Australian and New Zealand Journal of Psychiatry (1979) 13:209-217
MATERNAL DEPRIVATION: CAN ITS GHOST BE LAID? NEILMCCONAGHY
The hypothesis that separation from an established mother figure in early childhood has a detrimental effect on a child’s later mental health has been widely promulgated and commonly accepted both in academic and lay circles throughout the Western world. The hypothesis continues to have a significant effect on mothers’ decisions as to whether they should resume work or not, and on governmental policy concerning the provision of child-care facilities for the children of those mothers who do. The evidence for the hypothesis is reviewed and it is concluded that it does not satisfy the requirements of scientific methodology. The theory that a child’s attachment to its mother figure is the emotional basis for its future love relationships, group affiliations and loyalty to the state, is now being accorded similar acceptance without further evidence than that supporting the original hypothesis.
In 1953 a report by Bowlby entitled Maternal Care and Mental Health published in the Bulletin of the World Health Organization was issued in abridged form by Pelican Books as Child Care and the Growth of Love. Given its authoritative backing and wide circulation the views expressed in this book strongly influenced the thinking of both lay people and specialists throughout the Western world concerning the significance of the ‘maternal role’. This occurred despite the fact that in the following 8 years several trenchant criticisms of Bowlby’s monograph (Mead, 1954; Casler, 1961; Yarrow, 1961) were published. Bowlby (1965) did not answer these criticisms but a colleague, Ainsworth (1962) put forward an ill-reasoned and unscientific rebuttal in a further World Health Organization publication. At this time Harlow (Seay & Harlow, 1965) misinterpreted data from primate studies so that this appeared to support Bowlby’s hypothesis that separation from a mother (or mother-substitute) in early life predisposes an
individual to psychopathology later in life. Perhaps due to the low level of academic competence in this area of psychiatry (Taylor, 1971) the efforts of Bowlby, Ainsworth and Harlow were successful. Subsequent criticism of their work has been muted or reverential (Clark, 1968; Rutter, 1972). Bowlby’s Pelican continues to be published and widely read, not only by lay people, but also as a recommended text by medical and paramedical university students. At a post-graduate level, the author has found almost all psychiatrists in training unaware of the literature attacking the work, and incapable of subjecting it to critical analysis. Bowlby has more recently published Attachment (1969), which extends his hypothesis in a way that, given the latter is accepted as true, has considerable significance for psychiatry and indeed for social policy a t a governmental level. If Bowlby’s original hypothesis is incorrect, attachment behaviour in childhood though of obvious importance to workers in normal child development, has no
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particular significance for psychiatrists, or medical and paramedical workers generally. If Bowlby’s theoretical structure is wrongly accepted as valid it could have grave social consequences. For this reason and to reassert academic standards of methodological rigour, it is important that this area of research and speculation concerning human behaviour be re-examined.
Social Implications
The position statement of the Australian and New Zealand College of Psychiatrists entitled Some Aspects of the Welfare of Children under Three whose Mothers are in Full-time Employment (1971) commences: It is of great importance for mental health that the infant and young child should experience a warm, intimate and continuous relationship with his mother or mother-substitute in which both find satisfaction, stimulation and enjoyment. The quality of mothering the child receives, especially in the first three years of life, affects profoundly his whole future development. This is almost word for word a quotation from Bowlby’s monograph (1951) and expresses its basic thesis. A similar statement is to be found in the Congressional Record, 16 October 1972 (Moore and Moore) arguing against the provision of preschool facilities for children. Bowlby’s monograph thus continues to be used by professionals to influence governmental policy particularly in relation to the provision of facilities for the children of working mothers. Soon after its publication Mead (1954) commented: The growing insistence that child and biological mother, or mother surrogate, must never be separated, that all separation, even for a few days is inevitably damaging, and that if long enough it does irreversible damage. This . . . is a new and subtle form of anti-feminism in which men-under the guise of exalting the importance of maternity-are tying women more tightly to their children than has been thought necessary since the invention of bottle feeding and baby carriages (p. 477). This statement of Mead’s was dismissed as a ‘quip’ by Lebovici (1962, p. 89), a proponent of the maternal deprivation hypothesis, in the World Health Organization monograph Deprivation of Maternal Care: A Reassessment of its Effects. In the same book, Ainsworth (1962) writing with Bowlby’s ‘full agreement’, says concerning working mothers:
The practical problem is not entirely solved by pressing mothers, in order to give adequate care to their infants and pre-school children, to delay resuming their careers . . . some mothers are themselves unable to provide sufficient maternal care (at least for these particular infants), and both infant and mother might well, therefore, thrive better with the mother working and with adequate and continuous supplementary mothering arrangements provided (p. 148). This recommendation that mothers capable of providing sufficient maternal care be pressed to delay resuming their careers, but not those judged incapable who were instead to find a ‘continuous supplementary mother’, must, when ineffective in preventing women from resuming their careers, have resulted frequently in severe anxiety and guilt in those who did so, carrying as it did the prestige of the World Health Organization. That it would come to their attention was virtually guaranteed by Bowlby’s including it in the Pelican Child Care and the Growth of Love since 1965 (pp. 210-21 1). In the same book is still to be found Bowlby’s description of the ideal mother’s behaviour: Such enjoyment and close identification of feeling (essential for the child’s mental health) is possible for either party (mother or child) only if the relationship is continuous . . . mother needs to feel that she belongs to her child, and it is only when she has the satisfaction of this feeling that it is easy for her to devote herself to him. The provision of constant attention day and night, seven days a week and 365 days in the year, is possible only for a woman who derives profound satisfaction from seeing her child grow from babyhood, through the many phases of childhood, to become an independent man or woman, and knows that it is her care which has made this possible (pp. 77-78). Apart from the direct harm to working women of these guilt inducing statements Wortis (1971) has stressed their broader social significance: Because the Bowlby-Spitz hypothesis has had such a profound impact on child-rearing practice, legislators, employers and educators have refused to provide sufficient adequate free child-care for working women. Consequently, working women are usually forced to find their own, individual solutions to the child-care problem (p. 736). Cox (1978), Director, Council of Social Service, N.S.W., reports that Bowlby’s theories continue to be used to limit the provision of services for the children of working mothers.
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Another area where Bowlby’s monograph has had harmful effects has been stressed by his apologists Prugh and Harlow (1962): Misplaced emphasis given to Bowlby’s earlier statements can lead to the facile conclusion that any child at any age is better off in his own home than in a foster-home, hospital, or other institutional setting (p. 14). To accuse professional workers in child placement of reaching this conclusion in a ‘facile’ manner, seems completely unreasonable in the light of the previously quoted and the following extracts from the present edition of Child Care and the Growth of Love: It must never be forgotten that even a bad parent who neglects her child is nonetheless providing much for him. Except in the worst cases, she is giving him food and shelter . . . above all is providing him with that continuity of human care on which his sense of security rests. . . It is against this background that the reason why young children thrive better in bad homes than in good institutions . . . can be understood (p. 78). Many leading workers today regard the removal of a child as a last resort and a confession of failure (p. 167). Further advice that Bowlby gives to case-workers with children in placement concerns: The child of psychopathic parents . . . In handling them the case-worker must first get rid of the notion that, because of ‘bad heredity’ these children are likely to turn out less favourably than those without such a supposed handicap (p. 147). Bowlby reached this conclusion on the basis of studies which he was aware inadequately controlled for hereditary factors, but which he considered could not be improved. Schulsinger (1972) subsequently carried out a study which did control heredity and environmental variables. It showed that children of psychopaths separated from them in infancy were more likely to be later diagnosed as psychopathic than were the separated children of non-psychopaths. The number and length of duration of experiences of separation from biological relatives were not related to the likelihood of the diagnosis. The argument of Prugh and Harlow (1962) continues to be advanced: Bowlby’s writings have often been misinterpreted and wrongly used to support the notion that only twenty-four hours care, day in and day out, by the same person, is good enough. Thus, it has been claimed that proper
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mothering is only possible if the mother does not go out to work (Rutter, 1972, p. 15). The reader must judge if these are misinterpretations of Bowlby’s statement and of that by Ainsworth advanced by Bowlby with his full agreement, that capable mothers be pressed not to resume their careers so they can give continuous care to their pre-school children. What in fact was the evidence for Bowlby’s thesis and what were the earlier criticisms that seem to have been so ineffective?
