No More Learning

Tony, in contrast, describes a happy childhood. The reality perhaps was that they had two childhoods - one in the country and one in the town. Lady Bowlby boasted that she never worried about her children and, especially in London, left them mostly to their own devices. She would visit the nursery to receive a report from Nanny after breakfast every day, and the children, clean and brushed, would come down to the drawing room from 5 to 6 p. m. after tea, where she would read to them, especially from her beloved Children of the New Forest. May Mostyn had vowed that she would never marry a 'city man', and Sir Anthony loved fishing and shooting. Every spring and summer there was a ritual of family holidays. At Easter the children were dispatched to Margate with the nurses while Sir Anthony and Lady Bowlby went to Scotland for fishing. In July May would take the children to the New Forest, in those days a wild and idyllic place. For the whole of August and half of September the entire family decamped to Ayrshire in Scotland, travelling by train in a specially hired railway carriage. (Sir Anthony and Lady Bowlby never owned a car: he used a
Biographical 17
brougham for his rounds in London and after his death she would travel around Gloucestershire in pony and trap well into the 1950s. )
On holiday John's mother seemed to come alive and, as 'Grampy' had done with her, ensured that her children were well versed in nature and country sports. From her and 'Grampy' they learned to identify flowers, birds and butterflies, to fish, ride and shoot, and John and Tony became and remained passionate naturalists. Sir Anthony seemed to be a fairly remote and intimidating figure, especially in London, but he gave the children special animal nicknames: John was known as 'Jack' the jackal (other nursery nicknames for John were 'Bogey' and the prophetic 'Admiral Sir Nosey Know-all'); Tony was 'Gorilla'; Evelyn 'Cat'. They saw little of him during the week but would walk with him in family procession across Hyde Park most Sundays to church, when he would instruct and occasionally amuse them with his deep factual knowledge about the world and its ways.
The war came in 1914 when John was seven. John and his elder brother were immediately dispatched to boarding school, because of the supposed danger of air raids on London. John later maintained that this was just an excuse, being merely the traditional first step in the time-honoured barbarism required to produce English gentlemen. The English preparatory school system took its toll: John was beaten for defining a 'cape' in a geography lesson as a cloak rather than a promontory, but, a resilient and self-assured little boy, he flourished. Sir Anthony was away in France as a surgeon-general for most of the war. When the war came to an end, John went as naval cadet to Dartmouth where he learned to sail, and gained a discipline and organisation which lasted a lifetime. Tony was destined to follow in his father's footsteps and become a surgeon, but he decided against this in his teens, feeling that it would mean 'failure' since he could never equal his father's eminence. This left the way clear for John to go into medicine, who, despite having passed out top in his Dartmouth exams, was already dissatisfied with the narrow intellectual horizons and rigidity of the Navy (as he was to become two decades later with the British Psycho-Analytical Society), as well as suffering badly from seasickness! Somewhat to John's surprise, Sir Anthony agreed to buy him out. Although not driven by a strong
18 Origins
vocational pull, John felt that a medical career would be least unacceptable to his father and, together with a close Dartmouth friend, applied to Cambridge and duly entered Trinity college as a medical student in 1925. His intellectual distinction was already in evidence at university where he won several prizes and gained a first class degree in pre-clinical sciences and psychology.
Already mature and independent-minded, with an 'inner calm' (Phelps Brown 1992) that was to stand him good stead throughout his life, John's next move proved decisive. Rather than going straight on to London to study clinical medicine, which would have been the conventional thing to do, he got a job instead in a progressive school for maladjusted children, an offshoot of A. S. Neill's Summerhill. His father, who would undoubtedly have opposed such a move, had, in John's words 'fortunately' already died when John was twenty-one, so he was free to chart his own course. At the school he had two sets of experiences which were to influence the whole course of his professional life. The first was the encounter with disturbed children, with whom he found he could communicate, and whose difficulties seemed to be related to their unhappy and disrupted childhood. Like one of Lorenz's (1952) greylag geese, who were to play such an important part in the development of Attachment Theory, one boy followed Bowlby round wherever he went:
There I had known an adolescent boy who had been thrown out of a public school for repeated stealing. Although socially conforming he made no friends and seemed emotionally isolated - from adults and peers alike. Those in charge attributed his condition to his never having been cared for during his early years by any one motherly person, a result of his illegitimate birth. Thus I was alerted to a possible connection between prolonged deprivation and the development of a personality apparently incapable of making affectional bonds and, because immune to praise and blame, prone to repeated delinquencies.
(Bowlby 1981a)
The second seminal encounter at the school was with another man working there, John Alford, who had had some personal therapy, and who advised John to go to London to train as a psychoanalyst.
Biographical 19
Psychoanalytical training
In the autumn of 1929, aged twenty-two, John came to London, to start his medical studies. He found these so tedious and wearisome that he started and managed 'Bogey's Bar', a sandwich bar patronised by his friends. While at University College Hospital (which was, and has remained, a home for would-be psychoanalysts wanting to acquire a medical degree) he entered the Institute of Psycho-Analysis, going into analysis with Mrs Riviere, a close friend and associate of Melanie Klein. His intention was to become a child psychiatrist, a profession which was then just emerging. After medical qualification in 1933, he went to the Maudsley to train in adult psychiatry, and then was appointed in 1936 to the London Child Guidance Clinic, where he worked until he became an Army psychiatrist in 1940.
The 1930s were a time of intellectual ferment. Progressive thought centred on Freud and Marx. Bettelheim vividly captures the atmosphere of debate:
In order to create the good society, was it of first importance to change society radically enough for all persons to achieve full self- realisation? In this case psychoanalysis could be discarded, with the possible exception of a few deranged persons. Or was this the wrong approach, and could persons who had achieved full personal liberation and integration by being psychoanalysed create such a good society? In the latter case the correct thing was to forget for the time being any social or economic revolution and to concentrate instead on pushing psychoanalysis; the hope was that once the majority of men had profited from its inner liberation they would almost automatically create the good society for themselves and all others.
