Childrearing, Culture and Mental Health

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 [24].

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 [25] and mother-infant bonding [26], 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.

A. 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 [26] 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 [26] 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 [29] in The Cultural Warping of Childbirth. She concludes:

Most of the practices ... have developed not from a lack of concern for the wellbeing of the mother and baby but from a lack of awareness as to the problems which can arise from each progressive digression from the normal childbearing experience. Like a snowbal1 rolling downhill. as one unphysiological practice is employed, for one reason or another, another frequently becomes necessary to counteract some of the disadvantages, large or small, inherent in the previous procedure.

Many of these practices cut clumsily across the fabric of hormonal and other mechanisms which have evolved to promote healthy mother-infant relationships [25]. 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 [33]. 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 [38]:

Breast milk has evolved to meet ideally the needs of babies and can provide their total nutritional requirements up to about six months of age. It also has important protective effects against various diseases, including gastro-enteritis and chest infections. No form of artificial feeding is as nutritious as breast milk nor as effective against infections. Furthermore, substitutes for breast milk interfere with the supply of breast milk by removing the important physiological stimulus of sucking. Unnecessary 'complementary feedings' are undesirable and should, therefore, be discouraged.

B. 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 [41] 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 [40].

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 [43] 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 [44]. Yet babies certainly love being walked and rocked to sleep. Similarly, Harlow's [45] infant monkeys showed a marked preference for cloth "mothers" which rocked rather than for those which remained still. Whiting [46] 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 [47] 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 [48] 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" [49]. 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 [51,52] 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, [53] 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 [54] 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 [44].

In discussing the relationship of culture and emotional disturbance, Montagu recalls Bostock's [56] 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 [19] 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 [12] 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 [42] and Konner [63].

The relevance of animal studies to human psychobiology is a complex matter and they must be interpreted with caution [64], but findings such as those in Blurton Jones [42] 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 [63] 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 [63]:

The horizontal (position) is almost unknown to them during their waking life. From their position on the mother's hip they have available to them her entire social world, the world of objects (particularly work in the mother's hands) and the breast, and the mother has immediate easy access to the infant. When the mother is standing, the infant's face is just at the eye-level of desperately maternal 10 to 12 year old girls who frequently approach and initiate brief, intense face-to-face interactions, including mutual smiling and vocalization. When not in the sling they are passed from hand to hand around a fire for similar interactions with one adult or child after another. They are kissed on their faces' bellies, genitals, sung to, bounced, entertained, encouraged, even addressed at length in conversational tones long before then can understand words. Throughout the first year there is rarely any dearth of such attention and love.

Nor is access to the world of objects in any way restricted, although there are no infant toys ... the entire natural world is open to them.

C. 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 [12]. 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 [65] 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.