Maternal Care and Mental Health

aternal Care and Mental Health. By JOHN BOWLBY. 1951. Geneva: World Health Organization Monograph Series. London: H.M. Stationery Office. Pp. 179. Price 10s. This brilliant and painstaking study leaves no doubt in the mind as to the importance of individual maternal care in the mental and physical well-being of all children. An uneasy conviction, rightly fostered by Bowlby and others in this country, has been growing that much official time and public funds are spent in doing the worst possible for the young child when he is removed from a bad home, and placed in a good Home. In this monograph, the author states his views clearly and vigorously, and supports them ably by his energetic survey of material from Europe and U.S.A. The bibliography covers the whole field of child care in the last 20 years or so, when in the period between two world wars and the economic depressions and social upheavals of the intervening years, this pioblem has become so clearly delineated in the minds of al who care for the child who is temporarily or permanently deprived of a normal upbringing in his own family home. The enquiry specifically excludes child refugees from war or other causes: even without this pathetic addition the problem is of formidable dimensions, and the author deserves and will doubtless receive unstinted praise for his grasp which has enabled him to reduce such a nass of material to the compass of this readable monograph. His thesis, succinctly stated on p. 47, is that deprivation, for any cause, of a mother-figure in the early years of childhood may so imperil necessary stages in emotional development that the child may develop permanently an affectionless psychopathic character owning aUlegiance to no on-, or may regress to such a point of emotional, mental and physical apathy that he remains permanently under-developed. The effects of lack of early care may be reduced (Goldfarb) if individual mothering is instituted before 12 months, but he regards the damage as likely to be permanent if delayed beyond 21 years. The limits ofvulnerability are uncertain and much further research is needed to clarify this point, and also to seek an explanation for the apparent immunity of some children to these effects. As Bowlby rightly points out, some children are apparently immune to the effects of tubercle-infected milk, but that does not make it right for them to risk drinking it. The direct evidence is briefly reviewed, and there is alarming uniformity in many of the follow-up reports cited. Alongside these are welcome indications, for instance in the Curtis report, of an awareness of this great problem. However, the official mind moves slowly away from the convenience of the beaten track, and even the paediatricians have not been guiltless in this matter of putting physical care first at the expense of the possibility of a normal emotional development. Both direct studies of deprivation and follow-up studies of the behaviour of deprived children tally with the evidence, much of it from psychoanalytic studies, that the crucial point lies in the infant's and young child's inability to pursue his development independently of some individual supporting figure to whom he may consistently turn for help, encouragement and refuge. Out of this relationship he develops in himself integrity and independence. Further research is called for, and suggestions are made as to the lines such research might folow. (The author is himself actively engaged upon one such group research.) The problems of prevention are perhaps less simple than they would seem to be, even if Bowlby's thesis is wholly accepted. In his chapter on the illegitimate child he brings evidence to show that in a high proportion of cases the unmarried mother has a very poor chance of maintaining her child, a chance which tends to lessen as the years go on. Even where the child is accepted and brought up by maternal grandparents there is often a great deal of normal emotional security lacking in his nurture. The remedy of adoption at an early age is unequivocally advocated, and the view is put forward that most unmarried mothers can be helped to accept this as a necessary step in a realistic frame of mind, taking the long view. The author also claims, rather surprisingly, that intelligence tests in the early months are of no predictive value whatever, a view which brushes aside Gesell's claims. But his statement is well supported by the evidence he quotes, and certainly the predictive value of an early intelligence test on a disturbed baby who had not settled to a normal home routine, and given by relatively inexperienced workers, is probably of very little use. Thus early adoption is certainly important from all sides. But it must be recognized that adoption has its own problems, and that the vast social and emotional problem which lies behind the undoubted fact of large numbers of parents willing to adopt illegitimate babies, is something which must be reckoned with. Here again is a suggested line of research, that of careful follow-up of illegitimate children whose mothers have been helped to accept full responsibility for their care. What is to be avoided at all costs is a mechanistic solution to what is essentially an individual human problem. This monograph does in fact go far to show how true it is that very few deprived children come from normal families as a result of sheer misfortune, and that a very high rate of personality factors is present in the parents of such children. That the need is for more work,