Childrearing, Culture and Mental Health
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parents, including those of a majority of disturbed children, still display the basic distrust orientation today, it no longer represents the childrearing ideas of some other parents and of many professionals who are concerned with child development.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
|Ideas influencing parents' perception of, and responsiveness to, the infant:|
|A Distrustful, Directive Approach||A Trusting, Cooperative Approach|
|Attitude of basic distrust and non-acceptance towards the biological "givens" influencing the needs and behaviour of the developing human being||Attitude of basic trust and acceptance towards the biological "givens" influencing the needs and behaviour of the developing human being|
|The infant is seen as:|
|(a) being selfish, demanding||(a) being immature, dependent|
|(b) wanting as much gratification and indulgence as he or she can get (probably too much)||(b) wanting as much gratification and satisfaction as he or she needs (an adequate supply)|
|To get gratification the infant may be perceived as behaving in ways that are:|
|self-willed, demanding, manipulative, cunning (which may confirm belief in inherent potential for badness)||influenced by possessing mechanisms whose function is ensure that his or her needs are adequately met|
|Gratification may be perceived as leading to:|
|danger of "spoiling", if more than the right amount is given||satisfaction and contentment; spoiling not a danger |
|Ideas influencing parents' requirements of their infants|
|A Distrustful, Directive Approach||A Trusting, Cooperative Approach|
|Emphasis in the basic parental goal is:|
|to control and direct the child's behaviour, and produce a "good" child (who will be obedient and conform)||to enjoy a good relationship with the child, and help to produce a "whole", healthy person (who is likely to be sufficiently "good" also)|
|Method of childrearing:|
|(a) mould the child to a predetermined pattern; secure control by regulating habits, and training to accept authority and discipline||(a) aim 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|
|(b) teach "right from wrong" and demand obedience; extinguish "naughty behaviour and insist on or reinforce "good" behaviour||(b) teach avoidance of common dangers and gradually encourage disposition to consider and respect the needs and feelings of others, through experiencing this consideration within the family|
|(c) child's point of view often misunderstood or ignored, and requirements often disregard the child's feelings and capacities, so that hostility and negativism tend to be aggravated, and unless these are repressed, control requires more force||(c) child's point of view more likely to be understood, and requests consider 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)|
|(d) disapproval more frequent, and may be reinforced by threats, punishment and sometimes violence, or inculcation of guilt||(d) inconsiderate behaviour discouraged, but the quality of relationships tends to make punishment inappropriate and it may be seldom or never required [86, 88]|
|(e) timing: get in early (perhaps from birth||(e) timing: await maturation and encourage development|
|Apparent frequent outcome |
|A Distrustful, Directive Approach||A Trusting, Cooperative Approach|
|(a) increased risk of conflict, frustration, and stress in unsatisfying relationships;||(a) mutual satisfaction in interpersonal relationships with joy and delight (sometimes) as a natural reward for health-promoting activities;|
|(b) sensitivity may be blunted; externally imposed discipline may break down sooner or later in rebelliousness;||(b) sensitivity intact; adequate self-discipline develops as appropriate the age;|
|(c) emotional maturation at risk; maladjustment and psychopathology||(c) emotional maturation facilitated; mental health|
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:
"It is our view that infants are genetically biased towards interaction with other people from the beginning ... A child is pre-adapted to a social world, and in this sense is social from the beginning ... If an infant is reared in a social environment not too dissimilar from that in which the species evolved ... an environment in which adults are responsive to the signals implicit in his behaviour ... it seems likely to us that he will gradually acquire an acceptable repertoire of more 'mature' social behaviours without heroic efforts on the part of his parents specifically to train him to adopt the rules, proscriptions, and values that they wish him to absorb. Because of these considerations we find the concept of 'socialisation' essentially alien to our approach."
This accords with the concept of the "innate sociality" of the child as described by Liedloff .