Evidence of the Effects of Maternal Deprivation
Thefirst type of evidence was from studies observing infants and children separated from their families and placed in institutions. Bowlby (1965) claims that ‘when deprived of maternal care, a child’s development is almost always retardedphysically, intellectually and socially-and that symptoms of physical and mental illness may appear’ (p. 21). Bowlby attributed these changes to the fact that such children were deprived of a mother or individual mother-substitute. This evidence tended to be exaggerated, producing a strong emotional reaction in the reader: These descriptions of the reactions of young children to conditions involving loss of a mother-figure have provided the basis for most of the generalizations about the severe effects of maternal separation. The dramatic character of these changes has overshadowed the significant fact that a substantial portion of the children in each study did not show severe reactions to separation. In Spitz’s study of 123 infants separated from their mothers between 6 and 8 months of age, severe reactions occurred in only 19 cases. Although in Robertson and Bowlby’s (1952) research on 45 children ranging in age from 4 months to 4 years, all but three are reported to have shown some reaction; the intensity and duration of the reactions are not clearly specified. Less than half, 20 cases, are reported as showing ‘acute fretting’, a behaviour pattern which is not welldefined. The reported duration of the reaction varied from 1 to 17 days. There are no data on the number of children who showed prolonged reactions (Yarrow, 1961, p. 474). Possibly due to the emotional response engendered by such reports, little significance was attached to the fact that these studies did not control relevant variables. Bowlby (1951) said of this:
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What each individual piece of work lacks in thoroughness, scientific reliability, or precision is largely made good by the concordance of the whole. Nothing in scientific method carries more weight than this. Divergent voices are few (P. 15). This is to say agreement reached in studies all of which fail to control several variables carries weight in scientific method. As will be pointed out, equally methodologically unacceptable assertions supporting the maternal deprivation hypothesis were subsequently made by Ainsworth and Harlow. The current practice of referring university students to these writings without adequate exposure to criticism of their weaknesses increases the likelihood that an academic readership will be produced incapable of subjecting research literature to adequate critical analysis. The variables inadequately or not controlled in the studies quoted by Bowlby included heredity, amount of physical and social stimulation, separation from other family members than the mother, stresses on the child prior or associated with the reason for separation, and the physical health of the child prior to and following separation. In addition the manner in which ‘the concordance of the whole’ was reached is commented upon by Casler (1 96 1): We have a right to wonder why Bowlby failed to so much as mention the following observation, included in Bakwin’s second paper: In a visit to a ‘large foundling hospital which houses some 250 children, more than half of whom are under one year of age’, Bakwin was ‘unable to find a single baby who showed the clinical features which have come to be associated with emotional deprivation in young infants’ (p. 6). While Bowlby refers more than once to the old study of Durfee and Wolf, he fails to mention what is perhaps the authors’ most important conclusion: that the ill effects of institutionalization are not inevitable but can be averted by alert and intelligent administrators (p. 7). Such frank criticism is in marked contrast to the protective attitude shown by Rutter (1972) in his more recent review. On the issue of investigating how infants react when left by their mothers in a familiar situation, he comments: Systematic studies are needed but pose difficulties in that, at least for longer separations, the children would have to be left with someone and if the setting was to be familiar the person would be likely to be known to the child. As discussed below, the presence of a
familiar person has similar stress-reducing properties to the mother’s presence (pp. 3637). Rutter seems to be saying that the child’s distress is likely to be minimal under these conditions of separation from the mother, and hence it is not appropriate to investigate the issue in this way. This objection appears to be based on the consideration that such an investigation would not support Bowlby’s hypothesis. In no way are these criticisms of Bowlby’s thesis intended to minimise the importance of distress in children separated from their families. However, if such distress is not common and can be minimised by a stimulating atmosphere or by the presence of familiar persons other than the mother (Rutter, 1972) then this is important in its handling. It would seem that pressure should not be put on mothers to remain with their children in hospitals until the intensity of the child’s reaction is assessed. If it is significant it might be more conveniently and as effectively dissipated by the presence of the father, a sibling or a friend as by that of the mother. Rutter (1972) concludes that the stress-reducing properties of the accompanying person are related to the strength of bond formation (the attachment the child shows for the person). Schaffer and Emerson (1964) have demonstrated that by 18 months approximately 4 out of 10 children in Western society are at least as attached to their fathers as their mothers. However, the major significance given maternal deprivation by Bowlby’s hypothesis lies not in its immediate but its postulated long term effects on ‘mental health’. These will be discussed in section 111. The second type of evidence Bowlby quoted was that provided by retrospective studies which showed that older children with various emotional disturbances or with intellectual retardation were more likely to give a history of separation from a mother or fostermother in their infancy or early childhood. Bowlby particularly laid stress on the frequency with which the affectionless or psychopathic character gave such a history. These studies also did not control for the effects of variables mentioned previouslyheredity, other stresses than separation from the mother, and different environmental, social and educational stimulation. If Schulsinger’s study (1972) which does attempt to control these variables is correct in its conclusion that psychopathy is inherited, psychopathic parents will produce ‘broken homes’ and psychopathic children. The fact that psychopathic children come from ‘broken
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homes’ would reflect the operation of this genetic factor, not be evidence that ‘broken homes’ result in psychopathy in children. Again Rutter (1972) is very tentative in his handling of this issue. On the basis of the methodologically unsatisfactory evidence quoted by Bowlby, Rutter regularly accepts through most of his book that mother-child ‘bond disruption’ leads to psychopathy. Only towards the book’s end does he raise the possibility that the association between ‘broken homes’ and psychopathy could result from a genetic cause-the child inheriting the psychopathic personality of the parent which was responsible for the ‘broken home’. Rutter largely rejects the possibility arguing that studies have failed to show a genetic factor in the aetiology of delinquent behaviour, criminality and alcoholism, which conditions he appears to regard as equivalent to psychopathy. As has been pointed out subsequent studies have established that there is a significant genetic contribution to the aetiology of psychopathy and indeed to criminality and alcoholism (Schulsinger, 1972; Crowe, 1975). Possibly the major reason workers wish to retain the belief that disturbances of the mother-child relationship leads to later psychopathic or affectionless behaviour is that this belief provides the only basis for the now widely accepted hypothesis that the nature of the child’s tie to the mother is of significance for his later emotional behaviour -an hypothesis on which Bowlby (1969) has erected a considerable theoretical edifice which innumerable research workers are busily developing. In fact Bowlby et al. (19.56) acknowledged that psychopathy only rarely follows early deprivation: It is clear that some ‘of the former group of workers (Bender, Goldfarb and Spitz), including the present senior author, in their desire to call attention to dangers which can often be avoided have on occasions overstated their case. In particular, statements implying that children who are brought up in institutions or who suffer other forms of serious privation and deprivation in early life commonly develop psychopathic or affectionless characters (e.g. Bowlby, 1944) are seen to be mistaken. The present investigation confirms the findings of Beres and Obers, and Lewis. Outcome is immensely varied, and of those who are damaged only a small minority develop those very serious disabilities of personality which first drew attention to the pathogenic nature of the experiences. Though we may be relieved that this is so, there are no grounds for complacency (p. 240).
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When Bowlby revised his widely read Pelican Child Care and the Growth of Love in 1965, he did not take the opportunity to incorporate this marked modification of his earlier conclusion but stated in the preface: ‘With only small revisions, therefore, the views I expressed in 1951 still stand’ (p. 10). These include: ‘Here, in brief, are many of the typical features (of maternal deprivation): superficial relationships; no real feeling-no capacity to care for people or make true friends . . .’ (p. 37). He does include two chapters by Ainsworth which qualify this but the overwhelming impression left by the book is contained in such statements as: There is a very strong case indeed for believing that prolonged separation of the child from his mother (or mother substitute) during the first five years of life stands foremost among the causes of delinquent character development (P. 41). The third type ofevidence Bowlby used was that of follow-up studies investigating the mental health of children who suffered deprivation in their early years. Bowlby was content to believe that by some matching procedure it was possible to find among children placed in foster-homes controls of similar heredity to children placed in institutions. Wootton (1962) comments concerning this: Such a light-hearted dismissal of the influence of differential inherited factors is astonishingly naive (p. 67). Clarke (1 968) more gently advances evidence supporting Wootton’s comment. Perhaps the most revealing exposition of the scientific methodology by which the maternal deprivation hypothesis was established appears in Chapter 6 of Bowlby’s monograph (1951). It commences: It is now demonstrated that maternal care in infancy and early childhood is essential for mental health . . . henceforward it should be regarded as unnecessary to spend time demonstrating the validity of the general proposition respecting the adverse effects of deprivation (P. 59). On the following page it is stated that: Ideally, to isolate the effects of deprivation, all other factors known to be emotionally disturbing would be absent from the cases. Thus the ideal sample would consist of healthy children of good parentage . . . The reason for separation, moreover, would not be traumatic in itself, while the conditions obtaining during separation would be carefully regulated. In
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practice few of these ideal research conditions hold (p. 60). That is to say the hypothesis has been demonstrated, although the relevant variables were not controlled.