(Bettelheim 1960)
Although by nature irreverent and at times iconoclastic, Bowlby tempered his rebelliousness with a belief in science and the need for evidence to back up ideas. He shared a house with his friend the Labour politician and academic Evan Durbin, who challenged his newly acquired psychoanalytic ideas - as did Aubrey Lewis at the Maudsley. While he believed in the practical efficacy of psychoanalysis, he was always sceptical about its theoretical basis. He came into conflict with his first psychoanalytical supervisor, 'a rather prim old maid . . . we never seemed to be on the same
20 Origins
wavelength' (Bowlby 1991), but got on very well with his next, Ella Sharpe, who supported Anna Freud against Klein in the 'Controversial Discussions', 'a warm hearted middle-aged woman who had a good understanding of human nature and a sense of humour' (Bowlby 1991). He qualified as an analyst in 1937, and immediately started training in child analysis with Mrs Klein as his supervisor. Here too there was conflict, especially when Bowlby felt that she paid insufficient attention to the part played by the environment in causing his patient's disturbance - in this case a hyperactive little boy of three whose mother was having a breakdown and had been admitted to mental hospital.
Meanwhile, Bowlby was beginning to develop his own ideas, based mainly on his experience at the Child Guidance Clinic. There he worked with two analytically orientated social workers who introduced him to the idea of the transgenerational transmission of neurosis in which unresolved problems from a parent's own childhood can play a large part in causing and perpetuating the problems of their children.
I was particularly struck by two cases, one of sibling rivalry in which the mother had herself been intensely jealous of her sister, and the other in which a father was deeply troubled by his seven-year-old son's masturbation and had dipped him under a cold tap whenever he found him touching his genitals, and who, it transpired, had himself fought an unsuccessful battle against masturbation all his life.
(Bowlby 1977)
With his stress on the role of the environment in causing psychological difficulty, Bowlby was aligned with a group of British psychiatrists who, while influenced by Freud and sympathetic to the analytic cause, also maintained some distance from it. These included David Eder, a left-wing intellectual associated with the Bloomsbury Group; Bernard Hart, psychiatrist at University College Hospital, whose influential Psychology of Insanity Bowlby would certainly have read; W. H. Rivers, famous as an anthropologist as well as psychiatrist, who had applied Freud's ideas to victims of shell-shock in the First World War and who felt that the self-preservative instinct was as important as Freud's sexuality; and, above all, Ian Suttie, whose Origins of Love and Hate proposed a primary bond between mother and child, unrelated to infantile sexuality (Heard 1986; Pines 1991;
Biographical 21
Newcombe and Lerner 1982), an idea which, as we shall see in Chapter 4, Bowlby was to develop and put at the heart of Attachment Theory.
In order to qualify as a full member with voting rights in the analytic society Bowlby had to read a paper. Many of his later ideas are to be found in embryonic form in 'The influence of the environment in the development of neuroses and neurotic character', which was published in the International Journal of Psycho-Analysis in 1940. It consists of a description of cases treated in the Child Guidance Clinic. He emphasises the scientific value of such one-weekly 'clinic cases' to complement more intensive analytic work. He boldly puts forward a 'general theory of the genesis of neurosis', in which environmental factors in the early years of a child's life are causative, especially separation from the mother through death or 'broken home'. He explicitly challenges the Kleinian view - actually something of a caricature, a product of the polarisation within the Society at that time, since Kleinians have never entirely denied the importance of the environment - that childhood phantasy is unrelated to actual experience: 'Much has been written about the introjection of phantastically severe parents, an imaginary severity being itself the product of projection. Less perhaps has been written recently about the introjection of the parents' real characters' (Bowlby 1940a). He cautions against unnecessary separation of children from parents - 'if a child must be in hospital the mother should be encouraged to visit daily' - and insists that
If it became a tradition that small children were never subjected to complete or prolonged separation from their parents in the same way that regular sleep and orange juice have become nursery traditions, I believe that many cases of neurotic character development would be avoided.
(Bowlby 1940a)
He advocates working with the mothers of disturbed children so as to elucidate their own childhood difficulties which are interfering with their role as parents, and thereby helping them to feel less guilty. A second paper, 'Forty-four juvenile thieves, their characters and home life' (which led to Bowlby's wartime nickname of Ali Bowlby and his Forty Thieves), was also based on his work in the Child Guidance Clinic and continues the same ideas in a more systematic way. His capacity for coining a telling phrase emerges in his notion of the 'affectionless psychopath' - a
22 Origins
juvenile thief for whom the lack of good and continuous childhood care has created in him (it almost always is a him) an absence of concern for others.
In this early work Bowlby shows a strong reforming drive: he saw psychotherapy as preventative medicine which would help to change not just individuals but also society. But he would not have accepted Bettelheim's view that one had to choose between Marx or Freud, nor was he prepared to swallow either whole. His attitude towards extremism, whether Kleinian or communist, might be compared with A. S. Neill's account of a wedding he had attended:
Filled with followers of Melanie Klein . . . they can't laugh; Melanie has evidently shown them humour is a complex which no normal man should have. To my asking what Klein was doing to prevent complexes there was a silence. I said: you can't analyse humanity but you can attempt to get a humanity that won't need analysis. No answer. Gott, they were a dull crowd. . . . Rather like talking to communists with a blank curtain that you could not penetrate.
(Grosskurth 1986)
Several of John's friends of both sexes were acquired through his more sociable older brother. Tony shared a 'staircase' at Oxford with Evan Durbin, later to become a minister in the post-war Attlee labour administration. Similar in physique, intelligence and temperament, he and John soon struck up a close friendship, based on shared intellectual interests and a love of walking (it was hard to keep up with them as they strode rapidly through the Cotswolds, deep in conversation). They collaborated in their book Personal Aggressiveness and War (Durbin and Bowlby 1938). In Bowlby's contribution we see again later talents and themes prefigured. He introduces psychoanalytic ideas in a common-sense (if slightly old-fashioned) way: in exemplifying the concept of unconscious aggression he ways, 'It is impossible to criticise some maids without paying for it in breakages. Plates "come apart in my hands" far more frequently after the maid has been reprimanded than when she has been praised' (Durbin and Bowlby 1938). He surveys the literature on aggression in apes and other higher mammals drawing parallels with human behaviour, just as he was to do in the 1950s when he applied ethological ideas to
Biographical 23
mother-infant behaviour. He also subjects Marxist ideas about war to the same critical scrutiny with which he had approached psychoanalysis as an ideology, pointing out the dangers of any global theory of human behaviour.
Bowlby's friendship with Durbin continued until the latter's untimely death by drowning while on holiday in Cornwall in the late 1940s. Bowlby, who was on holiday nearby, was called in to help and in his typically practical way immediately organised with Durbin's close parliamentary colleagues a trust fund which supported the Durbin children through their education. Durbin's death was the most overwhelming loss of John's life, and certainly influenced his interest in the themes of grief and loss which were to figure so centrally in his work.
