The Problem of Blame

On January 27, I posted Maternal Attachment in Infancy and Adult Mental HealthIn this article I reviewed a longitudinal study by Fan et al.  The main finding of the study was:

“Infants who experience unsupportive maternal behavior at 8 months have an increased risk for developing psychological sequelae later in life.”

In my article, I pointed out that the correlation between the low maternal attachment ratings and subsequent “mental health” issues was not perfect, so clearly this was not the only factor involved in the adult children’s subsequent problems.  But I also made the point that what we do as parents affects how our children function in adulthood.

For me this is simply an obvious fact of life that tragically has been barred from discussion by the psychiatric mantra – that all significant problems of thinking, feeling, and/or behavior are genetic-linked brain illnesses, and that parents couldn’t have impacted the outcome one way or the other.

The post generated a few comments on the blame-the-parents issue, and, since this is a critical topic in the current psychiatric debate, I thought it might be helpful to discuss the matter further.

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Firstly, we can’t have our cake and eat it too.  If we reject the facile psychiatric brain illness theory, then we ought to be willing to discuss other notions, and follow the evidence wherever it leads us.  Most people have no difficulty accepting the notion that the experience of being bullied during childhood can promote the development of significant problems in adult life.  Why is it such a reach that cold, detached parenting during infancy might also have importance in this respect?

Secondly, in matters of human behavior, there are always multiple paths to the same place.  In other words, two people might be engaging in pretty much the same kinds of activity, but for very different reasons.

Thirdly, human behavior (including thinking and feeling) is always multi-determined.  In other words, not only are there different ways to get to the same place, but a given individual may have traversed several of these routes simultaneously to arrive at his present position.  Linear, simplistic explanations of human activity are almost always incomplete, and sometimes downright false.

Fourthly, looking for, and finding, reasons for human behavior is not at all the same thing as assigning blame.  I read of an incident recently in our local newspaper that nicely illustrates this difference.

A few months back we had a tragic traffic accident on one of our highways.  Earlier, there had been a fender-bender in which a vehicle had been disabled and was blocking a lane.  A police officer and a tow-truck driver were clearing things up, when another vehicle, the driver of which had clearly become distracted, plowed through at about 70 mph, killing the tow-truck driver and seriously injuring the policeman.  The driver was charged, of course, and the case is grinding its way through the legal system.

Recently the widow of the tow-truck driver asked the court if the matter could be expedited, because she and her family had forgiven the culprit, recognized that it was a tragic accident, understood how it had happened, and wanted to move on.

The point of the story is that blaming and asking why are two completely different activities.  The former is generally unhelpful; the latter is necessary if we are to learn from our mistakes.

Fifthly, in my experience, most parents are willing to accept a measure of credit when their children do well and a measure of responsibility when they don’t do so well.  I often hear parents of grown children say things like:  my son is kind of timid, and I think maybe it’s because I was too hard on him; or my daughter doesn’t have a lot of initiative, I think maybe we were too protective; or my son is a bit on the wild side, I don’t think I was strict enough, etc…

Most parents of grown children, including myself, can identify with these kinds of statements, and can see in hindsight things we might have done differently.  So why should the problems embraced by the term “mental health” be conceptualized differently?  These are not a special class of problem, despite psychiatry’s insistence to the contrary.

Psychiatry routinely condemns as parent-bashing any attempt to explore or discuss these problems in terms of family dynamics.  Anyone who doesn’t accept their orthodoxy must be a parent-basher.  This spurious nonsense has been developed and promoted to win parents over to the “take-your-pills-for-life” philosophy, but in fact it is nothing more than deceptive propaganda.  What they’re saying essentially is:  all significant problems are gene-linked brain illnesses, and anyone who suggests otherwise must be a parent-basher.  We need to recognize this self-serving nonsense for what it is.

So for all of these reasons, I think we need to keep an open mind.  I’m certainly not advocating a return to the “cherchez-la-femme” type of thinking that was popular in the 50’s, but we do ourselves no favors if we over-react to that kind of approach and deny the simple reality – clear and obvious to previous generations – that parents, mothers and fathers, have a significant impact on their children’s lives.  We are not the only influencing factor, but our impact is not trivial.  We can do a great deal of good, but we can also do a great deal of harm.

Psychiatry – in pursuit of its own self-serving agenda – has made this a taboo subject.  We need to break this taboo, and start discussing these matters, as well as other pertinent factors such as poverty, discrimination, injustice, bullying, etc., openly and honestly – not in a mode of blame and censure – but rather in a mode of exploration and understanding.  Some of the most effective therapy I’ve ever done was with parents and their grown children, where these kinds of issues were aired with openness and candor.

With regards to the Fan et al paper, I have no inside information, but in general terms the study seems to have been conducted in a thorough and careful manner.  Longitudinal studies of this kind are something of a gold standard in addressing these sorts of questions, and it would, in my view, be foolish to ignore the results.

It would also be foolish to overstate the results.  As I pointed out in my earlier article, in many cases where low maternal attachment was noted in infancy, there were no “mental health” problems in adult life; and in some cases where low maternal attachment was not noted there were “mental health” problems later.  The study does not give us a simple discriminator that we can apply blindly to all mother-infant interactions.  Rather, it leaves us with the suggestion that it might be a good thing to encourage mothers to interact positively and affectionately with their babies, especially in cases where this kind of interaction does not seem to be happening.  And who can argue with that?

It might be objected that this kind of material is self-evident, and that everybody knows that mothers should be affectionate and comforting to their babies.  It could be argued that conducting research on something this obvious is a waste of time and resources.  But we should remember that for two or three generations prior to the 1950’s, it was widely promoted and accepted in pediatric circles that parents should avoid “excessive” affection with their babies and young children.  In 1894, Luther Emmett Holt, MD, a leading American pediatrician, wrote The Care and Feeding of Children.  This book quickly became a bestseller, and remained influential well into the twentieth century.  Here are two quotes:

“Are there any valid objections to kissing infants?

