Edward John Mostyn Bowlby (1953) Child care and the growth of love: based by permission of the World Health Organization on the report ‘Maternal care and mental health’ Harmondsworth: Penguin
This paperback was based on a report prepared by John Bowlby for the World Health Organisation. With the establishment of the United Nations and the need to grapple with a range of social problems, the various bodies of the United Nations had commissioned research from leading experts in their respective fields to inform their decision-making, in particular about which programmes they would support.
The ideas which John Bowlby set out were not new; they had already played a part in the wartime debate on whether to provide nurseries or encourage child-minding (Riley, 1983). But they took on a significance for many people, including many of the child care officers emerging from the new training courses in the 1950s, which was not dissimilar to the ideas in the Bible for a devout Christian and they continue to resonate in twenty-first century debates as his defenders variously dismiss the evidence against his fundamental thesis or argue that he was misunderstood.
- Maternal deprivation is a key cause of mental ill-health.
- Mothers are central to a child’s development with fathers and extended family members providing a supporting role.
- Any maternal separation will adversely affect a child to some degree.
- Efforts should be made to avoid family failure but even state support may not be enough where the fundamental problem is failing parents.
- Adoption should be undertaken as soon as possible.
- Where possible, the mothers of illegitimate children should be given the support to care for their children.
- Fostering, if possible with the extended family or neighbours, should be used for short term emergencies.
- Group care should be confined to treatment, the care of adolescents or the short-term care of younger children and sibling groups.
- In both fostering and group care parental contact should be encouraged.
- Treatment, whether for physical or mental illnesses, should if possible be provided in the child’s natural home and otherwise in homes close enough for parental contact.
In Chapter 1 Some causes of mental ill-health, he sets out the argument that the quality of parental care is significant for a person’s future mental health; any child that does not have “a warm, intimate and continuous relationship with his mother (or permanent mother-substitute …)” (p. 13) will suffer from “maternal deprivation”. A child who is separated from his mother and cared for by someone else, however well, will suffer “partial deprivation” to some extent or other. While the effects of deprivation will vary with different levels of deprivation, they will always be present.
In this context the role of the father is to provide the environment in which the mother can devote themselves to the care of the child.
In arguing for an environmental cause for later mental health, he is not arguing against hereditary causes of mental health but rather arguing that, just as the mother catching German measles during pregnancy can cause irreparable damage to a child, so can other adverse environmental events.
He then reassures mothers that they only need to do what comes naturally to them, that they can leave their children while they are under three if they place them with someone they know, make careful arrangements for their absence and are not surprised if the child appears to reject them on their return. Until the age of three absences should be for no longer than a week to ten days.
In Chapter 2 How we can study the harm done, he identifies direct studies in institutions, retrospective studies of those suffering mental illnesses and follow-up studies of those who have suffered deprivation. He then describes the results of several institutional studies and rebuts the arguments for alternative causes for the symptoms he describes by pointing out that children not reared in institutions do not suffer these symptoms. He also describes examples of recovery from these symptoms once children are restored to their mothers.
He then goes on to discuss the provision of a “mother-substitute”, the earliest age at which separation anxiety may occur and the responses of children when their mothers return. He argues that separation anxiety can continue beyond seven, particularly in children who are already vulnerable in other ways.
In Chapter 3 How we can study the harm done, he continues his theme by looking at children deprived in infancy and in particular the number of studies demonstrating a link between children with the asocial responses of a deprived child and stealing, and quotes the work of Goldfarb (1943) in detail. He then quotes other studies where the conclusions are ambiguous or contradict his earlier arguments and either suggests they lacked methodological rigour or, as in the case of the Kibbutzim, it is too soon to be clear that such group rearing will not have an adverse effect. He quotes from Brosse (1950) as well as from other studies of war-damaged children.
