Do Parents Matter?

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Parent-Blaming in America

IN THIS BOOK we propose a new way of thinking about how parents affect their children’s development—one that is social as well as psychological, consistent with the cross-cultural evidence, and less worrisome for parents than the views that have been dominant for many years. Theories offered as scientific have grossly exaggerated not only the amount of parents’ psychological influence but also the risks that parents face in raising their children.

We see parents as their children’s sponsors in a social world with multiple influences, setting priorities for the training of young children and selecting the environments that will shape their children’s development rather than influencing that development themselves. This viewpoint retreats from the exorbitant claims of psychological influence that were prominent in public discourse about parenting during the middle decades of the twentieth century and have never been fully dispelled.

During that period, psychiatrists and psychoanalysts replaced pediatricians as advice-givers and captured public attention through best-selling books and magazine articles that blamed parents for their children’s mental disorders. Psychiatrists or psychoanalysts serving as advice-givers to parents differ drastically from pediatricians like Benjamin Spock. Pediatricians, whatever their prejudices, are general practitioners who work with and monitor basically healthy children as they undergo minor and major illnesses. Child psychiatrists and psychoanalysts, however, are specialists who see only those children already considered problematic in their behavior by parents or teachers. Psychoanalysts treating adults are even further removed from ordinary children, being exposed primarily to their patients’ childhood memories. Thus, when these mental health practitioners formulate the advice they would give to the ordinary parent, they have to imagine what normal child development is like, without basing it directly on their own experience as practitioners. They may draw on their personal experience as parents or on their construction of an ideal child who lacks the pathologies they confront in their practice. We believe that they almost always underestimate the variability of child behaviors accepted as normal in the general population. In effect, mental health professionals treat “normal” as a coherent “syndrome” similar to a diagnostic category of disease in medicine, marked by a certain set of tendencies and attitudes. But “normal” behavior is actually a broad range of (nonpathological) behaviors and dispositions; there are many kinds of normal. As a result, experts end up putting pathological labels on a large part of that normal range, thus exaggerating the dangers of “abnormal” development. Where did these exaggerations come from, and how did they come to be believed?

    Public Responsibility: The Government and Parents

In the early years of the republic, the US population was largely rural, parents were responsible for their own children, and the Protestant churches provided moral guidance and schools in which a majority of boys, and a lesser proportion of girls, acquired biblical literacy. In the mid-nineteenth century, this began to change as mass public schooling became established and, together with urbanization, immigration, industrialization, and new conceptions of the child, altered the conditions for parenting.

One early landmark is the Massachusetts legislature’s adoption of the “Prussian system of education” in 1852, on the recommendation of the state’s secretary of education, Horace Mann, who had visited schools in Prussia, England, and Scotland in 1843.¹ This was a secular system of public schools offering standardized instruction to all children, with a bureaucratic organization designed to maintain quality and equality through inspection, examinations, and teacher training. Mann promoted its spread throughout the United States, and it became the form that spread to many other countries as well. Public school education did not become universal in the United States immediately, but it expanded rapidly after the end of the Civil War in 1865, and by the end of the century primary schooling was virtually universal.

When the various US states passed laws to make schooling compulsory (as most European countries also did, at the national level, in the 1870s), thus requiring parents to send their children to school, they were assuming a responsibility that had previously belonged to parents. But the rise of public responsibility for children did not end there. Americans, like the British Victorian-era reformers before them, increasingly recognized that children were being abandoned, exploited, and abused under conditions wrought by urbanization and industrialization. Influenced by representations of children as innocent victims in Romantic literature (notably, the novels of Charles Dickens), they sought remedies in political and social action. The sentimental conception of the child in literature was a call to action in the real world and gave rise to organized reform movements. The New York Society for the Prevention of Cruelty to Children was founded in 1875, followed by the Massachusetts society of the same name three years later, and orphanages were established to provide care to those who had lost their parents.