Subsequent History of the Maternal Deprivation Thesis
It is not surprising that Bowlby’s monograph was strongly criticized by the workers referred to already or that Casler (1961) after an extensive review of the literature concluded: It thus appears that none of the clinical or institutional studies ostensibly supporting the so-called ‘Spitz-Ribble’ hypothesis really does so, simply because none is able to demonstrate the probable causes of the adverse effects of institutionalization, other than maternal deprivation, are inoperative (p. 12). What is surprising is that the maternal deprivation hypothesis continued to be widely accepted as established after Bowlby elected to ignore this criticism. Equally surprising was the reception given the article by Ainsworth which ostensibly dealt with this criticism. It was the final article in the World Health Organization publication, ‘Deprivation of Maternal Care. Reassessment of its effects’ (1962). Rutter refers to this article as ‘Ainsworth’s excellent and thoughtful reappraisal of the topic’ (p. 122). It contains a statement which surely demonstrates the grossest limitation of understanding of scientific method to be found in an academic publication: Once the hypothesis had been put forward that prolonged deprivation experiences in early childhood may have lasting adverse effects upon subsequent development, it was out of the question to expose young children experimentally to deprivation in order to test the hypothesis (p. 105). It expresses not only a lack of realization that among the various patterns of child care existing throughout the world, many could be found where each of the variables considered a part of ‘maternal deprivation’ could be controlled in a completely ethical way, but suggests that a hypothesis is put forward in scientific research not to be tested but to be acted upon as correct. It is equivalent to stating that once the hypothesis is put forward that a particular treatment is effective for a condition, it is out of the question experimentally to expose patients with the condition to deprivation of the treatment in order to test the hypothesis. That is to say, it is out of the question to carry out a controlled
trial. What effect has this statement on the students referred to Ainsworth’s article, particularly in the light of Rutter’s comment as indicative of the attitude of their teachers to it? The advantage of this statement of Ainsworth was that she and the other proponents of the maternal deprivation hypothesis could opt out of doing research to confirm their hypothesis and continue to state that it was true expecting, successfully as it has eventuated, that the academic world would accept this scientifically unacceptable procedure, that an unproven hypothesis was true until disproved. The reason that this procedure is scientifically unacceptable is that it is impossible to disprove such an hypothesis. If an hypothesis is demonstrated-say that children of a specific age exposed to a specific type of deprivation demonstrate a specific type of mental ill-health-it is possible to affirm or refute this by replicating the conditions and seeing if the same result occurs. If the hypothesis is not demonstrated, then one must attempt to show that children of a variety of ages, exposed to a variety of deprivations, develop no illeffects of any sort in any area of their behaviour. This task would require an infinity of experiments. Ainsworth in her review took full advantage of this position. She did not refute or even discuss the criticism that the studies on which the maternal deprivation hypothesis was based were inadequately controlled. She treated the hypothesis as established and attacked studies which did not find ill-effects of maternal deprivation on the basis that ill-effects had occurred, but the studies had not detected them: Not all damage is sufficiently gross to be obvious at a crude level of observation (p. 100). Differences in vulnerability are commonly found in etiological research (p. 101) It is very likely that some lasting effects are manifested overtly only under special circumstances-perhaps much later in life (p. 102). A further objection was that the tests of mental function used were inappropriate. For example, Ainsworth rejected one study which did not use verbal tests, arguing that such tests correlate highly with general intelligence (p. 132); she rejected another, because measurements of general intelligence could not be accepted as measures of verbal performance (p. 118). The Null Hypothesis: A Red Herring
The acceptance of this position that the maternal deprivation hypothesis does not have to be proved but rather has to be disproved to the satisfaction of its believers is now widespread. Gellis, editor of the
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Year Book of Paediatrics (1972), commenting on a study by Caldwell which advanced evidence that day-care does not lead to differences in strength of attachment as compared with home care, states: Perhaps we are entirely wrong in our attitude, perhaps the infant does not need the closeness and warmth of its mother the entire day . . . However, we believe that the burden of proving that infant day-care is beneficial and not harmful must fall on its advocates (p. 352). As has been pointed out, it is only methodologically possible to do what Gellis requires if the nature of the harm is specified. Yet research attempting this has been rejected for that very reason that it only applies to the types of harm investigated, a classical double bind: (Caldwell’s) direction o f . . . day care centres has led to claims (on the purported benign impact of day care) that are classical violations of statistical inference, viz., that if one’s research method and data don’t disprove a null hypothesis, then one is free to assume that the opposite is correct. German researchers on Thalidomide made the same type of error (Meers, 1972). This is methodologically sound-if research data do not disprove a null hypothesis, one cannot assume that the opposite is correct. However, it is much more inappropriate to assume the opposite is not correct, that is to assume that day care is harmful, in the absence of any evidence that it is. The introduction of the concept of the null hypothesis into the controversy functions as an ideal red herring. Most readers are both impressed, and convinced they will not be able to understand the issue, once such a term is introduced. Hence they are likely to accept uncritically any argument advanced in this context, particularly if it is reinforced with highly emotive though unjustified analogies such as the identification of day care (and its associated maternal deprivation) with Thalidomide. German researchers had not spent 30 years attempting to demonstrate that Thalidomide was harmful before it was discovered that it was. Thirty years of research have not produced evidence that maternal deprivation is associated with any deterioration of behaviour when all other variables which could cause such a deterioration are controlled. When Gellis demands the impossible-that the proponents of day care prove that it is not harmful in non-specified ways; and Meers reinforces this demand by the identification of day care of children with a known horrifying pathogen (Thalidomide), the determination of the proponents of the maternal deprivation hypothesis to cloud the issue with
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emotion and retain this unproven hypothesis as true becomes apparent. Until this situation is recognized as scientifically unacceptable the maternal deprivation hypothesis, true or false, is safe from refutation. Ethology and Attachment
The maternal deprivation hypothesis, having apparently been placed in this unassailable position of being accepted as proven without adequate evidence, could serve as the basis for Bowlby’s elaboration (1969) of his concept of attachment. In this he was strongly influenced by early ethological work on the adult behaviour of some birds to the person who tended them in their first few days of life: ‘they become deeply attached to human beings instead of to other birds, and later fall in love with human beings’ (Bowlby, 1965, p. 17). In this area of ethology Bowlby’s maternal deprivation hypothesis has been strongly supported by Harlow. A recent study by him and colleagues (Young et al., 1973) commences: Separation experiences in early life have long been regarded in psychiatric theory and practice as traumatic events that can predispose individuals to psychopathology later in life. In general the validity of this relationship has not been questioned (p. 400). The study puts forward as a model of maternal separation, the isolation of rhesus monkeys from all living creatures for 22 hours a day from birth until 12 months of age as well as exposure to 30 days of ‘profound environmental isolation’ in a vertical chamber. In an earlier article (Seay and Harlow, 1965) ‘designed to study the effects of infant-mother separation on the social and emotional behaviour of rhesus monkey infants’ (p. 434), the monkeys were separated from peers as well as their mothers. If these investigators were investigating the effects of infant-mother separations, why separate the infants from their peers? If they wished to increase the stress of the situation why claim they were studying the effects of infant-mother separation? In fact if the behaviour of such monkeys is relevant to that of human infants, Harlow and Harlow (1962) had already provided evidence weakening the maternal deprivation hypothesis. They demonstrated that monkeys brought up with peers only, showed none of the defects of behaviour reported in those brought up in isolation. The changes in this latter group of monkeys have been used as evidence for the existence of a critical period in infancy when maternal deprivation brings about irreversible effects (Scott, 1962). Failure to replicate these
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changes has been reported (Meier, 1965) and in any case Harlow and his colleagues have advanced evidence that they are reversible (Suomi et al., 1972, 1976). Bowlby (1969) required an acceptance that some emotional patterns of behaviour are irreversibly established in chldhood when he advanced that attachment behaviour in adult life is ‘a straightforward continuation of attachment behaviour in childhood’ (p. 207) at which period it was directed initially to the mothering person (p. 182). Attachment behaviour in adult life is directed to age-mates, and to groups; and ‘for many a citizen attachment to his state is a derivative of and initially dependent on his attachment to its sovereign or president’ (p. 207). What is assumed in this obscure hypothesis is that there is some immutable entity termed attachment behaviour which is shown by infants initially to their mothers and which then remains a basic element in their subsequent emotional relationships throughout life: When an older child or adult maintains an attachment to another person he does so by diversifying his behaviour so that it includes . . . the basic elements of attachment behaviour present at the first birthday . . . (p. 350). However, the criteria by which attachment behaviour can be recognized are not yet established: We may need to distinguish more carefully than has hitherto been done between attachment-figures and playmates . . . Unfortunately, the two pioneering studies on which we are drawing for our data do not make these distinctions (p. 307). One of the most obvious criteria in terms of which to describe a child’s attachment behaviour is whether or not he protests when his mother leaves him for a brief time and how strongly he does so. This has been the criterion of strength of attachment used by Schaffer. Ainsworth, however, has found this criterion alone to be insufficient, indeed misleading (p. 333). The situation is remarkably reminiscent of that of the maternal deprivation hypothesis. The statement is made that attachment behaviour in infancy becomes an important feature of adult emotional behaviour, while its exact characteristics are still unknown. Findings which fail to confirm the attachment hypothesis can be rejected because they used inappropriate criteria: Owing to the restricted criterion of attachment used by Schaffer and Emerson it is not easy to be sure how some of their other data should be interpreted (p. 306).
