Mental Health (Infants)

John Pugh Excerpts

Tuesday 26th October 2010 Westminster Hall

[Dr John Pugh (Southport) (LD)]

It is a privilege to talk in the debate under your chairmanship, Mr Bone. It is a tribute to your unswerving party loyalty over the years that you have got to your position.

I congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on starting an important and significant debate. I think we would all agree that the human infant, as she has analysed, has definite needs that go beyond the basic biological necessities of food, water and shelter. The human infant requires emotional support and, as the hon. Lady and my hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke) have argued, an element of attachment—a mother or mother substitute—in the early stages to bond or imprint with. This is essential for wholesome psychological development.

The evidence for a child’s emotional needs is strong. I am aware of an experiment conducted with primates, in which a young rhesus monkey was separated from its mother but given two alternative “wire” mothers—wire constructions. One was surrounded with soft cloth and the other had milk attached to it. The monkey’s behaviour was interesting. It went to one mother for feeding, but after being fed it needed some comfort and went to the other mother and cuddled up close against it, requiring some tactile contact that was not strictly necessary in terms of its biological survival, but clearly deeply emotionally necessary. Some horrific but illuminating experiments have been done in this field. One recalls the behavioural psychologist, Watson, who endeavoured to bring up his child without any tactile direct contact but provided him with all the necessary immediate needs.

It is obvious that we have a raft of emotional needs over and above our ordinary biological needs. The lack of such contact—and the evidence about this lack—is always fairly apparent, showing itself in infants in rocking behaviour, attention-seeking, unresponsiveness and slow development. We also believe that we have discovered, in addition to these obvious symptoms of emotional deprivation and abuse, other effects that we would not have picked up without the benefit of modern science. For example, it has been argued that hormonal effects lead in turn to neurological effects, some of which are long term. Heightened aggression, for example, is suggested to be an outcome of poor attachment, and other social handicaps may ensue. The hon. Member for South Northamptonshire mentioned that psychopathy can be a consequence of severe lack of attachment.

The exact causal link between all these factors is not as clear as we would like to believe. In particular, ways of treating infants and neurological and behavioural outcomes are matters for debate. The evidence is complex and can be oversimplified; it has been contested in some areas and can be interpreted speculatively. We do not know enough about the effects of cortisol to be totally sure in this respect. We do not want to go down the Watson behavioural route to sort this matter out, conducting horrible, elaborate experiments on infants to find out what bottom-line evidence we ought to rely on.

We must recognise that the emotional deprivation and abuse endured by people in infancy is also overlaid in time by subsequent social and cultural differences. That slightly clouds the picture as well, and makes it rather more difficult to establish the clear causal links that the hon. Lady implied existed. If people believe in free will, there is an element of individual mediation at the end of the day. Despite all this, it is not difficult to spot when a child is turning out underdeveloped, unhappy and antisocial. Even if we disagree, according to our different values, about what constitutes a truly well-adjusted child, we certainly know when we have a severely maladjusted child on our hands. It is impossible to dismiss the role of first experiences in constructing those outcomes—that has been established for some time.

It is easier to identify failure than absolute success. After all, as my hon. Friend the Member for Mid Dorset and North Poole suggested, none of us does a perfect job of bringing up our children. All children—all of us—are brought up by amateurs. People do not get a set of children to practise on first until they get good at it. One recalls a quote from Philip Larkin, which I will not use here because it contains unparliamentary language, about the effects of parents on one’s general well-being. But it is still true that some people mismanage the process far more than others, even if none of us succeeds in getting it totally right. I recall Jack Dee’s remark, questioning the point of having children, because they only grow up to be teenagers and slag you off at parties. There is an element of truth in that.

There is a social policy issue concerning how we reduce incompetence, especially the worst sorts of incompetence that lead to the catastrophic effects that the hon. Member for South Northamptonshire mentioned. It is important that we find out what the state can do to encourage success, given that most parents appreciate some guidance, having never done the job before, and crucial that we find out what the state needs to do to avoid catastrophic failure—as in the case of baby P and other cases we could specify—or general failure, if that is what is happening.

The hon. Lady suggested that there is a general failure in society and quoted UNICEF statistics. She suggested that, collectively as a society—as a social group—we have something to learn. In a sense, that is what the debate on child care in the first two or three years in life has been about. There has been strenuous and long-standing debate about the conflict between the role of the mother as breadwinner and home-maker; about whether the social gains of early interaction in a nursery or child care environment are offset by emotional security; about whether encouragement to return to work is encouragement to short-change one’s child; and about whether the high percentage of nursery and child-minded children in our society correlate in an interesting way with levels of general child happiness. I will pass over that debate and leave it to hon. Members around me who are more expert than me, but I want to make two observations.

It is hard to generalise in this matter. I have two grandchildren. One took to everyone in the family very early and is very social, at home with other children, confident and assured, and I had a close relationship with the child from an early age. The other granddaughter has only just convinced herself that I am not an ogre. For the first few months of her life, she clung to her mother in a way that the first child did not. Not all children are the same, and not all homes are the same, so the consequences of keeping children at home with mum differ depending on whether the mother is middle-class and has lots of books and blocks and things, or is a heroin addict.