There are many serious objections. Tuberculosis, diphtheria, and many other grave diseases may be communicated in this way. The kissing of infants upon the mouth by other children, by nurses, or by people generally, should under no circumstances be permitted. Infants should be kissed, if at all, upon the cheek or forehead, but the less even of this the better.” p 168

 “At what age may playing with babies be begun?

Babies under six months old should never be played with; and the less of it at any time the better for the infant.”  p 165

The psychologist John Watson (1878-1958) also advocated a businesslike approach to child-rearing.  In the book Psychological Care of the Infant and Child (1928), which he co-authored with his wife, Rosalie Raynor Watson, he stated:

“Let your behavior always be objective and kindly firm. Never hug and kiss them, never let them sit on your lap. If you must, kiss them once on the forehead when they say goodnight. Shake hands with them in the morning. Give them a pat on the head if they have made an extraordinary good job of a difficult task.” (Quoted in Bigelow and Morris, John B. Watson’s Advice on Child Rearing, Behavioral Development Bulletin, Vol. 1, Fall 2001).

 As with Dr. Holt, the Watsons’ child-rearing advice was generally well received.

So the notion that parenting, even of very young babies, should be rather businesslike and unemotional had a lot of momentum in the first half of the twentieth century, and in fact it was largely in reaction to this kind of child-rearing ethos that Benjamin Spock, MD, wrote his famous book The Commonsense Book of Baby and Child Care in 1946.

It was presumably also in response to these kinds of ideas that the 1960’s researchers who initiated the longitudinal study currently under discussion had included a measure of maternal over-involvement which included displays of affection.  Not surprisingly, this measure was found to be not associated with the development of problems in adulthood.

Underlying the parent-bashing objection there is an unspoken assumption: that if a mother is not displaying strong emotional attachment to her baby, then she must be a “bad mother” – somehow defective – a disgrace to her gender.  But, in fact, there are all sorts of reasons why a mother might be emotionally detached.  Perhaps she’s an abused spouse.  Perhaps she’s never had role models and doesn’t really know what to do.  This is an increasing problem as families get smaller, and children aren’t involved in the care of younger siblings.  Perhaps the new mother lacks confidence and fears she might hurt the baby.  Perhaps she’s carrying some trans-generational vestige of the old Holt-Watson ideas.  Or perhaps she’s so worn-out and tired that she can’t generate much enthusiasm for anything beyond the bare necessities of childcare.  Whatever the reason, she needs help and coaching rather than censure.

But this kind of help won’t happen until we get to a point where we can discuss the link between parent-child interactions and subsequent development openly, and undefensively.  If this had been a study about sports, for instance, and had found that children of parents who encouraged their toddlers in sporting activities were more likely to pursue sports in later life, we would have no difficulty in joining the dots.  But the logic is essentially the same.  We critique psychiatrists for cherry picking their research results.  Let’s not fall into the same trap.  If there are methodological flaws in the Fan et al study, let’s critique them.  But we shouldn’t resist the paper just because we don’t like its conclusions.  We must not allow psychiatry’s threat, to brand us as parent-bashers, to scare us from stating the obvious.

 

  • Stefan Björk

    Thank you for a well written blog post, Philip! I do agree with what you write, and I realise that I was unaware of the pervasive “don’t-talk-about-my-parents-paradigm” in US psychiatry. I do not work within psychiatry, so I honestly can’t tell if it is that bad in Sweden, but I don’t think so – although, at the end of the day, the treatment will be the same, namely medication.

    When I wrote that “mother-blaming” concerned me, I wanted to emphasize the “mother” rather than the “blaming” part of the concept. The Collaborative Perinatal Project started in 1959 during a period where parenthood mainly were understood in a psychoanalytic framwork or in terms of John Bowlby’s emergent attachment theory. These theories are characterized by their almost exclusive focus on the mother and the mother–infant relationship. As such, the theories reflects the societal structure of the time: for the most part, mothers cared for the children, whereas fathers were expected to provide for the family.

    The problem with the CPP data – as far as I have been able to tell from the data sets included – is this “mothering-bias”. Fan and her colleagues have found an association between “unsupportive maternal behavior” and “psychological sequelae later in life”, which for me, as a fellow psychologist, seems like a matter of course. Why would anyone expect otherwise? From what you write in this post, I understand some people do (psychiatrists in particular?).

    As with many such studies, the mothers are treated out of context, and you touch on that topic in your post. If there is an association between “unsupportive maternal behavior” and “psychological sequelae later in life” (which I do not doubt), why the “unsupportive maternal behavior” in the first place? I totally agree with you that this is where we run the risk of “blaming” instead of “understanding”.

    As a scholar of gender theory (yes, I’m both), I wonder what the CPP dataset does not reveal. For example, where are the fathers? The father can be anything between supportive, abusive and abscent. If the father is abusive, is anyone surprised if the mother is “emotionally detached” or the child “avoidant”?

    This is the problem with longitudinal studies. If you want to say something about causality (which I think Fan et al do with their detour to “experiences” in their conclusion) you never know if you have taken enough factors into account, and in this case, I don’t think they have. But the association still stands, of course. The question is only: an association between what?

    In short, if you want to argue for the importance of parenting for childrens future mental health based on Fee et al, I don’t mind – but with the caveat that this study is gendered and must be understood as such.

    However, if someone would use Fee et al to argue for the importance of the *mother* (as opposed to “parent” or “parents”), I would strongly object.

  • Phil_Hickey

    Stefan,

    Thanks for your comment. The points you make are valid and important. Nothing is simple!