Again there is an absence of studies controlling relevant variables which support the hypothesis: There has been much speculation about the possible long-term effects of interference with the establishment of early social attachments . . . Retrospective and long-term studies on which such speculation are based have come up with equivocal evidence (Danziger, 1971, p. 111). As advanced, Bowlby’s attachment hypothesis is so vaguely stated that it will explain anything and predict nothing. Hence it will not be possible either to confirm or reject it. The acceptance on inadequate evidence of the maternal deprivation hypothesis leads to the acceptance on inadequate evidence of Bowlby’s hypothesis concerning attachment. Scientific method requires that the appropriate hypothesis to test is the null hypothesis-the only type of hypothesis which can be statistically rejected. This hypothesis would propose that maternal deprivation of an assessable type operating for a defined period at a defined time in the child’s life has no long-term consequences for the child’s mental health. If evidence is produced that such deprivation in the absence of other significant variables does effect the child’s later mental health the null hypothesis is rejected and maternal deprivation can be accepted as a pathogen. Until such evidence is available the appropriate scientific procedure demands that the null hypothesis not be rejected. Can the expectation be advanced that child development theory in psychology and psychiatry accept the conventional rules of scientific methodology? References AINSWORTH, M. D. (1962)The eflects of maternal deprivation:a review orfindings and controversyin the contextof researchstrategy. In Deprivation of Maternal Care. Public Health Papers. 14, World Health Organization, Geneva. AINSWORTH. M . D. (1965) Further research into the adverse effects of maternal deprivation. In Child Care and rhe Growth o f b v e . (2nd ed.) by J. Bowlhy, 9.v. BOWLBY, 1. (1951) Maternal Care and Mental Health, World Health Organization, Geneva. BOWLBY, 1. (1953) Child Care and the Growth of Love. Pelican Books. Harmondsworth. BOWLBY. J. (1965) Child Care and the Growth of Love. (2nd ed.)Pelican Books, Harmondsworth. BOWLBY, J . (1969) Attachment. The Hogarth Press, London. BOWLBY. J., AINSWORTH. M., BOSTON, M. and ROSENBLUTH, D.(1956) The effectsof motherchild separation:a follow-up study. Brirish Journal of Medical Psychology, 29.21 1-247. CASLER, L. (1961) Maternal deprivation: a critical review of the literature. Monographs of the Societyfor Research in Child Developmenr. 26, No. 2. CLARKE, A. D. B. (1968) Learning and human development. British Journal of Psychiatry, 114, 106-1077. COX, E. (1978) Child care-who cares? Current Anairs Bulletin, 20-28. CROWE, 8. R. (1975) Adoption studies in psychiatry. Biological Psychiatry. 10, 353-371. DANZIGER, K. (1971) Socialization. Penguin Books, Harmondsworth. GELLIS, S. S. (1972) Infant day care and attachment. (Ed. comment). Yearbook of Paediatrics. Year Book Medical Publishers, Chicago. HARLOW, H. F. and HARLOW, M. K. (l%Z) Social deprivation in monkeys. Scientific American, 207, 136-147.
NEILMCCONAGHY LEBOVICI. S. (1962) The concept of maternal deprivation: a review of research. In Deprivation of Maternal Care, Public Health Papers, 14, World Health Organization. Geneva. MEAD, M. (1954) Some theoretical considerations on the problem of mother-child separation. American Journal of Orthopsychiatry. 24, 471483. MEERS. D. R. (1972) Psychiatric ombudsmen fordaycare?Presented t0U.S. Senate’s Sub-committee on Children and Youth Concerning Day Care Legislation. Reprint requests to Dr. Meers, Children’s Hospital National Medical Centre. 2125 13th Street. N.W.. Washington, D.C. 20009. MEIER,G. W. (1965)Other dataontheeffectsofsocial isolationduringrearingupon adult reproductive behaviour in the rhesus monkey, (Macaca-Mulatla). Animal Behaviour. 13, 228-231. MOORE, R. S. and MOORE, D. R. (1972) Early schooling for all. Congressional Record, Oct. 16, E8726740. PRUGH. D. G. and HARLOW, R. G. (1962) Masked deprivation in infants and young children. In Deprivation of Marernal Care. Public Health Papers, 14, World Health Organization, Geneva. RUTTER. M. (1972) Maternal Deprivation Reassessed. Penguin Books, Harmondsworth. SCHAFFER, H. R. (1971) The Growth of Sociability. Penguin Books, Harmondsworth. SCHULSINGER, F. (1972) Psychopathy: heredity and environment. Inrernalional Journal of Mental Health, 1, 190-206.
NEILMCCONAGHY, M.D.. F.R.A.N.Z.C.P. Associate Professor, School of Psychiatry, University of N.S.W., Prince of Wales Hospital, Randwick, N.S.W. 2031.
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SCOTT, J. P. (1962) Critical periods in behavioural development. Science. 138, 949-958. SEAY. B. and HARLOW, H. F. (1965) Maternal separation in the rhesus monkey. Journal of Nervous and Mental Disease, 140,4344Il. SIEGEL. A. E. and HAAS, M. B. (1963) The working mother: a review of research. Child Developmenf.34, 513-542. SUOMI, S. I., HARLOW, H. F. and McKINNEY, W. T. (1972) Monkey psychiatrists. American Journal of Psychiatry, 128,927-932. SUOMI.S. 1.. DELIZIO, R. and HARLOW, H. F. (1976) Social rehabilitation of separation-induced depressive disorders in monkeys. American Journal of P.sychiafry. 113, 1279-1285. TAYLOR, W. R. (1971) Developmental theory: unsolved problem for child psychiatry. American Journal of Orthopsychiatry, 41. 557-565. WOOTTON, B. (1962) A social scientist’s approach to maternal deprivation. In Deprivation of Maternal Care. Public Health Papers, 14, World Health Organization. Geneva. WORTIS. R. P. (1971) The acceptance of the concept of the maternal role by behavioural scientists: irs’ e k t s on women. American Journal of Orthopsychiarry, 41. 733-746. YARROW, L. I. (1961) Maternal Deprivation: toward an empirical and conceptual re-evaluation. Psychological Bulletin, 58,459490. YOUNG, L. D.. SUOMI,S. S., HARLOW, H. F. and McKINNEY, W. T. (1973) Early stress and later response to separation in rhesus monkeys. American JourM/of Psychiatry. 130,4O0-405.