The number of adults infused with a concern for other people’s children kept growing, and with it the sense that society and its representatives in government must intervene with laws and institutions to protect innocent children from exploitation and other harsh conditions. The political struggle against child labor began in this period and continued into the twentieth century. Industrialization, with children working in factories and mines, slowed down the expansion of school attendance in some places, but the battle to ban child labor was ultimately won in the twentieth century. The reformers who cared about other people’s children established a role for government as the protector—as well as educator—of children, irreversibly modifying the role of parents.

Though public action diminished parents’ control over their offspring, the mother’s private role as nurturer was idealized in the prevailing spirit of the age. The loving mother was celebrated in romantic paintings, poems, and songs, her domesticity represented in sentimental terms as boundless affection for her infants and toddlers. (Paternal discipline would apply to the older children.) Science had yet to invade the nursery.

    Hygiene: Parenting as Disease Prevention

The nineteenth century’s educational progress had not been matched by an equivalent improvement in child health. In 1900 the US infant mortality rate (deaths per 1,000 live births in the first year of life) was 100, a rate nowadays considered unacceptable even in the poorest countries. (The current US rate is 6 per 1,000.) Mortality rates of older children and adults were also high. But measures to improve the situation had been made possible by nineteenth-century advances in the scientific understanding of infectious diseases and how to control them. Beginning in the 1890s, state and local governments in the United States undertook major works to improve public health, including sewage disposal systems and the purification of drinking water. The pasteurization of milk followed in the first decades of the twentieth century. Chicago, in 1908, became the first city to pasteurize its milk supply.

In addition to these public health measures, advice to mothers dispensed not only in books and the mass media but also by private charities and governments promoted “hygiene”—the maintenance of sanitary and antiseptic conditions in the home to prevent the transmission of infectious diseases to the young. The care of infants and young children was increasingly seen as a series of medical problems that could be solved through the mother’s use of information provided by medical experts.

An influential text in the hygiene movement was The Care and Feeding of Children: A Catechism for the Use of Mothers and Children’s Nurses, published in 1894 by the New York pediatrician L. Emmett Holt.² The book became extremely popular and went through many editions over the next forty years. Set up as a catechism of questions and answers, the book simulates a consultation between a mother and her doctor, but most of the questions are about the routine care of well babies and older children. The answers cover topics ranging from the desirable temperature of the baby’s bathwater to the firmness of the child’s mattress, with a great deal of attention to diet and food preparation. Holt was a physician, but most of the book is not focused on disease or pathological conditions; it implicitly asserts his medical expertise as a general warrant for authoritative recommendations on child care. Some of his admonitions are couched as preventive medicine: if the mother does not follow his advice, illness could occur. But some of the advice is designed to provide guidance in avoiding, or dealing with, “bad habits” and “indulgence,” so a moral element unrelated to hygiene is clearly present. The medical authority of Dr. Holt is extended to include morally correct training based on a pseudoscientific psychology, as in the following excerpts from the 1914 (seventh) edition:

Should a child sleep in the same bed with its mother or nurse?

Under no circumstances, if this can possibly be avoided. Very young infants have often been smothered by their mothers by overlying during sleep. If the infant sleeps with the mother, there is always the temptation to frequent nursing at night, which is injurious to both mother and child.

How is an infant to be managed that cries from temper, habit, or to be indulged?

It should simply be allowed to “cry it out.” This often requires an hour, and, in extreme cases, two or three hours.

When may young children be played with?

If at all, in the morning, or after the mid-day nap; but never just before bedtime.

Are there any valid objections to kissing infants?

There are many serious objections. Tuberculosis, diphtheria, syphilis and many other grave diseases may be communicated in this way. The kissing of infants upon the mouth by other children, by nurses, or by people generally, should under no circumstances be permitted. Infants should be kissed, if at all, upon the cheek or forehead, but the less even of this the better.³

The kissing taboo, though weakened in the last statement (Holt often asserts a stern mandate, then qualifies it), is significant culturally because it stands in opposition to the romantic and sentimental mother-child relationship of the mid-nineteenth century, now rejected by a medical expert on a morally higher ground made possible by the scientific understanding of disease transmission. The medical warning also carries with it a moral distaste for the mother’s affectionate act. So much for the loving mother!