The war years
Bowlby volunteered in 1940 at the age of thirty-three, but was not called up and joined instead a group of Army psychiatrists whose main job was, by using statistical and psychotherapeutic methods, to put officer selection on a scientific footing - to put, as it was said, the 'chi' into psychiatry. His organisational and intellectual qualities soon showed themselves and he worked closely with members of the 'invisible college' (Pines 1991) of psychoanalytic soldiers like Wilfred Bion, Eric Trist and Jock Sutherland on the selection boards.
By 1944 the War Office had established a Research and Training Unit in Hampstead, of which Bowlby was a member. This enabled him to continue active participation in the affairs of the Psychoanalytic Society, riven at that time by factional fighting between the Kleinian and Freudian groups. Emerging from the 'Controversial Discussions' these differences were contained by the 'gentlemen'sagreement'betweenthetwoladies,AnnaFreudandMelanieKlein. Thisestablishedtwotrainingstreams:'A',theFreudians,and'B',whichcomprised the Kleinians and 'Independents' (who later split off as a separate 'middle group' of which Bowlby was a member). The President of the Society, Sylvia Payne, herself an Independent, proposed Bowlby as Training Secretary in 1944, and despitenotbeingaTrainingAnalyst,andagainststrongoppositionfromMelanie Klein, his balance and organisational ability were recognised, and he was duly elected. Bowlby'spassionateanduncompromisingfeelingsweremuchinevidence at meetings of the Psycho-Analytic Society during that period. As well as the Klein-Freudsplittherewasamoregeneraldivisionabouttheaimsandmethods oftheSociety. UnderJones'sandlaterGlover'sleadershiptheSocietyhadadopted
24 Origins
something of the features of a secret cell: purist, esoteric, autocratically led, unwilling to sully itself with anything but the 'pure gold' of psychoanalysis, and refusing to have anything to do with the analytic fellow travellers represented by the Tavistock Clinic, who included several Christian psychiatrists like J. R. Rees and Suttie, and which was referred to contemptuously by the psychoanalysts as the'parson'sclinic'(Pines1991). AllthiswasanathematoBowlby,whobelieved in democratic methods and was appalled by what he saw as the Society's indifference towards the emergence of a National Health Service which was clearly going to be established after the war. He advocated full participation in the discussions between the Government and the medical profession:
We find ourselves in a rapidly changing world and yet, as a Society, we have done nothing, I repeat nothing, to meet these changes, to influence them or to adapt to them. That is not the reaction of a living organism but a moribund one. If our Society died of inertia it would only have met the fate it had invited.
(King and Steiner 1990)
Bowlby and the progressives carried the day, and Bowlby was delegated as a member of the Government's Mental Health Standing Committee, where he proceeded to have the same effect on the civil servants as he did on the older members of the Society, and he was described in a Whitehall report as 'a "live" member, with embarrassing enthusiasm for his own speciality. An advanced theorist who does not always give weight to practical considerations' (Webster 1991).
Family life
Tony Bowlby married young: a beautiful musician and actress whom he met through his sisters who were at the Royal Academy of Music. John had had several tempestuous liaisons, but as his analysis progressed and he approached his thirties, began to wish to settle down. On holiday in the New Forest he encountered the Longstaffs, a family of seven attractive daughters living with their pipe-smoking mother whose father, Dr Longstaff, the famous alpinist, had abandoned her for a younger woman. Ursula, the third daughter, intelligent and beautiful but more diffident than her older sisters, attracted his interest. On a shooting holiday in Ireland she and John fell for each other. They were married in 1938. John, like his father, was some ten years older than his
Biographical 25
bride. Ursula proved a devoted and loyal companion. Although highly intelligent and literate, she had no knowledge of psychology, and claims not to have read any of his books except the biography of Darwin on which she collaborated extensively. She also helped to supply the quotations for the chapter headings in the 'trilogy'.
The Bowlbys had four children, the day-to-day care of whom John left almost entirely to Ursula. The family was afflicted by dyslexia, a condition unrecognised at the time, and his children's academic difficulties were a source of some sorrow and frustration to their father, although they were fully compensated by their practical and technical abilities. John had had little experience of close parent-child relationships, and found fatherhood a difficult role. He was, by contrast, in his daughter Mary's words, a 'brilliant grandfather' ('Grampy's' good influence making itself felt again) - tolerant, funny and adoring. John and Ursula's grandson, Ben, in the Bowlby tradition of independence and originality, received first-class honours in engineering for designing and building his own racing car - an 'external working model' (see Chapter 4). John, a slightly remote father, followed his own father's tradition of hard work and long holidays, so much so that his eldest son asked, around the age of seven, 'Is Daddy a burglar? He always comes home after dark and never talks about his work! ' Family holidays were in Scotland, and a house was first rented and then bought on Skye where John, Ursula and the children could enjoy the walking, boating, bird-watching, shooting and fishing in beautiful and remote surroundings that repeated the pattern of his own childhood.
The Bowlbys and the Durbins had shared a house in York Terrace (where Adrian and Karen Stephens and Ernest Jones had their consulting rooms). This pattern was continued after the war when John's democratic ideas and recognition of the benefits of an extended network of friends and family when bringing up small children were realised, when he and Ursula and their growing family shared a large house in Hampstead with the Sutherlands (Jock Sutherland was soon to become director of the Tavistock Clinic) and with a young psychologist, later to become Mrs Mattie Harris, who became organising tutor of the child psychotherapy training programme at the Tavistock (Sutherland 1991).
26 Origins
The post-war years: the Tavistock Clinic
Immediately after the war the 'invisible college' of Army psychoanalysts re-grouped themselves around the Tavistock Clinic, hitherto ruled out of bounds by the autocratic Jones. An election was held and, although neither had previously worked there, Jock Sutherland was elected Director, with Bowlby as Deputy, given the specific task of developing a Department for Children.
John went about this with his usual energy, efficiency and determination. He established a clinical service, treating patients, seeing mothers and children together, spending one day a week in a well-baby clinic, supervising, and chairing case conferences. Together with Esther Bick he set up the child psychotherapy training and continued to support it, even when its Kleinian orientation began to diverge sharply from his own views.