MATERNAL DEPRIVATION: CAN ITS GHOST BE LAID? NEILMCCONAGHY
The hypothesis that separation from an established mother figure in early childhood has a detrimental effect on a child’s later mental health has been widely promulgated and commonly accepted both in academic and lay circles throughout the Western world. The hypothesis continues to have a significant effect on mothers’ decisions as to whether they should resume work or not, and on governmental policy concerning the provision of child-care facilities for the children of those mothers who do. The evidence for the hypothesis is reviewed and it is concluded that it does not satisfy the requirements of scientific methodology. The theory that a child’s attachment to its mother figure is the emotional basis for its future love relationships, group affiliations and loyalty to the state, is now being accorded similar acceptance without further evidence than that supporting the original hypothesis.
In 1953 a report by Bowlby entitled Maternal Care and Mental Health published in the Bulletin of the World Health Organization was issued in abridged form by Pelican Books as Child Care and the Growth of Love. Given its authoritative backing and wide circulation the views expressed in this book strongly influenced the thinking of both lay people and specialists throughout the Western world concerning the significance of the ‘maternal role’. This occurred despite the fact that in the following 8 years several trenchant criticisms of Bowlby’s monograph (Mead, 1954; Casler, 1961; Yarrow, 1961) were published. Bowlby (1965) did not answer these criticisms but a colleague, Ainsworth (1962) put forward an ill-reasoned and unscientific rebuttal in a further World Health Organization publication. At this time Harlow (Seay & Harlow, 1965) misinterpreted data from primate studies so that this appeared to support Bowlby’s hypothesis that separation from a mother (or mother-substitute) in early life predisposes an
individual to psychopathology later in life. Perhaps due to the low level of academic competence in this area of psychiatry (Taylor, 1971) the efforts of Bowlby, Ainsworth and Harlow were successful. Subsequent criticism of their work has been muted or reverential (Clark, 1968; Rutter, 1972). Bowlby’s Pelican continues to be published and widely read, not only by lay people, but also as a recommended text by medical and paramedical university students. At a post-graduate level, the author has found almost all psychiatrists in training unaware of the literature attacking the work, and incapable of subjecting it to critical analysis. Bowlby has more recently published Attachment (1969), which extends his hypothesis in a way that, given the latter is accepted as true, has considerable significance for psychiatry and indeed for social policy a t a governmental level. If Bowlby’s original hypothesis is incorrect, attachment behaviour in childhood though of obvious importance to workers in normal child development, has no
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particular significance for psychiatrists, or medical and paramedical workers generally. If Bowlby’s theoretical structure is wrongly accepted as valid it could have grave social consequences. For this reason and to reassert academic standards of methodological rigour, it is important that this area of research and speculation concerning human behaviour be re-examined.
Social Implications
The position statement of the Australian and New Zealand College of Psychiatrists entitled Some Aspects of the Welfare of Children under Three whose Mothers are in Full-time Employment (1971) commences: It is of great importance for mental health that the infant and young child should experience a warm, intimate and continuous relationship with his mother or mother-substitute in which both find satisfaction, stimulation and enjoyment. The quality of mothering the child receives, especially in the first three years of life, affects profoundly his whole future development. This is almost word for word a quotation from Bowlby’s monograph (1951) and expresses its basic thesis. A similar statement is to be found in the Congressional Record, 16 October 1972 (Moore and Moore) arguing against the provision of preschool facilities for children. Bowlby’s monograph thus continues to be used by professionals to influence governmental policy particularly in relation to the provision of facilities for the children of working mothers. Soon after its publication Mead (1954) commented: The growing insistence that child and biological mother, or mother surrogate, must never be separated, that all separation, even for a few days is inevitably damaging, and that if long enough it does irreversible damage. This . . . is a new and subtle form of anti-feminism in which men-under the guise of exalting the importance of maternity-are tying women more tightly to their children than has been thought necessary since the invention of bottle feeding and baby carriages (p. 477). This statement of Mead’s was dismissed as a ‘quip’ by Lebovici (1962, p. 89), a proponent of the maternal deprivation hypothesis, in the World Health Organization monograph Deprivation of Maternal Care: A Reassessment of its Effects. In the same book, Ainsworth (1962) writing with Bowlby’s ‘full agreement’, says concerning working mothers:
The practical problem is not entirely solved by pressing mothers, in order to give adequate care to their infants and pre-school children, to delay resuming their careers . . . some mothers are themselves unable to provide sufficient maternal care (at least for these particular infants), and both infant and mother might well, therefore, thrive better with the mother working and with adequate and continuous supplementary mothering arrangements provided (p. 148). This recommendation that mothers capable of providing sufficient maternal care be pressed to delay resuming their careers, but not those judged incapable who were instead to find a ‘continuous supplementary mother’, must, when ineffective in preventing women from resuming their careers, have resulted frequently in severe anxiety and guilt in those who did so, carrying as it did the prestige of the World Health Organization. That it would come to their attention was virtually guaranteed by Bowlby’s including it in the Pelican Child Care and the Growth of Love since 1965 (pp. 210-21 1). In the same book is still to be found Bowlby’s description of the ideal mother’s behaviour: Such enjoyment and close identification of feeling (essential for the child’s mental health) is possible for either party (mother or child) only if the relationship is continuous . . . mother needs to feel that she belongs to her child, and it is only when she has the satisfaction of this feeling that it is easy for her to devote herself to him. The provision of constant attention day and night, seven days a week and 365 days in the year, is possible only for a woman who derives profound satisfaction from seeing her child grow from babyhood, through the many phases of childhood, to become an independent man or woman, and knows that it is her care which has made this possible (pp. 77-78). Apart from the direct harm to working women of these guilt inducing statements Wortis (1971) has stressed their broader social significance: Because the Bowlby-Spitz hypothesis has had such a profound impact on child-rearing practice, legislators, employers and educators have refused to provide sufficient adequate free child-care for working women. Consequently, working women are usually forced to find their own, individual solutions to the child-care problem (p. 736). Cox (1978), Director, Council of Social Service, N.S.W., reports that Bowlby’s theories continue to be used to limit the provision of services for the children of working mothers.
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Another area where Bowlby’s monograph has had harmful effects has been stressed by his apologists Prugh and Harlow (1962): Misplaced emphasis given to Bowlby’s earlier statements can lead to the facile conclusion that any child at any age is better off in his own home than in a foster-home, hospital, or other institutional setting (p. 14). To accuse professional workers in child placement of reaching this conclusion in a ‘facile’ manner, seems completely unreasonable in the light of the previously quoted and the following extracts from the present edition of Child Care and the Growth of Love: It must never be forgotten that even a bad parent who neglects her child is nonetheless providing much for him. Except in the worst cases, she is giving him food and shelter . . . above all is providing him with that continuity of human care on which his sense of security rests. . . It is against this background that the reason why young children thrive better in bad homes than in good institutions . . . can be understood (p. 78). Many leading workers today regard the removal of a child as a last resort and a confession of failure (p. 167). Further advice that Bowlby gives to case-workers with children in placement concerns: The child of psychopathic parents . . . In handling them the case-worker must first get rid of the notion that, because of ‘bad heredity’ these children are likely to turn out less favourably than those without such a supposed handicap (p. 147). Bowlby reached this conclusion on the basis of studies which he was aware inadequately controlled for hereditary factors, but which he considered could not be improved. Schulsinger (1972) subsequently carried out a study which did control heredity and environmental variables. It showed that children of psychopaths separated from them in infancy were more likely to be later diagnosed as psychopathic than were the separated children of non-psychopaths. The number and length of duration of experiences of separation from biological relatives were not related to the likelihood of the diagnosis. The argument of Prugh and Harlow (1962) continues to be advanced: Bowlby’s writings have often been misinterpreted and wrongly used to support the notion that only twenty-four hours care, day in and day out, by the same person, is good enough. Thus, it has been claimed that proper
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mothering is only possible if the mother does not go out to work (Rutter, 1972, p. 15). The reader must judge if these are misinterpretations of Bowlby’s statement and of that by Ainsworth advanced by Bowlby with his full agreement, that capable mothers be pressed not to resume their careers so they can give continuous care to their pre-school children. What in fact was the evidence for Bowlby’s thesis and what were the earlier criticisms that seem to have been so ineffective?