In Chapter 4 What observation has shown, he argues that the available evidence shows that lack of any opportunity for attachment, a significant break in an attachment or multiple attachments can all have adverse effects. These may not be apparent in all cases but the significance of the first year of life has been established. Children who are adopted between six and nine months of age appear to do all right but adoption cannot be delayed beyond two and a half and the true limit for adoption may be much lower. He concludes by arguing that psychiatric help is most successful where a child has not suffered significant maternal deprivation and that regression therapy may be needed to treat some conditions.
In Chapter 5 Theoretical problems, he argues that the mother manages the environment for the child until s/he is old enough to begin to manage aspects of it her/himself. This process proceeds by phases which must be completed within certain periods; institutionalised children lose the support of their mothers to assist them with the appropriate phase and thus fail to develop. Moreover, it is likely that a child will develop angry feelings against those who have let them down, which will impede learning. Also, young children have no concept of time and so a relatively short absence may appear to them an eternity.
In Chapter 6 Methods of research, he argues that, having made the case for maternal deprivation, research needs to focus on the limits that need to be set on any periods of deprivation and the possibility of recovery from maternal deprivation. Given the ethical dilemmas involved in subjecting children to such research, he turns to what can be learnt from animal studies and how they might be applied in the human context.
In Chapter 7 The purpose of the family, he argues that the results of maternal deprivation are so serious that children generally do “better in bad homes than in good institutions” (p. 78), pointing to the attachment children from ‘bad’ homes often have to their ‘bad’ parents and citing the Ministry of Health’s conclusion following the wartime evacuation programme that it was better to improve home conditions that to remove children from unsatisfactory homes. He concedes that there may be cases where removal may be necessary but argues that these are very few in number.
In Chapter 8 Why do families fail? he argues that societies where the extended family is available to support the parents have a lower rate of failure in the upbringing of children. He argues that problems arise where
- there is no natural home group, for example, where the child is born out of wedlock,
- the natural home group is not functioning,
- the natural home group has broken.
These have largely been accepted as inevitable aspects of society but they need to be addressed if we are to prevent maternal deprivation. Pointing out that physical and emotional neglect are not necessarily associated with poverty, family size, housing, whether the mother goes out to work or learning disability, he concludes that it arises from a parental maladjustment or a temporary condition such as depression or mental illness.
He points out that parents who have difficulties often have difficulties with the extended family and therefore are unable to call on it for support.
In Chapter 9 Prevention of family failure, he argues that state aid to families, including money, health provision, counselling and special education, is cheaper in the long term than not providing it. The immediate unsolved problem is the form of intervention with failing parents.
In Chapter 10 Illegitimacy and deprivation, he says that, while societies vary in the extent to which they accept illegitimate children, he is only concerned with the ‘unaccepted’ ones. He cites a number of studies from which he concludes that illegitimate children are born to emotionally disturbed parents. He then cites studies into the subsequent situation of illegitimate children from which he suggests that, while adoption is currently widely favoured, consideration should be given to supporting the unmarried mother and that, in any case, more research is needed in this area.
In Chapter 11 Substitute families: Adoption, he argues that, where the mother is willing to breast-feed the child, a decision about adoption should be postponed but that otherwise it should be taken as early as possible and that the child should be fostered rather than placed in a residential nursery. He dismisses the argument that children should be thoroughly assessed before they are placed for adoption on the grounds that any tests taken on a very young child are unlikely to be reliable. He does stress the assessment of the adoptive parents’ capacity to provide a loving environment for the child.
In Chapter 12 Substitute families: Foster homes, he considers foster homes, arguing that for the emergency care of pre-school children only foster care should be used, preferably with the extended family or neighbours. He stresses the importance of maintaining family links and of working with parents in ways which do not alienate them from supporting their children. He also argues for paying foster parents and for treating them as professional colleagues rather than as clients of the social worker. He stresses the need for social work support for the child in the foster home and also the difficulties of working with the children of psychopathic parents.
In selecting foster homes, he recommends:
- sibling placements,
- a four-year difference between the foster child and any natural child of the same sex,
- another foster child of the same age but opposite sex,
- matching the temperament of the child to the temperament of the foster home.