About a third of his week was devoted to clinical and administrative duties. The rest was for research. One of John's unsung qualities was his ability to raise research funds. On the basis of his pre-war experiences in the Child Guidance Clinic, he had decided to make a systematic study of the effects of separation on the personality development of young children. He recruited James Robertson, a conscientious objector in the war who had worked as a boilerman in Anna Freud's Hampstead residential children's nursery, and who later became an analyst and filmmaker. Mary Ainsworth, later to become the co-founder of Attachment Theory, also joined the team, as did Mary Boston. The outcome of Bowlby's collaboration with Robertson was the famous film A Two-year-old Goes to Hospital, which showed the intense distress of a small child separated from her mother, made with a hand- held cine-camera without artificial light, almost impossible to watch dry-eyed, and which did so much to liberalise hospital visiting rules. As mentioned in the previous chapter, the film met with a mixed reception when shown to the Psycho-Analytical Society, the Kleinians being particularly unimpressed, a foretaste of the response Bowlby was to meet when he presented his breakthrough papers on Attachment Theory a few years later.
Bowlby's research interests, together with his Forty-four Thieves paper, made him an obvious choice when the World Health Organisation was looking for an expert to prepare a report on the mental health of homeless children. Bowlby travelled widely
Biographical 27
in Europe and the United States, meeting the leading figures in child development, and combined their views with his own in a review of the world literature, Maternal Care and Mental Health (Bowlby 1951). This was published in a popular edition as Child Care and the Growth of Love (Bowlby 1953), which became an instant best-seller, selling 450,000 in the English edition alone, and was translated into ten different languages.
Bowlby's reputation was by now secure and he was able to follow his innovative instincts without anxiety. He was keen to break down the ivory towerism of the Tavistock and to foster links with local health visitors, GPs and social workers. His efforts to establish liaison were blocked until the Minister of Health issued a directive asking the London County Council to pay more attention to mental health. The Chief Medical Officer of the LCC invited Bowlby to give a lecture on the subject. He refused, saying that mental health could not be properly taught by didactic methods, but offering to join a study group if one were set up. A week later he received a message from the Chief Medical Officer: 'Your "study group" is ready. When would you like to start? ' (Mackenzie 1991).
Ainsworth (1982) believes that the idea of attachment came to Bowlby 'in a flash' when in 1952 he heard about and then read Lorenz's and Tinbergen's work in ethology, having been lent an advance copy of King Solomon's Ring by Julian Huxley. The ethological approach provided the scientific grounding that Bowlby believed was needed to update psychoanalytic theory. Seen psychobiographically, Attachment Theory might be seen as a return by Bowlby to the values of his mother which he had rejected when he became a psychoanalyst. Disappointed with his mother's self-preoccupations and favouritism, he turned to the many mothers of psychoanalysis - Klein, Riviere, Payne. But these too, partly through their own limitations, partly because they contained his hostile projections, disappointed in their turn. By marrying the biology of ethology with Freudian theory, he managed to reconcile the discordant elements in his personality: his country-loving mother with her respect for nature, and the intimidating urban medical father whose success and intelligence were inspirational but whose Gradgrindian devotion to fact and duty dominated his life. Bowlby soon organised regular attachment seminars which were attended by a talented and eclectic group including the ethologist Robert Hinde and, for a
28 Origins
time, R. D. Laing. A year as a fellow at the Centre for Behavioural Sciences in Stanford, California, gave him an opportunity to reread Freud and to prepare the breakthrough papers of the late 1950s, starting with 'The nature of the child's tie to his mother' (Bowlby 1958).
Bowlby remained active in the Psycho-Analytical Society in the post-war years. He was Deputy President to Donald Winnicott between 1956 and 1961, responsible for 'everything administrative' (Bowlby 1991). He set up and chaired the Research Committee, and initiated several other committees, including the Public Relations Committee; a committee to look at indemnity insurance for non-medical members (typical of Bowlby to be alert to the possible hazards to members uncushioned by the secure base of medicine); and the Curriculum Committee (set up to prevent trainings becoming interminable - another typically practical move).
While the society was happy to benefit from his organisational skills, Bowlby's theoretical papers, presented between 1957 and 1959, excited considerable discussion but little enthusiasm, and were received by the Kleinians with outright hostility. Typical comments were: from Guntrip, 'I think it is very good for an eminent psychoanalyst to have gone thoroughly into the relation of ethology to psychoanalysis, but my impression is that he succeeds in using it to explain everything in human behaviour except what is of vital importance for psychoanalysis' - (1962, letter to Marjorie Brierley, in Archives, Institute of Psychoanalysis); from Winnicott, although generally friendly and sympathetic to Bowlby's contribution (Malan 1991), 'I can't quite make out why it is that Bowlby's papers are building up in me a kind of revulsion although in fact he has been scrupulously fair to me in my writings'; and, from an anonymous analyst, 'Bowlby? Give me Barabbas' (Grosskurth 1986). The analysts found his patrician manner and 'orotund' (Rycroft 1992) delivery offputting, although these may well have been exaggerated in the intimidating atmosphere of the Psycho-Analytical Society at the time. Bowlby had an impish quality and a capacity for amusing tomfoolery which was clearly not evident to the analysts. Whether Bowlby did indeed betray psychoanalysis, or breathed new life into it, will form much of the discussion in subsequent chapters.
Biographical 29
The trilogy
Partly no doubt because of his hostile reception, and partly because of his growing reputation elsewhere, Bowlby spent little time in the Psycho-Analytical Society after the mid-1960s although, unlike other distinguished dissidents such as Rycroft and Meltzer, he did not discontinue his membership. While continuing his clinical role at the Tavistock, in 1963 he became a part-time member of the Medical Research Council, which enabled him to devote yet more time to writing. The years 1964 to 1979 were devoted to his monumental trilogy Attachment (1969b), Separation (1973a), and Loss (1980). These have also been bestsellers, with the first volume selling well over 100,000, the second 75,000, and the third 45,000 (Bowlby et al. 1986). Colin Murray Parkes and Dorothy Heard joined him at the Tavistock in the 1960s. Like Bowlby, Parkes had been struck by the relevance of Darwin's ideas about grief to abnormal mourning, and a fruitful partnership developed (Parkes 1964, 1971, 1975). Bowlby was much in demand as a lecturer, especially in the United States where, through the work of Ainsworth (1969), Attachment Theory was exciting increasing interest.