I do not want to embroil myself in a matter in which I have no expertise—whether the recommended techniques for dealing with babies in the early stages are correct. I do not want to get into the routine versus emotional spontaneity debate, about which there is plenty of literature that is scoured by many young mums as they take their first steps. However, the fame of experts in that field is usually in direct proportion to their tendency to challenge common sense. Books do not sell if they suggest something that is part of motherhood and apple pie, and has been well understood for years.

My fundamental point is that parenting is an art, albeit a rough art, that in some homes goes disastrously and persistently wrong. I had a chilling experience recently on a train. A young child of perhaps three or younger was being controlled by what seemed to be her grandmother. The child responded by producing expletives, which would have been a disgrace even in a football ground. The grandmother responded by saying things such as, “Please stop that because the man doesn’t like it.” The child showed the classic symptoms of one who has been brought up in the wrong environment with the wrong cues and has been given the wrong sort of discipline. It struck me as a disastrous way of carrying on.

When one witnesses such incidents, which are repeated in many places, and recognises the terrible consequences for the individual and their emotional stability, and the huge collateral damage for society, one starts seriously to think about what society can do to support parenting in general and to support such parents who, for whatever reason—it may not be their fault—are not making a good fist of it. Should good parenting be taught in children’s centres? I certainly believe so. Do we need more health visitors? I certainly believe that we do. Do we need to build the skills of often damaged people? I certainly believe that we do.

One hugely overlooked dimension is that we simply do not do enough in schools to inculcate good parenting, or do what we can to get across to young people who are coming up to being parents how parenting sometimes works and sometimes does not.

[Annette Brooke]

My hon. Friend is making some important points. Does he share my vision that it should be considered normal to have parenting classes, and not a reflection on someone’s inability to do something? If someone has a perpetual headache, they go to their doctor, and if they have a perpetual difficulty with a baby or toddler, it should be the norm for them to seek assistance. My ideal is to reach the cultural perspective that seeking help is the thing to do. We would then be able to move forward.

--- Later in debate ---

[Dr Pugh]

Yes, that is an important and valuable suggestion. I am trying to say that we should take pre-emptive action to encourage people to think about parenting and what goes wrong at a time when parents are thinking about all the other important issues of life. There is a lot of good practice on such subjects in personal, social and health education in schools, but the people who are pointed in that direction and encouraged to treat that area of the curriculum seriously tend to be not the most academically high-flying, and tend to be female. There tends to be an exemption for people who have better things to do, but there can be few better things to do than to teach generations to come how better to bring up their children. That can only add value to society as a whole, and happiness to people’s life.

One may waffle on about academies and put money into the pupil premium, but the biggest indicator and determinant of success in the education system and therefore in life is a strong, supportive home in which good parenting is attempted. We are inclined to pay lip service to that and do not spend sufficient time on it. We tend to spend more time thinking about other things such the bias with which history is taught.

[Andrea Leadsom]

On the importance of a supportive family for education outcomes, does my hon. Friend agree that there is a lot of talk about intervening at all levels and all ages, but a supportive family either develops very early or not at all? That is why I focus on the under-twos. That is the point when lifelong good relationships can be set up between family and baby. It is much more difficult to put things right with later intervention.

[Dr Pugh]

I thoroughly agree, and that bears out the point made by my hon. Friend the Member for Mid Dorset and North Poole about the family approach. The arrival of children often puts a strain on relationships and finances, and creates a series of difficulties for couples, which may have severe ramifications. I have attended Home Start events in my constituency at which mothers testified to the initial difficulties and isolation when they became mothers, and the support that they needed. In the past, that might have been provided in the neighbourhood or by an extended family, but is no longer there for many people, who need to be able to plug into facilities and groups—charitable, voluntary, social enterprise and so on—for help with their difficult job. Society must ensure that that help exists because we all recognise the importance of parenting.

One reason for the restraint in our support for teaching parenting is the liberal angst about being too prescriptive in our society, but we must get over that. We must prioritise parenting and invest in it. We must insist on its being taught in schools, and we must assess secondary schools on how well they do that, not only with girls but with boys. Every child in every school is likely to become a parent at some time. Some will do that well and some will do it badly, but unfortunately some will begin without the faintest inkling of what to do and without the experience of a good example, or even the awareness that getting it right matters.

None of us can ultimately escape the inevitable guilt that parents feel about not having been a better parent, but we must not let people go out into the world without knowing what they should do or, worse, not caring whether they do it well or badly. The fundamental point made by the hon. Member for South Northamptonshire was that early years and early months are crucial determinants of someone’s fundamental personality. Freud also made that point, and even said that how someone is born matters. I must declare an interest. I was born easily and during a good summer, and I was a contented baby, which is probably why I became a Liberal Democrat.