He recommends against placing older children in foster care or with elderly foster parents, placing a child in a foster home with widely differing standards from the child’s own home and placing maladjusted children in foster homes.
In Chapter 13 Group care, he argues that group care can be used for the treatment of maladjusted children prior to fostering, adolescents, short-term care of children over six, the children of parents who are threatened by the idea of fostering and need time to decide whether to permit fostering or resume care of their children and large sibling groups who might otherwise be split up. He argues for children’s homes of no more than 100 split into family groups large enough to keep all the siblings in a family together or what came to be known as ‘family group homes.’ Parental contact should be encouraged and provision made for psychological care.
He argues against the use of residential nurseries which, if they must be used, should be organised into family groups and used for short-term care only and against the use of the recently introduced reception and observation centres on the grounds that it is perfectly feasible to assess most children in their own homes.
In Chapter 14 Care of maladjusted and sick children, he argues that, while treating children in their own homes should be the preferred option, there will be instances where this is not possible and foster care is not feasible. In this case group homes organised on the family principle within easy reach to maintain parental contact with trained staff capable of dealing with difficult behaviour are needed. He recommends self-government be introduced in stages to suit the age and development of the children. He rather dismisses the healing effect of the group and concentrates on adults providing therapeutic relationships for children.
He argues that, where possible, sick children should be cared for at home or their mothers admitted with them to hospital where there are no formal visiting hours.
In Chapter 15 Administration of child-care services and problems of research, he argues that the major failing of child services is the lack of constructive case-work which must be provided for both family and child by trained staff. In relation to research he argues for much greater research into both support within the home and provision outside it.
The arguments against Bowlby’s fundamental thesis are well set out in Clarke and Clarke (1976a) but it is worth looking at what we know with hindsight that he got right before considering why he got things so badly wrong and why people still cling to his fundamental thesis.
First of all, he was absolutely right about parental contact; at a time when this barely registered on most people’s radar, his arguments for parental contact were spot on – you cannot expect a child to forget their parents and you have to take account of the memories they have of their parents in any relationships you make with them.
Secondly, he was right about sibling contact.
Thirdly, he was moving into the right areas when he argued that family difficulties are a key cause of problems for children and when he argued that foster parents should be paid and treated as professional colleagues. However, if the corollary to that was that they should not become involved in offering a secure attachment to foster children as full members of the foster family, then he was going in the wrong direction (Tizard, 1977; Stein and Carey, 1986).
Fourthly, he was right in picking out the issues of siblings, the age of the foster parents’ children and the presence of other foster children as key factors in successful foster care (Berridge and Cleaver, 1987).
Fifthly, he was right that you do not need to remove children from home to assess them and that it is worth trying to deal with things in the child’s home rather than taking them into care. However, it is important to distinguish this from the rather dogmatic approaches taken by some which then meant that children were admitted to care later with more serious problems because the attempts to treat them at home had been unsuccessful (Rowe et al., 1989).
So, why did he get some things so badly wrong? First, he was somewhat cavalier with the evidence (Clarke and Clarke, 1976b); he quotes selectively from Brosse (1950), ignoring her overall conclusion that “a child needs a personal relationship with an adult” (p. 85) who is not necessarily the child’s mother.
Secondly, he had a blind spot about women, which emerges in his later book A secure base (1988) and which appears to have led him to blame everything that goes wrong in the world on women.
Thirdly, so many people wanted to agree with him that it would have taken great strength of character to say “I got it wrong” and disappoint the thousands, if not millions, of fans who wanted to believe him regardless of whether what he said really made any sense.
The book was published just as men were returning from the Far East after the Second World War and looking for jobs often in workplaces where women had been employed during their absence. The Central Office of Information which, during the war, had produced a series of films extolling the place of women in the workplace and the quality of the workplace nurseries that would care for their children while they contributed to the war effort suddenly switched to films extolling the virtue of the wife who gets everything ready for her husband’s departure to work, spends the day happily caring for his children and has his dinner on the table when he returns in the evening. As Konopka (1966) has observed, this approach had been taken by the Nazis to deal with male unemployment in the 1930s and it had not been enforced in Germany, any more than it was in the UK, against working class women; but making it official policy simply gave people another stick with which to beat working class working mothers.