Bowlby held numerous important positions and consultancies, and received many honours, including the CBE, Honorary Doctorates at Cambridge and Leicester, Honorary Fellowships of the Royal Society of Medicine and College of Psychiatrists, Fellowship of the British Academy, and several Distinguished Scientist awards and medals in the United States, including that of the American Psychological Association. As befits an innovator and original thinker, he was probably slightly more honoured abroad than at home, and neither received a knighthood nor became an FRS, both of which many thought were his due (Kraemer 1991). He did, however, do 'better' than his lifelong friend and rival, his brother Tony.
He retired from the NHS and the MRC in 1972, but remained at the Tavistock Clinic, dividing his time between London and his beloved Skye. He continued to encourage students and to receive many foreign visitors. During 1980 he was Freud Memorial Professor of Psychoanalysis at University College London, a post which gave him great satisfaction.
His lectures from there and his trips abroad were collected in The Making and Breaking of Affectional Bonds (1979c) and A Secure Base (1988a). Mentally and
30 Origins
physically active as ever, he began an entirely new project in his seventies, a psychobiography of Darwin (Bowlby 1990), which was published a few months before his death, and was well reviewed.
His eightieth birthday was celebrated in London with a conference with many distinguished speakers from around the world. The affection he inspired was palpable, as, garlanded with flowers, he embraced his many friends and colleagues to loud claps and cheers. A few weeks later he collapsed unconscious with a cardiac arrhythmia, but made a complete recovery, and was able to finish the Darwin biography. Three years later he suffered a stroke, while in Skye with his family, who had gathered as they did every year for the Skye Ball, where John had been a skilled exponent of Scottish reels. He died a few days later on 2 September 1990, and was buried at Trumpan on the Waternish peninsula, a hillside graveyard overlooking the cliffs of Waternish and the Ardmore peninsula. It was a favourite spot, wild and remote, from which John, with his great feeling for nature, often used to walk, and he had asked to be buried there. He had a traditional Skye funeral with three 'lifts' from the hearse to the grave. His friend Hyla Holden, a former Tavistock colleague, one of the bearers, concludes: 'his funeral and burial were in keeping with the straight-forward and loving simplicity which lay behind his formidable intellect' (Trowell 1991). His constancy and steadfastness of purpose are celebrated in the inscription on the headstone of pale grey Aberdeen granite, which reads: 'To be a pilgrim'.
BOWLBY THE MAN
What was John Bowlby like? In his work his greatest achievement was his bringing together of psychoanalysis and, via ethology, evolutionary biology. A similar capacity to reconcile divergent elements is to be found in his personality which, although remarkably coherent and consistent, contained many contradictory aspects: reserved, yet capable of inspiring great affection; quintessentially 'English' and yet thoroughly cosmopolitan in outlook; conventional in manner yet revolutionary in spirit; equally at home with the sophistication of Hampstead and in the wilds of Skye; outstandingly intelligent and yet not in a
Biographical 31
conventional sense an intellectual; a man of action who devoted his life to the inner world; determined in his convictions and yet without overt aggression; an explorer of the psyche who mistrusted the purely subjective; someone who believed passionately in the importance of expressing emotion, whose own feelings were an enigma; an enfant terrible who was always slightly formal.
It is hard to get an impression of Bowlby as a therapist because personal clinical material is so sparse in his writings. He is fierce in his opposition to rigid and punitive methods of child-rearing, detests the way in which children are deprived of love and affection in the name of not 'spoiling' them, and insists on the enduring nature of dependency which he refuses to see as a childlike quality to be outgrown, but rather an essential aspect of human nature. One guesses that he had first-hand experience of the child-rearing philosophy he rejects so vigorously. He consistently advocates flexibility and acceptance:
An immense amount of friction and anger in small children and loss of temper on the part of their parents can be avoided by such simple procedures as presenting a legitimate plaything before we intervene to remove his mother's best china, or coaxing him to bed by tactful humouring instead of demanding prompt obedience, or by permitting him to select his own diet and eat it in his own way, including, if he likes it, having a feeding bottle until he is two years of age or over. The amount of fuss and irritation which comes from expecting small children to conform to our own ideas of what, how, and when they eat is ridiculous and tragic.
(Bowlby 1979c)
The dangers of suppressing feelings is repeatedly emphasised by Bowlby:
a main reason why some find expressing grief extremely difficult is that the family in which they have been brought up, and with which they still mix, is one in which the attachment behaviour of the child is regarded unsympathetically as something to be grown out of as soon as possible . . . crying
32 Origins
and other protests over separation are apt to be dubbed as babyish, and anger and jealousy as reprehensible.
(Bowlby 1979c)
Bowlby describes one such patient:
I well remember how a silent inhibited girl in her early twenties given to unpredictable moods and hysterical outbursts at home responded to my comment 'it seems to be as though your mother never really loved you' (she was the second daughter, to be followed in quick succession by two much wanted sons). In a flood of tears she confirmed my view by quoting, verbatim, remarks made by her mother from childhood to the present day, and [describing] the despair, jealousy, and rage her mother's treatment roused in her.
(Bowlby 1979)
Bowlby himself came from a family in which there were two daughters, to be followed in quick succession by two much wanted sons, with a mother whose love her children may well have doubted (with the possible exception of Tony), so he probably knew what he was talking about. Even if he did not have a particularly loving mother, Bowlby had learned enough from her, and perhaps from his much-loved nursemaid Minnie who left when he was no more than four, to know what it takes to be one. In adult life he relied greatly on his wife Ursula'sintuitionandsensitivity. Inaposthumouslypublishedself-portraitBowlby modestly asserts:
I am not strong on intuition. Instead, I tend to apply such theories as I hold in an effort to understand the patient's problems. This works well when the theories are applicable but can be a big handicap when they are not. Perhaps my saving graces have been that I am a good listener and not too dogmatic about theory. As a result several of my patients have succeeded in teaching me a great deal I did not know. . . . I often shudder to think how inept I have been as a therapist and how I have ignored or misunderstood material a patient has presented. Clearly, the best therapy is done by a therapist who is naturally intuitive and also guided by the appropriate theory. Fortunately, nowadays I meet many such people in clinical seminars, and among supervisees.
