Friday, 29 August 2014

B is for Bowlby and “boat people” – attachment theory

Child care and the growth of love. Based by permission of the World Health Organization on the report Maternal Care and Mental Health by John Bowlby. Abridged and ed. by Margery Fry. With two new chapters by Mary D. Salter Ainsworth. [Pelican books] [Harmondsworth, England] Penguin Books [1965] Second edition, 1965

John Bowlby was a British psychologist, psychoanalyst and researcher. He was a pioneer who researched and wrote about infant and child development and the importance of bonding with a mother or mother-substitute in a warm and continuous relationship. Bowlby found growing evidence that good mental health was linked with the kind of care an infant and young child received.  Bowlby also wrote about the effects of “maternal deprivation”, permanent harm and harm that is overcome. His well-known works on infant attachment and loss are referred to today in health, psychology and early childhood education.

The World Health Organisation asked Bowlby to research maternal deprivation and the effects on infants. This was in the 1950s when the United Nations were deciding which social problems and programs were in most need of support. The report came about as people looked at care of children after WW2, including children in institutional care, many of whom were orphaned, disabled or hospitalized. Bowlby drew his work from visiting and reviewing studies in Europe and the United States. The report was reproduced and made available for a wider audience in the book ‘Child care and the growth of love’.

Bowlby looked at vulnerable mothers, children and their healthcare needs. Today’s vulnerable mothers and children include asylum seeker refugees.  The Association for the Wellbeing of Children in Healthcare has written a position statement with this focus. The policy draws on the work of the Royal Australian and New Zealand College of Psychiatrists, and the National Inquiry into Children in Immigration Detention 2004 report.

Bowlby begins, there was a common theme amongst research and evidence “mother-love deprivation” harms mental health of an infant or young child. He also described far-reaching consequences for the individual. Infants and young children at key times in socialisation need to have mother or primary carer bonding (infants 6 months to 18 months). The absence of infant attachment leads to slowed development, physically, intellectually and socially.

Bowlby describes infants and young children placed in institutional care, long-term hospitalization and foster care, some with mentally ill mothers. The research identified some of the effects of institutional care. There were children who had never experienced an emotional bond. Infants who were kept in cots, isolated, lonely, without play opportunities, who were part of a Western system with an emphasis on hygiene and lacking social and emotional care. Infants were observed rocking, listless, quiet, failing to smile at a human face or respond to a ‘coo’.

Educators of health professionals today show their students the 1952 film ‘A Two year old goes to hospital’. This is a powerful way to explore the parent-child bond, showing the detrimental effects of what happened when a child was unaccompanied in hospital. The girl is too young to understand why her mother has left her and in 1952, visiting hours were very restricted. She becomes withdrawn from her mother as a way of concealing her distress.

James Robertson produced this film and Bowlby collaborated on this work on attachment. Robertson later wrote ‘Separation and the very young’, and produced ‘Young children and brief separation’ (DVD). To read a summary of Robertson resources visit the Life Spirals blog.

With recent news and radio coverage on asylum seeker refugees and in particular, Professor Gillian Triggs’ visit to Christmas island, the plight of infants, children and mothers is concerning. It is shocking to hear about their great mental and physical stress, mothers who hold their infants with no room or clean and safe place to put them to play and develop.

Professor Elizabeth Elliott, accompanying leading paediatrician, found children who were refusing to eat, bed wetting, had impediments to their speech and poor sleep. Professor Triggs spoke of the boredom and desperation of children. There are children who will not engage in eye contact*. It is not hard to see overlapping similarities between the behaviour of institutionalized children in the 1950s and asylum seeker refugee children in these restrictive circumstances today.

Children are no longer held in detention on Manus Island
Photo from:
Bowlby observed, gathered evidence and reviewed institutional care in an area with emerging focus. He pointed towards parent and child bonds, ways of improving emotional care and the value of further research to encourage and support families. Bowlby has not been above criticism, some researchers thought he was fundamentally on the wrong track. Others point out both strengths and weaknesses. For example, now it is recognised a child may have a personal relationship with a parent or carer and not necessarily just “mother” as Bowlby emphasised. Despite this, it is not hard to see how messages of parental involvement and emotional care of all infants and children are both valuable and relevant today.

When we read about the gravity of mothers who are on suicide watch at Christmas Island, Bowlby’s writings on the role of a mother providing support bring to mind questions on the harm being done to families. This harm is carried with the children into the future affecting their physical and mental health and wellbeing.

For further information about children in detention visit the Chilout blog  A Last Resort - ten years on from National Inquiry into children in detention and the Refugee Council of Australia. More on attachment and refugee children can be found on the Startts blogspot. The article on healing and refugee children and adolescents within a school context will be informative reading for teachers and counsellors.

Jillian Rattray
AWCH librarian
September 2014

* A report giving voice to refugee children released in 2015: The Forgotten children: National Inquiry into Children in Immigration Detention 2014, Australian Human Rights Commission. Contents include a snapshot of children in detention, Australian law and the detention of children, Government and duty of care and International law. Also reports on impacts of life in detention and identifies the needs of mothers and babies, young children, primary school children and teenagers, also unaccompanied children and children indefinitely detained.

Friday, 8 August 2014

A is for anxious parents & children

Parents' emotional response to child's hospitalization
Helen Gofman, Wilma Buckman, George H. Schade

What was it like for children in hospital in the late 1950’s? This article is from the Pediatric Mental Health Unit, University of California Medical Center. In 1957, understanding of children's emotional response to hospitalization as well as parents was little understood.

This interesting article looks at parents’ perceptions and what it was like for families with hospitalized children. Parents were interviewed and questions asked included what information was provided by doctors as well as admission procedures. Interestingly, as the study progressed researchers became aware of the impact of separating children from their parents without preparation of any kind and modified their admission procedure. There were one hundred parents who were interviewed at the time of their child's admission and 68 parents were interviewed again at discharge from hospital.

This is a very touching article, with parent vignettes. Readers can see how difficult it was for both child and parent to be separated, vulnerable and fearful. The article describes the traumatic admission procedure where children were placed in bed in an isolation unit and parents were escorted to a nearby waiting room where they could hear their child crying calling for them but could not see or be with them. The modified procedure led to a more gradual separation. The changed procedure involved a nurse being assigned to the care of the child and parents, accompanying them to a room where the child was no longer isolated. The child shared a room with others of a similar age and the nurse acquainted the child with roommates before assisting parents to put the child in bed. Parents were encouraged to stay until the physician was available.
The article describes visiting hours and the success of a "further extension of visiting hours", some of the nursing staff were sceptical about the extension.

In the summary section of the article major points made were children and parents needed adequate preparation for hospitalization;

  •  An admission procedure which allowed for a more gradual separation of parent and child;
  • During hospitalization health personnel needed to focus on both the child's emotional and physical needs;
  • Continuing preparation of child and parent throughout hospital procedures and treatment;
At discharge, health professionals provide understanding of findings and implications both orally and in writing for further care of the child at home.

This article has been cited approximately 35 times, Google scholar.

Link to first page of article to read more:

View the record in the AWCH catalogue or contact the AWCH Librarian for more information:

Jillian Rattray
AWCH librarian
August 2014