Evidence of the Effects of Maternal Deprivation
Thefirst type of evidence was from studies observing infants and children separated from their families and placed in institutions. Bowlby (1965) claims that ‘when deprived of maternal care, a child’s development is almost always retardedphysically, intellectually and socially-and that symptoms of physical and mental illness may appear’ (p. 21). Bowlby attributed these changes to the fact that such children were deprived of a mother or individual mother-substitute. This evidence tended to be exaggerated, producing a strong emotional reaction in the reader: These descriptions of the reactions of young children to conditions involving loss of a mother-figure have provided the basis for most of the generalizations about the severe effects of maternal separation. The dramatic character of these changes has overshadowed the significant fact that a substantial portion of the children in each study did not show severe reactions to separation. In Spitz’s study of 123 infants separated from their mothers between 6 and 8 months of age, severe reactions occurred in only 19 cases. Although in Robertson and Bowlby’s (1952) research on 45 children ranging in age from 4 months to 4 years, all but three are reported to have shown some reaction; the intensity and duration of the reactions are not clearly specified. Less than half, 20 cases, are reported as showing ‘acute fretting’, a behaviour pattern which is not welldefined. The reported duration of the reaction varied from 1 to 17 days. There are no data on the number of children who showed prolonged reactions (Yarrow, 1961, p. 474). Possibly due to the emotional response engendered by such reports, little significance was attached to the fact that these studies did not control relevant variables. Bowlby (1951) said of this:
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What each individual piece of work lacks in thoroughness, scientific reliability, or precision is largely made good by the concordance of the whole. Nothing in scientific method carries more weight than this. Divergent voices are few (P. 15). This is to say agreement reached in studies all of which fail to control several variables carries weight in scientific method. As will be pointed out, equally methodologically unacceptable assertions supporting the maternal deprivation hypothesis were subsequently made by Ainsworth and Harlow. The current practice of referring university students to these writings without adequate exposure to criticism of their weaknesses increases the likelihood that an academic readership will be produced incapable of subjecting research literature to adequate critical analysis. The variables inadequately or not controlled in the studies quoted by Bowlby included heredity, amount of physical and social stimulation, separation from other family members than the mother, stresses on the child prior or associated with the reason for separation, and the physical health of the child prior to and following separation. In addition the manner in which ‘the concordance of the whole’ was reached is commented upon by Casler (1 96 1): We have a right to wonder why Bowlby failed to so much as mention the following observation, included in Bakwin’s second paper: In a visit to a ‘large foundling hospital which houses some 250 children, more than half of whom are under one year of age’, Bakwin was ‘unable to find a single baby who showed the clinical features which have come to be associated with emotional deprivation in young infants’ (p. 6). While Bowlby refers more than once to the old study of Durfee and Wolf, he fails to mention what is perhaps the authors’ most important conclusion: that the ill effects of institutionalization are not inevitable but can be averted by alert and intelligent administrators (p. 7). Such frank criticism is in marked contrast to the protective attitude shown by Rutter (1972) in his more recent review. On the issue of investigating how infants react when left by their mothers in a familiar situation, he comments: Systematic studies are needed but pose difficulties in that, at least for longer separations, the children would have to be left with someone and if the setting was to be familiar the person would be likely to be known to the child. As discussed below, the presence of a
familiar person has similar stress-reducing properties to the mother’s presence (pp. 3637). Rutter seems to be saying that the child’s distress is likely to be minimal under these conditions of separation from the mother, and hence it is not appropriate to investigate the issue in this way. This objection appears to be based on the consideration that such an investigation would not support Bowlby’s hypothesis. In no way are these criticisms of Bowlby’s thesis intended to minimise the importance of distress in children separated from their families. However, if such distress is not common and can be minimised by a stimulating atmosphere or by the presence of familiar persons other than the mother (Rutter, 1972) then this is important in its handling. It would seem that pressure should not be put on mothers to remain with their children in hospitals until the intensity of the child’s reaction is assessed. If it is significant it might be more conveniently and as effectively dissipated by the presence of the father, a sibling or a friend as by that of the mother. Rutter (1972) concludes that the stress-reducing properties of the accompanying person are related to the strength of bond formation (the attachment the child shows for the person). Schaffer and Emerson (1964) have demonstrated that by 18 months approximately 4 out of 10 children in Western society are at least as attached to their fathers as their mothers. However, the major significance given maternal deprivation by Bowlby’s hypothesis lies not in its immediate but its postulated long term effects on ‘mental health’. These will be discussed in section 111. The second type of evidence Bowlby quoted was that provided by retrospective studies which showed that older children with various emotional disturbances or with intellectual retardation were more likely to give a history of separation from a mother or fostermother in their infancy or early childhood. Bowlby particularly laid stress on the frequency with which the affectionless or psychopathic character gave such a history. These studies also did not control for the effects of variables mentioned previouslyheredity, other stresses than separation from the mother, and different environmental, social and educational stimulation. If Schulsinger’s study (1972) which does attempt to control these variables is correct in its conclusion that psychopathy is inherited, psychopathic parents will produce ‘broken homes’ and psychopathic children. The fact that psychopathic children come from ‘broken
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homes’ would reflect the operation of this genetic factor, not be evidence that ‘broken homes’ result in psychopathy in children. Again Rutter (1972) is very tentative in his handling of this issue. On the basis of the methodologically unsatisfactory evidence quoted by Bowlby, Rutter regularly accepts through most of his book that mother-child ‘bond disruption’ leads to psychopathy. Only towards the book’s end does he raise the possibility that the association between ‘broken homes’ and psychopathy could result from a genetic cause-the child inheriting the psychopathic personality of the parent which was responsible for the ‘broken home’. Rutter largely rejects the possibility arguing that studies have failed to show a genetic factor in the aetiology of delinquent behaviour, criminality and alcoholism, which conditions he appears to regard as equivalent to psychopathy. As has been pointed out subsequent studies have established that there is a significant genetic contribution to the aetiology of psychopathy and indeed to criminality and alcoholism (Schulsinger, 1972; Crowe, 1975). Possibly the major reason workers wish to retain the belief that disturbances of the mother-child relationship leads to later psychopathic or affectionless behaviour is that this belief provides the only basis for the now widely accepted hypothesis that the nature of the child’s tie to the mother is of significance for his later emotional behaviour -an hypothesis on which Bowlby (1969) has erected a considerable theoretical edifice which innumerable research workers are busily developing. In fact Bowlby et al. (19.56) acknowledged that psychopathy only rarely follows early deprivation: It is clear that some ‘of the former group of workers (Bender, Goldfarb and Spitz), including the present senior author, in their desire to call attention to dangers which can often be avoided have on occasions overstated their case. In particular, statements implying that children who are brought up in institutions or who suffer other forms of serious privation and deprivation in early life commonly develop psychopathic or affectionless characters (e.g. Bowlby, 1944) are seen to be mistaken. The present investigation confirms the findings of Beres and Obers, and Lewis. Outcome is immensely varied, and of those who are damaged only a small minority develop those very serious disabilities of personality which first drew attention to the pathogenic nature of the experiences. Though we may be relieved that this is so, there are no grounds for complacency (p. 240).
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When Bowlby revised his widely read Pelican Child Care and the Growth of Love in 1965, he did not take the opportunity to incorporate this marked modification of his earlier conclusion but stated in the preface: ‘With only small revisions, therefore, the views I expressed in 1951 still stand’ (p. 10). These include: ‘Here, in brief, are many of the typical features (of maternal deprivation): superficial relationships; no real feeling-no capacity to care for people or make true friends . . .’ (p. 37). He does include two chapters by Ainsworth which qualify this but the overwhelming impression left by the book is contained in such statements as: There is a very strong case indeed for believing that prolonged separation of the child from his mother (or mother substitute) during the first five years of life stands foremost among the causes of delinquent character development (P. 41). The third type ofevidence Bowlby used was that of follow-up studies investigating the mental health of children who suffered deprivation in their early years. Bowlby was content to believe that by some matching procedure it was possible to find among children placed in foster-homes controls of similar heredity to children placed in institutions. Wootton (1962) comments concerning this: Such a light-hearted dismissal of the influence of differential inherited factors is astonishingly naive (p. 67). Clarke (1 968) more gently advances evidence supporting Wootton’s comment. Perhaps the most revealing exposition of the scientific methodology by which the maternal deprivation hypothesis was established appears in Chapter 6 of Bowlby’s monograph (1951). It commences: It is now demonstrated that maternal care in infancy and early childhood is essential for mental health . . . henceforward it should be regarded as unnecessary to spend time demonstrating the validity of the general proposition respecting the adverse effects of deprivation (P. 59). On the following page it is stated that: Ideally, to isolate the effects of deprivation, all other factors known to be emotionally disturbing would be absent from the cases. Thus the ideal sample would consist of healthy children of good parentage . . . The reason for separation, moreover, would not be traumatic in itself, while the conditions obtaining during separation would be carefully regulated. In
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practice few of these ideal research conditions hold (p. 60). That is to say the hypothesis has been demonstrated, although the relevant variables were not controlled.