(Bowlby 1991)
Biographical 33
One such was Victoria Hamilton, who confirms Bowlby's listening skills, painting a vivid portrait:
a very unassuming person who at the same time displayed an unusual acuity. . . . My most constant image of John Bowlby . . . is of him sitting back in a chair, his legs crossed indicating an expression of relaxed concentration, and a very alert face. He had penetrating but responsive eyes, beneath raised eyebrows which expressed both interest and a slight air of surprise and expectation . . . a remarkable ability to listen to the thoughts and beliefs of others, combined with a capacity for objectivity and a rare facility with the English language. He could step back from an idea and reformulate it in a succinct articulate way. . . . Despite his somewhat military manner, expressed in a certain abruptness and stiffness very far from 'small talk', he was perfectly able to 'take turns', the essential ingredient of conversation.
(Hamilton 1991)
A lifelong friend, Jock Sutherland (1991), describes his first encounter with John during the war, in which he appeared 'somewhat formal and even aloof'. Sutherland and Eric Trist, another of John's half-century friends, speculated that Bowlby's description of the 'affectionless character' was based on empathic understanding (rather as Freud's discovery of the Oedipus complex was based on his own rivalry with his father):
We speculated that John's own early experience must have included a degree, if not of actual deprivation, of some inhibition of his readiness to express emotional affection . . . so that he developed in some measure a protective shell of not showing his feelings as readily as many people do. . . . John's slightly formal and even detached manner struck many people on first knowing him Eric Trist and I were always convinced he was the possessor of a deep and powerful fund of affection - the source of his intensely caring concern for those who worked with him.
(Sutherland 1991)
John Byng-Hall, another Tavistock colleague, sees Bowlby as a perfect embodiment of his idea of the secure base, capable of holding together family therapists and child psychotherapists despite their very different philosophies, alert to real dangers faced
34 Origins
by patients and therapists, and above all 'very reliable. I have images of him, even last winter [i. e. in his eighty-second year], shaking the rain off his green mackintosh and hat as he arrived on time for some evening meeting; while others sent their apologies' (Byng-Hall 1991).
Those clocks that Bowlby had grown up with did have their uses.
SPRINGS OF ACTION AND THOUGHT
It seems to be a characteristic of many outstanding men and women that they retain the freshness and innocence of childhood, however clothed it is with responsibility and the burdens of maturity. This was certainly true of Bowlby's great hero, Darwin (Bowlby 1990), with whom he strongly identified, and had much in common, although he would have been embarrassed by the comparison. Like Darwin, Bowlby had a boyhood love of outdoor sports, of the countryside and of exploration, with a keenness of intellect that was not precociously evident. Like Darwin, Bowlby had a strong and successful medical father; both seem to have aroused in their sons a rebelliousness hedged about with caution. Both were younger sons, with clever and rather overshadowing older brothers and sisters. Darwin's mother died when he was eight; Bowlby's was (at least in her London life) remote and self- centered. Both lived in times of social turmoil and had a strongly held but restrained sense of social justice, and of the responsibilities of the fortunate towards the disadvantaged, in the best Whig tradition. They both believed passionately in the power of reason to illuminate both the natural and social world. Bowlby admired Darwin's openness to all available evidence, as shown by the long hours he spent in smoke-filled public houses discussing breeding methods with pigeon fanciers in search of support for his theory of natural selection. Bowlby, too, mixed with mothers in nurseries and baby clinics, ever observant of patterns of attachment. Both showed generosity towards their supporters, and lacked rancour towards their detractors. Finally, it might be said of their theories that they have the quality of immediacy and 'obviousness' - of which it might be said, 'Why on earth did no one think of that before? ' In retrospect it seems obvious that species have evolved by natural selection, that people are attached to one another and suffer when they separate - but it took child-like simplicity of
Biographical 35
vision combined with mature determination and attention to detail to root out the obvious and to create for it a secure theoretical base.
Bowlby describes an early boyhood memory of Darwin's concerning showing off:
He recalls 'thinking that people were admiring me, in one instance for perseverance, and another for boldness in climbing a low tree, and what is odder, a consciousness, as if instinctive, that I was vain, and a contempt for myself'. This reference to self-contempt for being vain thus early in his life is of much significance, since we find it persisting as a major feature of his character into his final years.
(Bowlby 1990)
Here we see Bowlby's extreme sensitivity to the uncertainties, miseries and vulnerability of childhood, to the gulf between a child's fragile self- esteem and a potentially hostile or indifferent world. Bowlby cared intensely about the mental pain of children, and his life's work was directed towards trying to prevent, remove and alleviate it. Behind the disturbed child's tough, 'affectionless' carapace Bowlby had a sixth sense for the sadness and sense of betrayal. Apparently bolder than Darwin, Bowlby kept his vulnerability well hidden. But in his rebelliousness we see perhaps the protest of the child who has been hurt and neglected. In his application and indefatigability we find the attempt to make good the unthinking damage the adult world so often does to children.
Many of Bowlby's metaphors were medical. Famously, 'mother- love is as important for mental health as are vitamins and proteins for physical health' (Bowlby 1953); 'deprived children . . . are a source of social infection as real and serious as are carriers of diphtheria and typhoid' (Bowlby 1953); 'the basic fact that people really do want to live happily together . . . gives confidence [to the family therapist], much as a knowledge of the miraculous healing powers of the body gives confidence to the surgeon' (Bowlby 1948).
Bowlby's ideas were forged in the era of two world wars. Millions died in the first war. The enormity of the loss went unmourned by society in the triumphalism of Versailles and the manic activity of the twenties. The second war saw the horror of the Holocaust, countless more deaths, and the disruption of the lives of children throughout Europe. As early as the 1930s, Bowlby
36 Origins
saw loss and separation as the key issues for psychotherapy and psychiatry. It was the men - the fathers, sons, brothers, husbands, lovers - who died; it was a men's world that went to war. And yet in Bowlby's work men are conspicuous by their absence. It is maternal deprivation that made Bowlby's name. Bowlby's strong identification with his much-absent father comes through in his medical imagery, but he does not emerge as a live figure in the family drama as depicted by Bowlby, or indeed by the other outstanding analysts of his generation, Klein and Winnicott. Bowlby's contribution, and that of his contemporaries, has been to rehabilitate the female principle, the missing mother who until then was absent from social and psychoanalytic discourse (Freud's main preoccupation was with fathers and their children). In his concept of maternal deprivation it is as though Bowlby was simultaneously reproving and idealising his neglectful mother. Unlike Winnicott he seems uncertain of his intuitive feminine side, just as he may have mistrusted his mother with her fickle and uneven affections. In his theories of motherhood it is as though Bowlby is enacting the male role - the guardian of evidence and objectivity - without really examining it. His father is there in the metaphors but not at the meal table. Bowlby's maleness is in the counter-transferential blind spot through which he sees mother and child, but not himself seeing them - a typical example of the modern 'patriarchal but father-absent' family (Leupnitz 1988). To consider these and other issues we must now turn to the topic for which Bowlby is best known, that misnamed miscreant, maternal deprivation.
