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and more recently through the work of child guidance clinics. For instance, in the
opinion of the psychiatrists working in the Council's child guidance units in 1952,
in 80 per cent. of their new cases the genesis of the disorders lay in the pre-school years.
For 1953, the figure was 87 per cent. As the seeds of so much mental ill-health are sown
in infancy and early childhood it follows that action should be taken during those years
to prevent their growth. This constitutes an important part of preventive mental
health work.
8. Of the common sources from which difficulties may arise during infancy and
early childhood, there are three which are particularly relevant to preventive work:
(a) action based on false norms of development and behaviour;
(b) separation of infant and child from the family such as occurs when they are
taken into hospital or residential home;
(c) emotional disturbances in the parents, stemming from the parents' own
life-history, disturbances in which the child becomes entangled.
The first class of case can be corrected by the dissemination of better knowledge,
and the second by a combination of better knowledge with more wisely conceived
medical and social services; the third, which represents a large proportion of cases,
requires assistance of a more specialised and skilled kind.
9. Sound knowledge of norms of infant and child development, especially in respect of
behaviour, still needs dissemination. In particular there is insufficient recognition that
there is an extraordinarily wide range within which development is normal. A typical
example is the well-known fact that the range for the development of walking is about
15 months—between about 9 and 24 months. Similarly wide ranges occur in the
normal development of such things as age of weaning, toilet training, obedience,
partial independence of mother.
10. Unfortunately false norms have got into currency. These false norms are not
infrequently the result of assuming that the earliest time at which such a function
develops in any child is the age at which all children should develop the function.
These false norms, being quite unrealistically optimistic for the great majority of children,
have led to much harm. Mothers have become disheartened because their infants fail
to conform to their expectations and, by trying to force the pace, have often created
difficulties which would never have existed had there been better understanding of the
true norms of development. Thus the acceptance of wrongly based standards of behaviour
and achievement prevents some mothers from following their natural good sense with
confidence. By trying to make their children conform to unsuitable patterns they create
situations out of which conflicts and behaviour problems can arise. Unfortunately,
these false norms are still wide-spread in the community so that there is the task not
only of spreading knowledge of better based norms, but of correcting the belief in
false norms. This is a big educational task, the basic nature of which, nevertheless, is
easy to understand.
11. In the second class of case where emotional disturbances of all degrees of severity
are caused by separation of infant or child from the family, it should be possible to adapt
medical and social services in the majority of cases, once the basic facts and the seriousness
of the matter are fully appreciated.
12. However, the third very prevalent source of difficulty arises out of the emotional
disturbances of the parents, so that action quite other than education or reform of medical
and social services is required. These disturbances, in which deep human emotions
such as love, hate, fear and guilt are involved, are of a kind which have hitherto been
ignored in the training of health personnel who not only are as a rule unfamiliar with
these problems but, because of the nature of the problems, often reluctant to tackle
them. Experience of the teaching of this work to members of many professions, medical
and non-medical, shows that it is often a slow and laborious process for the student to
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