Holt was helping to usher in a new ideology of parenting, one presented as a scientific concern for the health of the child but carrying with it strong moral overtones censoring affection as a sign of parental weakness and “indulgence” that contributed to the formation of “bad habits” in the child. By 1910, women’s magazines were advising mothers, partly reflecting Holt’s influence, to feed their infants on a strict schedule, abstain from “love” and physical stimulation, and ignore “unnecessary” crying.⁴ And the experts advocated drastic measures for unsanitary habits like thumb-sucking: pediatricians in both Britain and America advised putting splints on toddlers’ arms at night.⁵ One expert wrote about a remedy for the nail-biting of an older child: “Get some white cotton gloves, and make her wear these all the time—even in school. This will not only serve as a reminder but also make her ashamed when people ask her about them.”⁶ If these “remedies” seem cruel from our contemporary perspective, they probably did to most parents then too, but they felt helpless in the face of authoritative medical opinion.

This remarkable turn in the ideology of parenting partly reflected the rising prestige of medical doctors. The reform of American medical education had been going on since the late nineteenth century, but it accelerated after 1910, resulting in lengthier, science-based training at medical schools tightly connected to universities and hospitals, the required state certification of doctors, and the closing of many proprietary (local, doctor-owned) medical schools.⁷ These measures turned the reduced number of those entitled to call themselves doctors into a professional elite practicing scientific medicine.⁸ Even before the reforms, elite pediatricians like Holt were offering their services to affluent mothers (and through charities, to some of the poor) in cities like New York and Baltimore. These women were also among the first readers of Holt’s book, but a broader readership for his message of schedules and “no play with baby” would be reached through the women’s magazines and, from 1914 to 1921, the widely distributed Infant Care Bulletins of the federal government’s new Children’s Bureau.⁹

Mothers also became increasingly dependent for child-care advice on private consultations with their doctors. Pediatricians and family doctors assumed the role of the family’s expert consultant on medical science, a role made possible by the new training for doctors. In the 1930s it was common for middle-class mothers to consult their pediatricians concerning infant and child care, believing, following the Holt model, that their advice represented the latest scientific findings, regardless of whether it was related to disease. Their advice included Holt’s strict regimes for feeding, sleeping, and other activities of the infant and young child that were unrelated to hygiene in the narrow sense but presented by the doctor as equally scientific and necessary for health. Mothers felt that they had to obey such orders to maintain a relationship with the doctor, perhaps the only person they ever met who wielded the authority of science—and who made house calls.

In his 1928 book Psychological Care of Infant and Child and in the many articles he wrote for popular magazines, John B. Watson declared that scientific child-rearing required parental discipline and emotional restraint during the child’s early years.¹⁰ Watson’s message was consistent with Holt’s, but more aggressively advocated. He was a psychologist and the foremost advocate of behaviorism, an approach exclusively focused on externally observable behavior without speculating about mental processes; behaviorists tend to assume that a child’s environment shapes his or her development. Behaviorism does not necessarily favor any particular way of raising children, but Watson claimed that his experiments proved discipline and regimentation to be best. Chapter 3 of his book is titled “The Dangers of Too Much Mother Love.” He warns that kissing, coddling, and other expressions of affection will produce children who “are always crying and always whining,” which “shows the unhappy, unwholesome state they are in.”¹¹ He advocates treating children like little adults. Despite his claims of scientific validity for this position, it was closer to moral doctrine than to science.