Chapter 3
Maternal deprivation
[The] evidence is now such that it leaves no room for doubt . . . that the prolonged deprivation of a young child of maternal care may have grave and far reaching effects on his character and so on the whole of his future life. It is a proposition exactly similar in form to those regarding the evil after-effects of German measles before birth or deprivation of vitamin D in infancy.
(Bowlby 1953)
Statements implying that children who experience institutionalisation and similar forms of privation in early life commonly develop psychopathic or affectionless characters are incorrect.
(Bowlby, Ainsworth, Boston and Rosenbluth 1956)
Psychotherapy can be seen as a branch of social psychiatry, using psychological methods to reverse or mitigate the damaging effects of environmental failure. This immediately raises two questions. First, given that the damage is already done, how can mere talk undo past miseries? Second, given that many people survive unhappy childhoods without developing psychiatric disorder, are therapists justified in attributing present difficulty to previous trauma? The two quotations from Bowlby above illustrate the transition between his career as a clinician and psychoanalyst to that of a researcher and theorist. The therapist, faced with the patient in front of him, naturally attributes his difficulties to the history of environmental failures he recounts. The researcher, with a control group and a sense of a population at risk rather than just one individual, is forced to more cautious conclusions.
The answer to both questions, in brief, lies in the fact that environmental failure is not merely impressed on a passive organism,
38 Origins
but is experienced and given meaning by the afflicted individual. Psychotherapy is concerned with the way that stress is mediated psychologically - with why this person succumbs while others survive - and, by altering psychological responsiveness and the attribution of meanings, to change not the facts of history, but their context and significance. In this chapter I shall approach these issues through a discussion of 'maternal deprivation', and its corollary, 'that maternal care in infancy and early childhood is essential for mental health' (Bowlby 1952). However self-evident it may seem to us now - and this is largely the result of Bowlby's work - the idea of maternal deprivation as a cause of mental illness was in its day a revolutionary concept which became a paradigm (Kuhn 1962), setting the terms of debate and research in social psychiatry for the ensuing forty years.
CHILD CARE AND THE GROWTH OF LOVE
As Rutter (1981) points out, the phrase 'maternal deprivation', the central concept of Bowlby's WHO report Maternal Care and Mental Health, is a misnomer. His report was concerned primarily with privation (the absence of something which is needed), rather than de-privation (the removal of something that was previously there). The distinction is important because, as we shall see, the results of the complete lack of maternal care are almost always damaging to the child and have severe long-term consequences, while deprivation is less easy to define and much less predictable in its impact.
In its popular edition, Maternal Care and Mental Health was retitled Child Care and the Growth of Love - a significant shift, since it suggests a universal message about mothers and children rather than confining itself to questions of mental health. The book is far more than a scientific work (and indeed has been criticised for its handling of the evidence - Andry 1962), and is perhaps best seen as a landmark social document, comparable to the great nineteenth-century reports such as Elizabeth Fry's account of sanitary conditions in prisons, or Mayhew's descriptions of the plight of the London poor.
What marks Child Care and the Growth of Love out in the history of social reform is its emphasis on psychological as opposed to economic, nutritional, medical or housing difficulties as a root cause of social unhappiness:
Maternal deprivation 39
In a society where death rates are low, the rate of employment high, and social welfare schemes adequate, it is emotional instability and the inability of parents to make effective family relationships which are the outstanding cause of children becoming deprived of a normal family life.
(Bowlby 1952)
The evidence
The central thrust of Bowlby's work is the effort to substantiate this claim and to consider its clinical, professional, ethical and political consequences. The evidence upon which the book is based includes Bowlby's own studies of juvenile delinquents, Goldfarb's comparison of institution-raised children in the United States with those who had been placed in foster homes, and the accounts of Anna Freud and Dorothy Burlingham from their residential nursery in Hampstead. All these studies strongly support the view that children deprived of maternal care, especially if raised in institutions from under the age of seven, may be seriously affected in their physical, intellectual, emotional and social development. Institution-raised children grow less well, and are retarded in their acquisition of language, and as they become older show evidence of impaired ability to form stable relationships - often tending to be superficially friendly but promiscuous (either metaphorically or literally) in their relationships. Based on his own finding that only two out of fourteen 'affectionless psychopaths' had not had prolonged periods of separation from their mothers in early childhood Bowlby asserts that 'prolonged separation of a child from his mother (or mother substitute) during the first five years of life stands foremost among the causes of delinquent character development' (Bowlby 1944; Bowlby 1952). It is worth noting that Bowlby was making very sweeping conclusions based on studies which had often only looked at relatively small numbers of cases - in his case fourteen, in Goldfarb's only fifteen, juvenile delinquents. By present-day standards these studies would also not be acceptable in that they often included no control groups, or, if they did, they were not rated blind by the researchers, who had a vested interest in establishing a link between deprivation and depravity. Bowlby was aware of these difficulties and,
40 Origins
anticipating the modern vogue for 'metaanalysis' (based roughly on the Maoist principle that '600 million Chinese people cannot be wrong'), suggested that, by combining many small studies, an overall trend emerges which is likely to have some validity.
Family care versus institutional care
Having established to his satisfaction that children without maternal care are indeed gravely disadvantaged, Bowlby goes on to contrast the quality of life in a family with that in an institution:
All the cuddling and playing, the intimacies of suckling by which a child learns the comfort of his mother's body, the rituals of washing and dressing by which through her pride and tenderness towards his little limbs he learns the values of his own, all these have been lacking.
(Bowlby 1952)
The tinge of sentimentality in this lyrical account has, as we shall see, been much criticised by feminist writers, as has his hymn of praise to what Winnicott was later to call the 'ordinary devoted mother':
The provision of constant attention night and day, seven days a week, 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.
