming the premise that the original tendency to naughtiness was strong, and the difficulties may be attributed to insufficient training and punishment.
Since feelings are suspect, any emotional reactions which may be engendered in the child by these processes are often regarded as unimportant. "Good" children are seen as those who do not manifest anger or aggression in response to their training, though if they do, this may be acceptable provided that they soon "forget all about it". Lingering resentment which is encountered in many disturbed children and adolescents is seen as a baffling phenomenon, which simply ought not to be there. Children are manifestly "ungrateful" for all the parents' sacrifices and efforts to teach them "right" from "wrong", often since infancy. "Where did we go wrong?" parents ask poignantly. This unfolding tragedy is accompanied by painful stresses and failures in interpersonal relationships. Parents who are caught up in this kind of process believe that they have the whole weight of morality and social authority on their side. Nevertheless, the damaging stress upon them is sometimes as great as it is upon their children.
If these self-fulfilling misconceptions, which stem from the beliefs of a bygone era can now be recognised as obsolete and counterproductive the way is prepared for them to be replaced by an approach which is more compatible with healthy and mutually satisfying parent-child relationships.