The drastic treatments recommended by experts to parents in the early decades of the twentieth century can be seen as by-products of the first phase of America’s great child survival revolution, in which infant mortality declined from 100 per 1,000 in 1900 to 29.2 in 1950; (post-infancy) child mortality showed a similar drop. The hygiene movement had in fact contributed to this improvement. Yet the genuine strides forward in public health and medicine that brought about this unprecedented change were accompanied, especially in doctors’ advice to mothers, by a pseudoscientific ideology of parental discipline and emotional restraint, possibly in opposition to the sentimentality of the previous era. Sentimentality about children had not disappeared, however, as evidenced by the enormously popular Shirley Temple movies of the 1930s. Indeed, the romantic view of children might still have been the most influential child-rearing ideology of the time, but it had yet to find its voice in medical authority. That would happen in the next period.

    Mental Health as a Parental Goal

In 1950 the child psychologist Celia Stendler began an article with the following paragraph:

The past two decades have witnessed a revolution in child training practices in America, which has been tremendous in its scope and far-reaching in its effects. From an era where the mother was taught that the child must have his physical wants cared for and then be left alone, must be fed on a rigid schedule, must learn to cry it out, must be toilet trained early and must not be spoiled by attention, we have come to a time when exactly the opposite advice is advocated. Today the mother is advised to feed the baby when he’s hungry, to delay toilet training until he’s ready for it, to see that the baby gets a reasonable amount of cuddling and mothering, to let the baby initiate the weaning process. And just as a mother of 1930 was taught that the popular doctrine of that era would produce the right kind of child, so the mother of today is assured that if she weans and toilet trains and cuddles in the approved fashion, her child will have a well-adjusted personality.¹²

Stendler doubted that “the new doctrine is any sounder than the old” and concluded “that the reasons for the revolution lie outside the realm of scientific fact.” She traced these trends through a content analysis of three widely read women’s magazines, Ladies’ Home Journal, Woman’s Home Companion, and Good Housekeeping, from 1890 to 1949. Among her findings were that, while 75 to 100 percent of the articles between 1910 and 1930 advised mothers that infants should be tightly scheduled and learn to “cry it out,” only 33 percent did so in 1940, and none did in 1948. She did not explain this trend but noted the growing prominence of the “mental hygiene approach,” which began with a series of articles, “Mental Hygiene in the Home,” in the Ladies’ Home Journal in 1930 by Karl Menninger, a Freudian psychoanalyst. (The early date of this series shows how the periods overlapped, with opposing ideologies competing for influence before a new one became dominant.)

The new advice had an effect: surveys during this period showed a distinct trend toward greater permissiveness in the reported behavior of American mothers, beginning in the 1940s, especially among middle-class women—in other words, the mothers who read the magazines and were most attuned to expert advice.¹³

Thus, by 1950 the gospel of preventive medicine through hygiene and rigid scheduling was being replaced by a mental health ideology that shifted the focus to children’s emotional development. This ideology broadened the concept of mental illness far beyond the severe conditions classified as psychosis that might call for hospitalization to include behaviors and anxieties that could be symptoms of neurosis but were not clearly outside the range of normal behavior. Following Freud’s concept of continuity in mental functioning between normal and abnormal, child and adult, sleeping and waking, everyone was potentially subject to the inner conflicts that can lead to mental disorders, but children were especially vulnerable. Parents were accused of jeopardizing their children’s long-term mental health, above all by failing to provide the conditions for emotional security in early childhood. As Stendler put it, the “mental hygiene approach to rearing children . . . emphasizes the importance of good emotional health. . . . The child’s need for love and affection if he is to be a secure individual is stressed, as is the necessity for understanding the child and accepting him for what he is.”¹⁴

The history of this sea change in concepts of parenting during the middle and second half of the twentieth century has yet to be written, though there have been biographies of its major figures. But having lived through it as participant-observers in the mental health world of that period, we can offer a provisional account of its major currents. We both received training in psychoanalysis, Bob as a research candidate at the Institute for Psychoanalysis in Chicago between 1962 and 1971, Sarah at the University of Chicago, where she studied psychiatric social work from 1964 to 1966. Bob later conducted seminars at the Chicago Institute; Sarah, while undergoing psychoanalysis, practiced psychotherapy at the Jewish Children’s Bureau, with Bruno Bettelheim as a consultant. Much later, we taught a seminar together at the Boston Psychoanalytic Society and Institute. Yet our primary commitment was to empirical research, and we were critical of many aspects of psychoanalysis. Our associates over the years have included psychiatrists and social scientists who were leading critics of the ideas of Sigmund Freud as well as those who were advocates.

