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 The Problem of Professional Anxiety
James and Joyce Robertson
"One factor that is big in this whole issue of childcare is put forward very well by James and Joyce Robertson, reviewing the work of their entire life in their 1989 book "Separation and the Very Young". They both worked at the Tavistock Clinic in England and did some filming of very young kids when they were separated from parents when put in hospital. Their film "A Two-Year Old goes to Hospital" literally changed the practise of not letting parents visit young children in hospital -- world wide.
They then did a series of equally powerful and significant films, the most famous of which is JOHN, a brief description of which follows the article presented here. At age 17 months John is a healthy baby and is put in residential nursery care for 9 days. Just 9 days. A normal kid. He is put in this place. It isn't daycare, it's around the clock day care in Britain twenty years ago. Well run, caring staff. It's a black and white film with voice over sound. James told me the original soundtrack would have made the film totally unbearable. It will scare the hell out of you, or make you mad. All James Robertson did was go to the nursery every day with his movie camera and record what happened to John emotionally while his mother was in hospital having a second baby and father visited periodically.
What the point is in this piece, and it is lifted out of their most recent book, is the final line, "I could kill you", said a distinguished psychoanalyst after seeing the film. So those of us who are psychiatrists and experts really can be resistant to looking at the damage inflicted on children. If you've ever said anything about the dangers of daycare publicly you'll know. Ask Burton White.
"Why is it that although the importance of meeting the emotional needs of young children is well established by research, and is taught in many trainings, this requirement of mental health is not well attended to in our child-care practice?"
It is common knowledge that experiences in the first years of life have a profound influence upon later mental health. In particular, it is known that to ensure good social and emotional development the young child needs a stable relationship with a responsive mother figure (Bowlby, 1951). This is an experience that most young children find within the security of their families.
An implication of this knowledge is that if a young child has for any reason to lose the care of his mother, it is essential that his experience of responsive mothering be maintained. But at the present time, if a young child goes into hospital without his mother, he will be handled by a succession of nurses, and if he goes into residential care he will rarely find there a stable mother substitute.
Why does this happen? Why is it that although the importance of meeting the emotional needs of young children is well established by research, and is taught in many trainings, this requirement of mental health is not well attended to in our child-care practice? Why is it that although we know it to be imperative that young children have stable relationships, we still fragment their care among many people when they come into hospital or other residential settings?
If the relevant professions had a serious concern to meet the mothering needs of young children in their care, practical difficulties arising from staff shortages and the short working week might be found to be hard to overcome. But scanning the journals of the paediatric, nursing and other caretaking professions reveals that, although there is an endeavour to provide play and education, there is little or no reference to the much greater need for mothering-type care.
Systems of care that disastrously fragment relationships can operate in institutions busy with 'child-oriented' activities, and are more likely to result from planning for work efficiency than from staff shortage. It is well known, for instance, that even in large teaching hospitals where there is no staff shortage, nursing is commonly organized on a 'job assignment' basis in disregard of the emotional needs of the young patients, even though in the same hospitals the nurses are likely to be taught the importance of stable relationships.
The major obstacle to suitable care is neither practical difficulty nor lack of knowledge. It is that, whatever of intellectual understanding may obtain throughout the professions, the appropriate sense of urgency and alarm is missing, or is dampened down. There is a tendency for even the best-educated and the best-motivated of people working with young children to become to some extent habituated to the states of distress and deviant behaviour that are commonly found in young people in hospitals and other residential settings...
...Although there is everywhere goodwill and good intention towards young children in care, with great resources and knowledge and understanding of their needs ... the common defence against pain allows the acuteness of the problem to be dulled as by a tranquillizer.
Without a sufficient degree of anxiety in the professions there can be little improvement, no matter how much knowledge is available. The problem is how to bring pain and anxiety back into the experience of professional workers, but in such a way that these are put to constructive use instead of being defensively sealed off by the constant pressure in all of us to escape hurt.
Our way of focusing attention on the problem was to turn to narrative film.
The advantages of a narrative film record are twofold: first, presentation on film gives the nearest approximation to actuality and the visual medium is much more effective than the spoken or printed word in piercing resistance in the field of child care. Secondly, by focusing on one child it is possible to show the sequence of events from first day to last, noting shifts and changes in significant areas of behaviour, and to condense the related factors within a relatively short presentation. This allows the child's experience and behaviour to be perceived in a longitudinal way that is not possible for staff caught up in multiple duties and diversions or for the occasional visitor open to impressions from the entire child group.
(See John: A Distressing Film About Separation)
Excerpted from Separation and the Very Young by James and Joyce Robertson, published by Free Association Books, London, 1989. This is an incredible book. It chronicles 50 years of the lives and work of the Robertsons whose work revolutionized the world's understanding of how small children feel when they are separated from their parents and familiar surroundings.ETB. |