(Bowlby 1952)
These much-quoted and sometimes derided overstatements have to be seen in context. The world was horrified in the 1990s by the revelation of the squalor and emotional deprivation in the orphanages of Romania. This was not just the result of a dictatorship but of an ideological devaluation of family life, and a belief in the power of public provision to overcome individual poverty. Bowlby was reacting against a similar trend to be seen throughout Europe and the United States in the post-war era, and indeed to a long tradition among the British middle classes, of which he had first-hand experience, of turning their sons and
Maternal deprivation 41
many of their daughters over first to nannies and then to institutional care in boarding schools from the age of seven! To the extent that Bowlby idealises motherhood - as opposed to offering a realistic appraisal of its central importance in child- rearing - this must be seen at least in part as a reflection of the deprivations which he and other members of his class had experienced in the nursery and at school. The long hand of the otherwise invisible nanny reached far.
The impact of Bowlby's advocacy has been enormous, and continues to the present day. It is now taken for granted, and enshrined in the 1989 Children Act, that individual care in foster homes is preferable to group care in nurseries, that 'bad homes are better than good institutions' (Bowlby 1952). The battle to replace institutional care for the mentally ill and mentally handicapped with care within the family, or at least provision of a family-type home atmosphere, is still being waged.
The need for professionalisation of child care
Critics have accused Bowlby of wanting to 'pin women down in their own homes' (Mead 1962). While it is true that he criticises cavalier attitudes towards elective separations of mothers from children under the age of three, he could rather be seen as arguing for a much greater valuation by society of motherhood - indeed, as being recruited in support of the feminist demand for state provision of 'wages for housework'. Whatever his views on housewives, he puts a strong case for the professionalisation for all child-care workers, including workers in day nurseries and children's homes, foster mothers and (we would now add, since this argument has also not been fully won) child minders. These workers must be skilled in understanding a deprived child's overwhelming needs: the craving for parental love; the need to idolise parents however flawed they are in reality; the importance of maintaining contact with absent parents, however fragmentary; the right to express pain, protest about separation, and to grieve loss. They must also be able to help parents in turn to recognise their children's and their own ambivalent feelings. He is intensely critical of case workers who 'live in the sentimental glamour of saving neglected children from wicked parents' (Bowlby 1952) (a comment still relevant today to the dilemmas presented by working with sexually abused children), and of actions which
42 Origins
'convert a physically neglected but psychologically well-provided child into a physically well-provided but emotionally starved one' (Bowlby 1952). All these principles are now enshrined at least in the theory of child-care practice, and for this too Bowlby is largely responsible.
Government action
Much of the debate about the de-institutionalisation of the mentally ill has centred on the question of funding. It was thought that community care must be cheaper than institutional care, and partly for this reason it received governmental support. Bowlby puts forward similar economic arguments in favour of family support for troubled children:
There are today governments prepared to spend up to ? 10 per week [this was 1952! ] on the residential care of infants who would tremble to give half this sum to a widow, an unmarried mother, or a grandmother to help her care for her baby at home. . . . Nothing is more characteristic of both the public and voluntary attitude towards the problem than a willingness to spend large sums of money looking after children away from their homes, combined with a haggling stinginess in giving aid to the home itself.
(Bowlby 1952)
Although, thanks to Bowlby and others, much has changed, much remains the same. For some things may be worse than in 1952: the haggling stinginess has returned, but is now accompanied by an unwillingness to spend large sums on public provision. The 1989 Children Act creates a partnership between parents and the local authorities to provide for 'children in need', a` la Bowlby, with cash payments if necessary, but no extra funding has been made available for this.
Vicious and benign circles
A major idea which emerges in Child Care and the Growth of Love is that of cycles of deprivation: 'the neglected psychopathic child growing up to become the neglectful psychopathic parent . . . a self-perpetuating social circle' (Bowlby 1952). Today's emotionally deprived child becomes tomorrow's neglectful parent: adverse experiences become internalised by the growing child in a way that leads on to further adverse experiences,
Maternal deprivation 43
thus perpetuating the vicious circle of neurosis. Writing in an era of social optimism, and with what, sadly, in hindsight must be seen as some nai? vety, Bowlby argued that, with concentrated social, economic and psychological effort, society could put these vicious circles into reverse, so that 'it may, in two or three generations, be possible to enable all boys and girls to grow up to become men and women who, given health and security, are capable of providing a stable and happy life for their children' (Bowlby 1952).
Psychoanalytical principles
One of the impressive features of Child Care and the Growth of Love is the way it presents psychoanalytical principles in an accessible and simple form. It is infused with the belief that it is always better to speak the truth, however painful, than to suppress it, and that to try to wipe the slate of the past clean is misguided and in any case impossible. Bowlby believed that children should be involved in any decisions about their welfare, and their own views and wishes taken into account - a principle which has only reached the statute book half a century later in the Children Act of 1989. He thought that children should be encouraged to express their ambivalent feelings about their parents. Children often believe themselves responsible for the calamities which befall them and their families, and child-care workers need to be aware of this and help put these feelings into perspective. For a child away from home 'the lack of a sense of time means that separation feels like an eternity', and this too needs to be understood. In a remarkable quotation from his psychoanalytic colleague Winnicott, a case is made that every child has a right to a primary home experience:
without which the foundations of mental health cannot be laid down. Without someone specifically oriented to his needs the infant cannot find a working relation to external reality. Without someone to give satisfactory instinctual gratifications the infant cannot find his body, nor can he develop an integrated personality. Without one person to love and to hate he cannot come to know that it is the same person that he loves and hates, and so cannot find his sense of guilt, and his desire to repair and restore. Without a limited human and physical environment he cannot find out the extent to which his aggressive ideas actually fail to destroy, and so cannot sort out the difference between fantasy and fact. Without a father and
44 Origins
a mother who are together, and who take joint responsibility for him, he cannot find and express his urge to separate them, nor experience relief at failing to do so.
(Winnicott and Britton in Bowlby 1952)
These principles are as relevant today as they were when they were written. The tragedy of contemporary 'community care' is that, while the need to avoid the negative aspect of institutions has been grasped, the primary home experience as described by Winnicott remains elusive.
Bowlby's outrage
Perhaps the greatest single thread in Bowlby's work, one which comes through strongly in Child Care and the Growth of Love, is his pain and outrage at the unnecessary separation of children from their parents. He could take heart at the changes in pediatric and obstetric practice it has led to. The book ends with this passionate outcry at a 'developed' society which has forgotten the fundamental importance of human attachment:
Finally let the reader reflect for a moment on the astonishing practice which has been followed in obstetric wards - of separating mothers and babies immediately after birth - and ask himself whether this is the way to promote a close mother- child relationship. It is hoped that this madness of western society will never be copied by so-called less developed societies.