In considering the mid-twentieth-century shift in views about child-rearing, it must be remembered, first of all, that by 1950 the United States had made great progress as a society in advancing the welfare of children according to Western concepts of human development. There was universal education in the United States, and the length of schooling was being extended; child labor laws were in effect everywhere, and the role of government as protector of children was well established. Infant and child mortality had dramatically declined and was being further reduced through the widespread use of new, effective treatments (especially antibiotics) and immunizations as well as other medical and public health interventions. There was more progress to be made, to be sure, but it was in continuing the advances of earlier periods—extending education for all to high school and college and reducing mortality even further. Thus, parents could feel a measure of confidence in the greatly improved conditions for raising children compared with those of their parents or grandparents. But as this most educated generation of Americans took to the books and magazines for advice about parenting, they were susceptible to new views of what being a good parent meant and what challenges lay ahead in raising children. And they found new causes for concern.

The publication in 1946 of Spock’s Baby and Child Care, destined to become one of the best-selling books of all time, gave authoritative voice to the trend toward permissiveness that was already under way. For the postwar generation of American mothers, “Dr. Spock,” a pediatrician, was a liberator, freeing them from the strictures of previous pediatric advice and encouraging them to depend more on their own judgment in child-rearing, even as they followed his instructions in the book. Spock did not endorse the strict regimes and disciplines of the past as he discussed in detail how a mother might respond to the options and problems presented at each point in her child’s development. He wrote: “You hear that a baby is spoiled by being picked up too much, but also that a baby must be cuddled plenty. . . . Don’t be overawed by what the experts say. Don’t be afraid to trust your own common sense.”¹⁵

Spock may have acquired this empathic attitude in his training at the New York Psychoanalytic Institute, but his advice was not Freudian in content. He stood back from doctrinaire positions on child-rearing as he described changes since the Victorian era, yet he was not neutral: “Doctors who used to conscientiously warn young parents against spoiling are now encouraging them to meet their children’s needs, not only for food, but for comforting and loving. These . . . changes of attitudes and methods have benefited most children and parents.”¹⁶ His book encouraged discussion among mothers, leading to further questioning, uncertainty, and—inevitably—anxiety about the choices involved. This created a demand for even more expert advice, and now there was a new breed of experts—the psychiatrists and other mental health professionals—ready to satisfy that demand.

The post–World War II period saw an unprecedented expansion of psychiatry and the elevation of its status as a medical specialty as new departments were established in medical schools, more young psychiatrists were trained in federally subsidized hospital residency programs, and greater efforts were made to communicate with the general public. Psychoanalysts from Europe who had come to the United States as refugees in the 1930s joined American psychoanalysts in psychiatry departments as well as at independent institutes. They played a role during the 1950s and 1960s in moving American psychiatry from its traditional focus on custodial care in mental hospitals to an interest in psychotherapy, research into families of the mentally ill, and even the prevention of mental illness.

This was also the period of the initial growth of the National Institute of Mental Health (NIMH), which promulgated the idea that mental health and disease were grounded in social as well as biological conditions. It was assumed that families and parenting were, or could be, sources of mental illness, and during this period when much mental health research was focused directly or indirectly on parenting, the concept of parental influence enjoyed an important place—perhaps too important a place—in the public discourse connecting psychiatry with the social sciences. Other doctors—psychiatrists and psychoanalysts as well as psychologists—joined pediatricians as experts giving guidance to American parents. And in their best-selling books, they often blamed parents—usually mothers—for their children’s mental illnesses, adjustment problems, and emotional disorders.