In practice, over 95% of women chose to get married and set up a family in the 1950s, the highest percentage since records began; so whether or not they had imbibed Bowlby’s ideas before they made that decision, his book confirmed that they had made the right choice.
Thirty years later Mrs Thatcher had great problems explaining that male unemployment was not primarily caused by her economic policies but rather by the decision of the next generation of women to join the jobs market and take at least some of the jobs which had previously been reserved, courtesy of John Bowlby, for men.
But Bowlby’s thesis also suits those who like to look for an explanation in the past for anything that is going wrong in the present; as Tizard (1977) discovered, adoptive and foster parents only criticised the residential nursery if something was going wrong in the present. Most violence in institutions is caused by something going wrong in the institution, not by anything that happened to the inmate before they were admitted (Cawson and Martell, 1979).
It also gives therapists something to ‘treat’ but, as Lyward (Burn, 1956), Neill (1962) and Winnicott and Britton (1957) had found, the only successful ‘treatment’ is to provide a healing environment for the child in the present (Bronfenbrenner, 1974). Indeed, Taylor and Alpert (1973) found that treatment was irrelevant to successful residential care, Rowe et al. (1989) that treatment was the aim least likely to be achieved in most placements, and Wiener and Wiener (1990) that plans were irrelevant to successful outcomes.
Since we know that the most successful way to bring children up is in happy families in or out of home care (Rutter, 1971; Millham et al., 1975), is the reason why the UK is the least successful developed country at doing that (UNICEF Innocenti Research Centre, 2007) because people would rather blame or ‘treat’ something from the past than give children what they need in the present?
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Bowlby, E J M (1988) A secure base: clinical applications of attachment theory London: Routledge
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Brosse, T (1950) War-handicapped children: report on the European situation Publication No 439 Paris: United Nations Educational, Scientiﬁc and Cultural Organization
Burn, M (1956) Mr Lyward’s answer London: Hamish Hamilton See also Children Webmag May 2009.
Cawson, P and Martell, M (1979) Children referred to closed units DHSS Research Report No 5 London: Her Majesty’s Stationery Office See also Children Webmag December 2009
Clarke, A M and Clarke, A D B (Eds) (1976a) Early experience: myth and evidence London: Open Books
Clarke, A M and Clarke, A D B (1976b) The formative years? In A. M. Clarke and A. D. B. Clarke (Eds) Early experience: myth and evidence, Chapter 1, pp. 3-24 London: Open Books
Goldfarb, W (1943) Effects of early institutional care on adolescent personality Journal of Experimental Education 12 (2), 106-129
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Rowe, J, Hundleby, M and Garnett, L (1989) Child care now: a survey of placement patterns Research Series 6 London: BAAF Publications See also Children Webmag April 2010
Rutter, M (1971) Parent-child separation: psychological effects on the children Journal of Child Psychology and Psychiatry 12 (4), 233-260
Stein, M and Carey, K (1986) Leaving care The practice of social work 14 Oxford: Blackwell
Taylor, D and Alpert, S W (1973) Continuity and support: following residential treatment New York: Child Welfare League of America See also Children Webmag March 2009.
Tizard, B (1977) Adoption: a second chance London: Open Books See also Children Webmag January 2010.
UNICEF Innocenti Research Centre (2007) Child poverty in perspective: an overview of child well-being in rich countries: a comprehensive assessment of the lives and well-being of children and adolescents in the economically advanced nations Report card 7 Florence: Innocenti Research Centre
Wiener, A and Wiener, E (1990) Expanding the options in child placement Lanham MD: University Press of America See also Children Webmag January 2010.
Winnicott, D W and Britton, C (1957) Residential management as treatment for difficult children In D. W. Winnicott (Ed.) The child and the outside world: studies in developing relationships Chapter II:6, pp. 98-116 London: Tavistock See also Children Webmag October 2009.