Subsequent History of the Maternal Deprivation Thesis
It is not surprising that Bowlby’s monograph was strongly criticized by the workers referred to already or that Casler (1961) after an extensive review of the literature concluded: It thus appears that none of the clinical or institutional studies ostensibly supporting the so-called ‘Spitz-Ribble’ hypothesis really does so, simply because none is able to demonstrate the probable causes of the adverse effects of institutionalization, other than maternal deprivation, are inoperative (p. 12). What is surprising is that the maternal deprivation hypothesis continued to be widely accepted as established after Bowlby elected to ignore this criticism. Equally surprising was the reception given the article by Ainsworth which ostensibly dealt with this criticism. It was the final article in the World Health Organization publication, ‘Deprivation of Maternal Care. Reassessment of its effects’ (1962). Rutter refers to this article as ‘Ainsworth’s excellent and thoughtful reappraisal of the topic’ (p. 122). It contains a statement which surely demonstrates the grossest limitation of understanding of scientific method to be found in an academic publication: Once the hypothesis had been put forward that prolonged deprivation experiences in early childhood may have lasting adverse effects upon subsequent development, it was out of the question to expose young children experimentally to deprivation in order to test the hypothesis (p. 105). It expresses not only a lack of realization that among the various patterns of child care existing throughout the world, many could be found where each of the variables considered a part of ‘maternal deprivation’ could be controlled in a completely ethical way, but suggests that a hypothesis is put forward in scientific research not to be tested but to be acted upon as correct. It is equivalent to stating that once the hypothesis is put forward that a particular treatment is effective for a condition, it is out of the question experimentally to expose patients with the condition to deprivation of the treatment in order to test the hypothesis. That is to say, it is out of the question to carry out a controlled
trial. What effect has this statement on the students referred to Ainsworth’s article, particularly in the light of Rutter’s comment as indicative of the attitude of their teachers to it? The advantage of this statement of Ainsworth was that she and the other proponents of the maternal deprivation hypothesis could opt out of doing research to confirm their hypothesis and continue to state that it was true expecting, successfully as it has eventuated, that the academic world would accept this scientifically unacceptable procedure, that an unproven hypothesis was true until disproved. The reason that this procedure is scientifically unacceptable is that it is impossible to disprove such an hypothesis. If an hypothesis is demonstrated-say that children of a specific age exposed to a specific type of deprivation demonstrate a specific type of mental ill-health-it is possible to affirm or refute this by replicating the conditions and seeing if the same result occurs. If the hypothesis is not demonstrated, then one must attempt to show that children of a variety of ages, exposed to a variety of deprivations, develop no illeffects of any sort in any area of their behaviour. This task would require an infinity of experiments. Ainsworth in her review took full advantage of this position. She did not refute or even discuss the criticism that the studies on which the maternal deprivation hypothesis was based were inadequately controlled. She treated the hypothesis as established and attacked studies which did not find ill-effects of maternal deprivation on the basis that ill-effects had occurred, but the studies had not detected them: Not all damage is sufficiently gross to be obvious at a crude level of observation (p. 100). Differences in vulnerability are commonly found in etiological research (p. 101) It is very likely that some lasting effects are manifested overtly only under special circumstances-perhaps much later in life (p. 102). A further objection was that the tests of mental function used were inappropriate. For example, Ainsworth rejected one study which did not use verbal tests, arguing that such tests correlate highly with general intelligence (p. 132); she rejected another, because measurements of general intelligence could not be accepted as measures of verbal performance (p. 118). The Null Hypothesis: A Red Herring
The acceptance of this position that the maternal deprivation hypothesis does not have to be proved but rather has to be disproved to the satisfaction of its believers is now widespread. Gellis, editor of the
NEILMCCONAGHY
Year Book of Paediatrics (1972), commenting on a study by Caldwell which advanced evidence that day-care does not lead to differences in strength of attachment as compared with home care, states: Perhaps we are entirely wrong in our attitude, perhaps the infant does not need the closeness and warmth of its mother the entire day . . . However, we believe that the burden of proving that infant day-care is beneficial and not harmful must fall on its advocates (p. 352). As has been pointed out, it is only methodologically possible to do what Gellis requires if the nature of the harm is specified. Yet research attempting this has been rejected for that very reason that it only applies to the types of harm investigated, a classical double bind: (Caldwell’s) direction o f . . . day care centres has led to claims (on the purported benign impact of day care) that are classical violations of statistical inference, viz., that if one’s research method and data don’t disprove a null hypothesis, then one is free to assume that the opposite is correct. German researchers on Thalidomide made the same type of error (Meers, 1972). This is methodologically sound-if research data do not disprove a null hypothesis, one cannot assume that the opposite is correct. However, it is much more inappropriate to assume the opposite is not correct, that is to assume that day care is harmful, in the absence of any evidence that it is. The introduction of the concept of the null hypothesis into the controversy functions as an ideal red herring. Most readers are both impressed, and convinced they will not be able to understand the issue, once such a term is introduced. Hence they are likely to accept uncritically any argument advanced in this context, particularly if it is reinforced with highly emotive though unjustified analogies such as the identification of day care (and its associated maternal deprivation) with Thalidomide. German researchers had not spent 30 years attempting to demonstrate that Thalidomide was harmful before it was discovered that it was. Thirty years of research have not produced evidence that maternal deprivation is associated with any deterioration of behaviour when all other variables which could cause such a deterioration are controlled. When Gellis demands the impossible-that the proponents of day care prove that it is not harmful in non-specified ways; and Meers reinforces this demand by the identification of day care of children with a known horrifying pathogen (Thalidomide), the determination of the proponents of the maternal deprivation hypothesis to cloud the issue with
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emotion and retain this unproven hypothesis as true becomes apparent. Until this situation is recognized as scientifically unacceptable the maternal deprivation hypothesis, true or false, is safe from refutation. Ethology and Attachment
The maternal deprivation hypothesis, having apparently been placed in this unassailable position of being accepted as proven without adequate evidence, could serve as the basis for Bowlby’s elaboration (1969) of his concept of attachment. In this he was strongly influenced by early ethological work on the adult behaviour of some birds to the person who tended them in their first few days of life: ‘they become deeply attached to human beings instead of to other birds, and later fall in love with human beings’ (Bowlby, 1965, p. 17). In this area of ethology Bowlby’s maternal deprivation hypothesis has been strongly supported by Harlow. A recent study by him and colleagues (Young et al., 1973) commences: Separation experiences in early life have long been regarded in psychiatric theory and practice as traumatic events that can predispose individuals to psychopathology later in life. In general the validity of this relationship has not been questioned (p. 400). The study puts forward as a model of maternal separation, the isolation of rhesus monkeys from all living creatures for 22 hours a day from birth until 12 months of age as well as exposure to 30 days of ‘profound environmental isolation’ in a vertical chamber. In an earlier article (Seay and Harlow, 1965) ‘designed to study the effects of infant-mother separation on the social and emotional behaviour of rhesus monkey infants’ (p. 434), the monkeys were separated from peers as well as their mothers. If these investigators were investigating the effects of infant-mother separations, why separate the infants from their peers? If they wished to increase the stress of the situation why claim they were studying the effects of infant-mother separation? In fact if the behaviour of such monkeys is relevant to that of human infants, Harlow and Harlow (1962) had already provided evidence weakening the maternal deprivation hypothesis. They demonstrated that monkeys brought up with peers only, showed none of the defects of behaviour reported in those brought up in isolation. The changes in this latter group of monkeys have been used as evidence for the existence of a critical period in infancy when maternal deprivation brings about irreversible effects (Scott, 1962). Failure to replicate these
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changes has been reported (Meier, 1965) and in any case Harlow and his colleagues have advanced evidence that they are reversible (Suomi et al., 1972, 1976). Bowlby (1969) required an acceptance that some emotional patterns of behaviour are irreversibly established in chldhood when he advanced that attachment behaviour in adult life is ‘a straightforward continuation of attachment behaviour in childhood’ (p. 207) at which period it was directed initially to the mothering person (p. 182). Attachment behaviour in adult life is directed to age-mates, and to groups; and ‘for many a citizen attachment to his state is a derivative of and initially dependent on his attachment to its sovereign or president’ (p. 207). What is assumed in this obscure hypothesis is that there is some immutable entity termed attachment behaviour which is shown by infants initially to their mothers and which then remains a basic element in their subsequent emotional relationships throughout life: When an older child or adult maintains an attachment to another person he does so by diversifying his behaviour so that it includes . . . the basic elements of attachment behaviour present at the first birthday . . . (p. 350). However, the criteria by which attachment behaviour can be recognized are not yet established: We may need to distinguish more carefully than has hitherto been done between attachment-figures and playmates . . . Unfortunately, the two pioneering studies on which we are drawing for our data do not make these distinctions (p. 307). One of the most obvious criteria in terms of which to describe a child’s attachment behaviour is whether or not he protests when his mother leaves him for a brief time and how strongly he does so. This has been the criterion of strength of attachment used by Schaffer. Ainsworth, however, has found this criterion alone to be insufficient, indeed misleading (p. 333). The situation is remarkably reminiscent of that of the maternal deprivation hypothesis. The statement is made that attachment behaviour in infancy becomes an important feature of adult emotional behaviour, while its exact characteristics are still unknown. Findings which fail to confirm the attachment hypothesis can be rejected because they used inappropriate criteria: Owing to the restricted criterion of attachment used by Schaffer and Emerson it is not easy to be sure how some of their other data should be interpreted (p. 306).
