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Childrearing, Culture and Mental Health

Introduction

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.

All the world loves a baby, so it is said. We as a society do not act that way. A newborn baby is a reaffirmation of the miracle of the creation of life. Most infants are near-perfect at birth and possess enormous potentialities for bringing deep joy to themselves and others. - Joint Commission on Mental Health of Children [1]

In fact, judged by adult social standards the normal baby is for all practical purposes a born criminal. - Glover [2]

We are more sensible of what is done against culture than against nature. - Plutarch [3]

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, [4] 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 [5]in the following statement:

"There is always an argument going on, audibly or silently, between people who have two quite opposite attitudes about how children should be raised. There are those who feel that children are real human beings who are striving to become more mature, have generally good motives, are eager to learn, are perceptive of the truth and deserve kindness and respect despite their inexperience and their need for constant adult guidance. At the opposite extreme are those who believe that children are naturally lawless, lazy and uncivilized; that they can be held in line only by pressure, material rewards, threats and physical punishment administered by parents and teachers who make all the judgements and decisions. They assume that if children are not controlled with a stern hand they surely wil1 end up incompetent or delinquent. Most people are not at the extremes in their views but lean in one direction or the other."

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[6]; 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 [7] 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.

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