Again there is an absence of studies controlling relevant variables which support the hypothesis: There has been much speculation about the possible long-term effects of interference with the establishment of early social attachments . . . Retrospective and long-term studies on which such speculation are based have come up with equivocal evidence (Danziger, 1971, p. 111). As advanced, Bowlby’s attachment hypothesis is so vaguely stated that it will explain anything and predict nothing. Hence it will not be possible either to confirm or reject it. The acceptance on inadequate evidence of the maternal deprivation hypothesis leads to the acceptance on inadequate evidence of Bowlby’s hypothesis concerning attachment. Scientific method requires that the appropriate hypothesis to test is the null hypothesis-the only type of hypothesis which can be statistically rejected. This hypothesis would propose that maternal deprivation of an assessable type operating for a defined period at a defined time in the child’s life has no long-term consequences for the child’s mental health. If evidence is produced that such deprivation in the absence of other significant variables does effect the child’s later mental health the null hypothesis is rejected and maternal deprivation can be accepted as a pathogen. Until such evidence is available the appropriate scientific procedure demands that the null hypothesis not be rejected. Can the expectation be advanced that child development theory in psychology and psychiatry accept the conventional rules of scientific methodology? References AINSWORTH, M. D. (1962)The eflects of maternal deprivation:a review orfindings and controversyin the contextof researchstrategy. In Deprivation of Maternal Care. Public Health Papers. 14, World Health Organization, Geneva. AINSWORTH. M . D. (1965) Further research into the adverse effects of maternal deprivation. In Child Care and rhe Growth o f b v e . (2nd ed.) by J. Bowlhy, 9.v. BOWLBY, 1. (1951) Maternal Care and Mental Health, World Health Organization, Geneva. BOWLBY, 1. (1953) Child Care and the Growth of Love. Pelican Books. Harmondsworth. BOWLBY. J. (1965) Child Care and the Growth of Love. (2nd ed.)Pelican Books, Harmondsworth. BOWLBY, J . (1969) Attachment. The Hogarth Press, London. BOWLBY. J., AINSWORTH. M., BOSTON, M. and ROSENBLUTH, D.(1956) The effectsof motherchild separation:a follow-up study. Brirish Journal of Medical Psychology, 29.21 1-247. CASLER, L. (1961) Maternal deprivation: a critical review of the literature. Monographs of the Societyfor Research in Child Developmenr. 26, No. 2. CLARKE, A. D. B. (1968) Learning and human development. British Journal of Psychiatry, 114, 106-1077. COX, E. (1978) Child care-who cares? Current Anairs Bulletin, 20-28. CROWE, 8. R. (1975) Adoption studies in psychiatry. Biological Psychiatry. 10, 353-371. DANZIGER, K. (1971) Socialization. Penguin Books, Harmondsworth. GELLIS, S. S. (1972) Infant day care and attachment. (Ed. comment). Yearbook of Paediatrics. Year Book Medical Publishers, Chicago. HARLOW, H. F. and HARLOW, M. K. (l%Z) Social deprivation in monkeys. Scientific American, 207, 136-147.
NEILMCCONAGHY LEBOVICI. S. (1962) The concept of maternal deprivation: a review of research. In Deprivation of Maternal Care, Public Health Papers, 14, World Health Organization. Geneva. MEAD, M. (1954) Some theoretical considerations on the problem of mother-child separation. American Journal of Orthopsychiatry. 24, 471483. MEERS. D. R. (1972) Psychiatric ombudsmen fordaycare?Presented t0U.S. Senate’s Sub-committee on Children and Youth Concerning Day Care Legislation. Reprint requests to Dr. Meers, Children’s Hospital National Medical Centre. 2125 13th Street. N.W.. Washington, D.C. 20009. MEIER,G. W. (1965)Other dataontheeffectsofsocial isolationduringrearingupon adult reproductive behaviour in the rhesus monkey, (Macaca-Mulatla). Animal Behaviour. 13, 228-231. MOORE, R. S. and MOORE, D. R. (1972) Early schooling for all. Congressional Record, Oct. 16, E8726740. PRUGH. D. G. and HARLOW, R. G. (1962) Masked deprivation in infants and young children. In Deprivation of Marernal Care. Public Health Papers, 14, World Health Organization, Geneva. RUTTER. M. (1972) Maternal Deprivation Reassessed. Penguin Books, Harmondsworth. SCHAFFER, H. R. (1971) The Growth of Sociability. Penguin Books, Harmondsworth. SCHULSINGER, F. (1972) Psychopathy: heredity and environment. Inrernalional Journal of Mental Health, 1, 190-206.
NEILMCCONAGHY, M.D.. F.R.A.N.Z.C.P. Associate Professor, School of Psychiatry, University of N.S.W., Prince of Wales Hospital, Randwick, N.S.W. 2031.
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SCOTT, J. P. (1962) Critical periods in behavioural development. Science. 138, 949-958. SEAY. B. and HARLOW, H. F. (1965) Maternal separation in the rhesus monkey. Journal of Nervous and Mental Disease, 140,4344Il. SIEGEL. A. E. and HAAS, M. B. (1963) The working mother: a review of research. Child Developmenf.34, 513-542. SUOMI, S. I., HARLOW, H. F. and McKINNEY, W. T. (1972) Monkey psychiatrists. American Journal of Psychiatry, 128,927-932. SUOMI.S. 1.. DELIZIO, R. and HARLOW, H. F. (1976) Social rehabilitation of separation-induced depressive disorders in monkeys. American Journal of P.sychiafry. 113, 1279-1285. TAYLOR, W. R. (1971) Developmental theory: unsolved problem for child psychiatry. American Journal of Orthopsychiatry, 41. 557-565. WOOTTON, B. (1962) A social scientist’s approach to maternal deprivation. In Deprivation of Maternal Care. Public Health Papers, 14, World Health Organization. Geneva. WORTIS. R. P. (1971) The acceptance of the concept of the maternal role by behavioural scientists: irs’ e k t s on women. American Journal of Orthopsychiarry, 41. 733-746. YARROW, L. I. (1961) Maternal Deprivation: toward an empirical and conceptual re-evaluation. Psychological Bulletin, 58,459490. YOUNG, L. D.. SUOMI,S. S., HARLOW, H. F. and McKINNEY, W. T. (1973) Early stress and later response to separation in rhesus monkeys. American JourM/of Psychiatry. 130,4O0-405.
